Big Changes Coming Up for Uninsured, Under-insured, and Medicaid Clients: How You Can Help?

Since the historic passage of federal health reform last March, the Utah Health Policy Project is all about making the new health reform law work for Utah.  As Utah’s ‘Implementation Station’ we are here to help you (and your clients) make sense of it all: to determine how—and when—the reforms will bring added security and better health care to Utah residents. 

Today we are asking for your input on a key building block of federal reform implementation: a ‘no wrong door’ approach to outreach, enrollment support, consumer health assistance, and navigation. 

Please take a moment to complete a survey (link below) so that we may recognize all the current work that is being done in this area. Included in the survey is an opportunity for you and your agency to indicate your level of interest in participating in the network as we move forward.

Take the survey, hosted by survey monkey,  here: http://www.surveymonkey.com/s/5RLMTSK. The survey is open until July 30, 2010.  Feel free to circulate this invitation to other human service providers.

Our next step will be to compile the information and share the results with you all and include them in the final version of our report (see Executive Summary below).

Thank you for your time and support as we move closer to the goal of affordable, quality health care for all Utah residents!

EXECUTIVE SUMMARY: from Consumer Health Assistance & Navigation for the Age of Reform: Design Considerations and Recommendations for Utah

Across the land, Utah is known for its delivery of high-quality, cost-effective health care. Life is good for those whose health care coverage gives them access to this excellent care: They can sleep better at night knowing they will get good care when they need it. Yet, too many Utahns are not able to benefit from our community’s state-of-the-art health care.  Some feel pretty healthy now, so why should they enroll in their employer’s health plan? They have better things to spend their money on than their part of the premiums. Others may be one diagnosis or accident away from financial ruin, without even knowing it. Low-income families eligible for Medicaid may not be in a place in their lives where they can appreciate the benefits of coverage. They may have so much stress in their lives that they will risk going without.

The new federal health reform law changes all of this—and, we think, for the better. It begins with the fundamental premise that everyone should have affordable health care coverage, and not only for their benefit, but for the benefit of the entire society.  Covering all Americans is the only way to avoid the staggering cost, not to mention waste, of delaying care until folks show up in the emergency room, at which point their treatment options have often become frightfully limited.  Last year CHIPRA (Children’s Health Insurance Program Reauthorization Act) started us down this path by giving states every possible incentive to cover most of their kids.

Like CHIPRA which came before it, the federal reform law will bring just about every American into the system by making decent coverage affordable on the private market; expanding Medicaid for those without a reasonable offer of coverage at work; and mandating a minimum level of coverage for those who can afford it. But implementation of the new expansions and mandate will be tricky in places like Utah, where so many are not enrolled in plans for which they already qualify now. An estimated one-third of our uninsured are eligible for public programs but not enrolled; another one-third are the so-called ‘young immortals:’ they could possibly afford coverage but nonetheless choose to go without. How can we bring newly eligible Utahns into the system when we can’t even cover those eligible now? And once they are in the system, how do we know they will get the care they need?  The reforms will bring new consumers into a system riddled with difficulties, for example:

• Denials of care, treatment, and services;
• Delays in getting care;
• Lack of access to specialty care or primary care providers;
• Inappropriate or inadequate care;
• Lack of understanding about how the health care system or coverage works.

Now is the time for a coordinated effort around eligibility and consumer health assistance, and navigation in Utah.  Right now this capacity is weak and disjointed, to say the least. Most of the coverage expansions do not happen until 2014; but before we kick back, we must consider that we stand a better chance of getting these new expansion groups covered if we puzzle out the enrollment and navigation challenges now, for those currently eligible. 

This report proposes a public-private sector partnership dedicated to helping all Utahns make sense of and navigate their choices for coverage and care. What we need is a “no wrong door’ approach: Human service agencies need proven tools and incentives to help their clients get and keep coverage. Consumers need a specialized, independent helpline to help them navigate coverage choices and assist with appealing denials of claims.

Finally, and perhaps most importantly, Utah’s CHAP must do more than assist individual consumers, a “bottomless task;” it must analyze broad trends in consumers’ problems in order to identify and fix systemic weaknesses for the eventual benefit of all consumers. These and other recommendations are based on best practices around the nation and on an assessment of current capacity and strengths here in Utah.

Read the full discussion draft of our Consumer Health Assistance & Navigation for the Age of Reform: Design Considerations and Recommendations for Utah