Enrollment 4 Health Wisconsin website opens Event and Training Calendar

Learning to be an enrollment assister? Mobilizing your community? Educating consumers? Learn how to do it best by attending one of the many trainings and events listed on the E4Health Wisconsin Website calendar.

The new E4Health Wisconsin website is the central resource for the Affordable Care Act in Wisconsin with quick links to essential tools, helpful organizations, and policy notices from the responsible agencies, in addition to a searchable calendar with events for enrollers and consumers.

Look there first to increase your knowledge and send your events for posting through the contact us form.




Navigator Grants Awarded in Wisconsin

Last week the Department of Health and Human Services announced the organizations awarded funding to implement Navigator programming in Wisconsin.  Navigators will be one piece of the consumer support network charged with outreaching to and enrolling eligible individuals and families into appropriate health insurance when the Marketplace opens on October 1.

Organizations who are not housing Navigators but wish to provide enrollment assistance support can apply to become Certified Application Counselors (CACs).  For more information on becoming a CAC organization, visit http://marketplace.cms.gov/.

Both Navigators and CACs will be required to go through training and certification processes.   An inventory of available CAC organizations will be made available after they are identified so local organizations know where to refer consumers in need of assistance.  Organizations who will house Navigators are listed below.

For more information on who’s doing what in your community and how to get involved, feel free to contact us here at CKF – 608-261-1455.


Navigator Grants Awarded in Wisconsin

Partners for Community Development, Inc.
Anticipated grant amount: $315,720
Partners for Community Development will facilitate the enrollment of the uninsured with
emphasis on reaching out to Hispanic and Hmong families and other hard-to-reach eligible consumers in Door, Kewaunee, Manitowoc, Ozaukee, and Sheboygan Counties in Wisconsin. It will focus outreach and enrollment efforts in its service area on hard-to-reach consumers and families with limited English proficiency.

Northwest Wisconsin Concentrated Employment Program, Inc.
Anticipated grant amount: $285,035
The Northwest Wisconsin Concentrated Employment Program will help lead a Navigator project in their region to promote accessibility to health insurance Marketplace and the health care system in Wisconsin. The cooperative agreement will be used to provide Marketplace Navigator services at 21 Wisconsin Job Centers without reach provided at libraries, Senior Centers and college campuses by existing staff that have experience working with diverse populations.

Legal Action of Wisconsin, Inc./SeniorLAW
Anticipated grant amount: $70,000
SeniorLAW is a community and consumer-focused nonprofit located in Milwaukee that
provides a variety of services to individuals age 60 or over, mostly related to health insurance and public benefits. This group will conduct outreach to the 60-64 population in Wisconsin, using community education, client contacts and agency relationships that SeniorLAW has established throughout Southeastern Wisconsin.

National Council of Urban Indian Health*
Anticipated grant amount: $35,000
National Council of Urban Indian Health is the only national, membership-based organization dedicated to outreach and education on behalf of Urban Indian Health. It provides training, technical assistance, outreach, and education to Urban Indian Health Programs.

National Healthy Start Association
Anticipated grant amount: $191,667
The National Healthy Start Association is a non-profit organization that works to improve birth outcomes and health disparities across the country through the federal Healthy Start programs. They will reach out to the uninsured population and provide education and assistance services for Marketplace enrollment.

R&B Receivables Management Corporation DBA R&B Solutions
Anticipated grant amount: $104,520
R&B Receivables Management Corporation currently works to connect uninsured and
underinsured individuals with coverage options to help them afford health care. They will expand their services to connect with a broader range of underserved populations, and leverage their experience screening people for eligibility for medical assistance programs to connect people with coverage.

ACA impacts on Mental Health Treatment

As full implementation of the Affordable Care Act draws near, we continue to receive many questions about how it will affect people in Wisconsin.  Many of these questions involve how mental health and substance abuse treatment will change beginning in 2014.  When the Affordable Care Act takes full effect, access to mental health and substance abuse treatment should improve due to the following provisions of both the ACA and state Medicaid changes.  This information was referenced from a blog on the federal government’s healthcare.gov site.

  1. Plans that offer coverage for dependents are required to extend that coverage until the dependent turns 26, providing insurance to many young adults.  This has been in effect since 2010.
  2. Also since 2010, insurance companies haven’t been able to deny children coverage because of pre-existing conditions–which include mental health and substance abuse.  There are currently about 60,000 children in Wisconsin living with mental health issues according to NAMI Wisconsin.
  3. Beginning in 2014, this provision is expanded to include adults, so they too will not be denied coverage because of their mental health or substance abuse issues.
  4. Also beginning in 2014, mental health and substance abuse disorder services are required to be covered as an Essential Health Benefit by all health insurance plans sold on the Marketplace, state Medicaid programs and private employer-based insurance plans. Prescription drugs are also included in the Essential Health Benefits Package.
  5. In 2008, Congress and President Bush passed a law requiring “parity” for mental health care.  At the time this meant that if an insurance plan covered mental health services, the co-payments, deductibles, and all other costs must be covered to the same amount as other medical and surgical services.  Now with the Essential Health Benefits, this parity requirement will apply to all health plans.
  6. The Affordable Care Act also prevents insurance companies from applying lifetime limits to coverage or dropping patients because of a diagnosis, whether mental health or otherwise.
  7. Wisconsin has chosen to make changes to its Medicaid eligibility, which will likely affect many with mental health or substance abuse issues.  Starting in January of 2014, adults with incomes below 100% of the federal poverty level (FPL) will now be eligible for BadgerCare+.  Many of these adults were previously uninsured and may have lacked access to care and treatment.
  8. Finally, because of the Affordable Care Act, preventive care and wellness services, including smoking cessation programs, are available without paying copayments or deductibles.  This is good news for many people with mental illness.  Currently, patients with mental illness are at a higher risk for conditions such as diabetes and heart disease.  Additionally, those with mental illness are twice as likely to be obese or smoke.

As you can see, the Affordable Care Act puts in place several-consumer friendly provisions that help all patients, not just those with mental health and substance abuse issues.   Wisconsin’s Medicaid program and the Health Insurance Marketplace will make coverage available to many mental ill patients who had previously been unable to afford coverage.  In addition to treating mental illness, the ACA seeks to make that population healthier by focusing on prevention and wellness services for their other healthcare needs.  For more information, check out this factsheet about health coverage from the National Alliance on Mental Illness.


Navigator Grant Submitted

With support from a number of organizations including Covering Kids & Families, the Wisconsin Primary Health Care Association has submitted an application for Navigator funding made available through the Affordable Care Act.  Navigators are entities who will help educate our communities and help consumers apply for coverage in the new Health Insurance Marketplace when it opens on October 1, 2013.  The proposal was submitted on June 7th, and the award announcement is scheduled for August 15th.  Covering Kids and Families will inform you as grantees are awarded and the Navigators are identified.  Check out the CKF web page for links to fact sheets and other information.

Here is a copy of the press release announcing WPHCA’s proposal submission:

June 7, 2013

Contact: Stephanie Harrison, sharrison@wphca.org, 608-277-7477

For immediate release

WPHCA Submits Navigator Grant on Behalf of Statewide Consortium

Madison, Wis.—The Wisconsin Primary Health Care Association has submitted an $829,000 grant application to the US Department of Health and Human Services on behalf of Enrollment for Health Wisconsin, Inc. – a newly incorporated not for profit consortium that proposes to serve as the Navigator entity for the new federally-facilitated health insurance marketplace. If awarded, Enrollment for Health Wisconsin would employ 6 FTE Navigators to be deployed in public health and community based organizations across the state. The Navigators would be responsible for connecting with and educating consumers about the new insurance options available via the exchange, assisting them in securing subsidies and enrolling into Qualified Health Plans.

Enrollment for Health Wisconsin developed out of the Wisconsin Access Network, a multi-stakeholder learning collaborative made up of over 71 Wisconsin-based organizations committed to assisting uninsured or underinsured residents with securing public and or private health insurance. Together these organizations promise to engage the maximum number of individuals possible to achieve shared health insurance coverage goals. The Notice of Grant Award is anticipated on August 15, 2013. The health insurance marketplace will be open for enrollment in October 2013.

The Wisconsin Primary Health Care Association is the statewide member association of Wisconsin’s 17 Community Health Centers. To learn more and find a Community Health Center near you, please visit us at http://www.wphca.org.


New Fact Sheet on the Marketplace!

Do your uninsured clients, co-workers or family members have questions about how health care reform affects them?  Chances are they probably do!  According a recent poll done by Kaiser, 58% of uninsured Americans don’t know how healthcare reform will affect them.  This means that over half of the people who will have access to affordable healthcare insurance beginning October 1st through the Health Insurance Marketplace don’t know about it!

In order to catch people up to speed, Covering Kids & Families created a fact sheet explaining the basics about this new way to get health insurance, including what the Marketplace is, how it works, who can access it, and how people can get additional help.

Here’s a link to the two-page fact sheet.  Please use, distribute and help us spread the word!  Let’s make sure our uninsured know their options and know that help is just around the corner.

Marketplace fact sheet

Application for Health Insurance on the Marketplace Released

The application forms for individuals and families to apply for health insurance benefits have been published.  The Centers for Medicare and Medicaid Services (CMS) released the final applications this week after receiving public input.  These forms will be found at www.healthcare.gov on October 1, 2013 when individuals and families can start applying for benefits.  Those benefits will begin January 1, 2014.


CMS released three application forms: one for individuals, one for individuals who are not looking for financial assistance, and one for families.  The applications were shortened in length so the ones for individuals are three pages plus appendices, and the family application is six pages plus appendices.  The application can be completed online, by phone (through a call center) or printed and mailed in.  We don’t know if all three applications will be displayed online or if only one will be displayed and then modified based on the type of applicant.

The opening page of the application packet specifies what the application is for, who can use it, how it can be accessed, what is needed to apply and why that information is needed, what happens next, and how to get help with the application.

The applicant is then asked to complete a variety of questions relating to their household demographics, including residency information, employment, income and any access to insurance they currently have.  One of the appendices request specifics about the applicant’s access to health insurance and requires information on their employer and benefit plan.

After the application is completed, it must be printed, signed and sent in for processing.  The applicant is informed that they will then be contacted in 1-2 weeks for further instructions.  We are not yet sure what, if any, next steps the applicant will be required to take next or how this application will interface with the state’s ACCESS database, which is where individuals in Wisconsin go now to apply for Medicaid benefits.  Both state and federal officials have maintained that this will be a streamlined and consumer-friendly process.

The application packet references a call center (whose number is not yet public) and the www.healthcare.gov website which applicants can access for assistance or additional information.  Locally, advocates and community-based organizations will likely be helping individuals with the application process.   If you are working with uninsured individuals or for those who are interested in learning more about healthcare reform and its provisions, healthcare.gov is a great place to start.  As always, CKF can be contacted to provide clarification and answer questions as well.

An example of the application form can be viewed here: http://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/marketplace-app-short-form.pdfCMSap

Part-time Workers and the Affordable Care Act

part-time, full time

(photo courtesy of Michael S. Williamson/The Washington Post)

Consumer Reports recently published an article by Nancy Metcalf responding to the question “Will health reform help part-time workers get insurance?”  Here’s a summary of her response:

Though figuring out their access to insurance may not be as simple and straightforward as it is for a full-time employee, part-time or seasonal employees will have access insurance one way or the other, through their employer or through the Marketplace.  Here’s how employers will decide their employee’s eligibility for their insurance: The employer chooses a measurement period (three months to one year) to identify the average number of hours worked by the employee.  If the employee averages 30+ hours per week during that period, he/she will be eligible for the employer-sponsored insurance (ESI).  If the employee averages less than 30 hours/week, he/she will be referred to the Marketplace to access coverage.  The employee will have that coverage for the designated measurement period (three months to one year). After that initial measurement period, the employer will repeat the same process to re-evaluate the employee’s average hours for the next measurement period.  Depending upon the average hours worked, the employee may maintain their current coverage or have to switch.

Here’s an example:

Employer ABC defines the first measurement period from January through June of 2013.  During that time, Shondra averages well over 30 hours a week and is therefore eligible for ABC’s insurance.  During the second measurement period, July through December, Shondra averages only 27 hours per week.  The employer will notify Shondra she is no longer eligible for the ESI, and she will then have to access the Marketplace to shop for a new plan.  Though Shondra may be eligible for tax subsidies to purchase new insurance, the plan’s cost and coverage may be different than the one offered through her employer.

The above example demonstrates that this process may get confusing for part-time employees. Metcalf advises individuals who worry they may be in this situation to connect with their employer and discuss the details.  Covering Kids & Families can also be contacted to provide more information on this issue and others relating to the implementation of the Affordable Care Act by emailing info@ckfwi.org.