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DC Exchange Approves Plan for Robust In-Person Assistance Program to Guide Consumers in Choosing Health Coverage

Friday, April 19, 2013

DC Exchange Approves Plan for Robust In-Person Assistance Program to Guide Consumers in Choosing Health Coverage

The program will involve community-based organizations.

The DC Health Benefit Exchange (HBX) Executive Board has unanimously approved a plan to launch a major effort to provide in-person assistance to individuals and small businesses in the District to help them make decisions about health care coverage. The initiative will help inform individual consumers and small business owners about the range of health coverage and access options available to them and help people understand and use coverage once they have it.

Beginning in October, thousands of DC residents and small businesses (with 50 or fewer workers) will have the opportunity to enroll in qualified health plans.  Many will be eligible for federal tax credits to help pay premiums and out of pocket expenses for medical care. Coverage will begin on January 1, 2014. The DC Health Benefit Exchange will be an easy-to-use on-line website where consumers can determine eligibility for tax credits, review and compare insurance options, and purchase coverage that best suits their needs and budgets. Many consumers and small businesses will need help navigating this new system and making important decisions about the type of coverage they select.

“Thanks to the Affordable Care Act, thousands of DC residents will be able to obtain high-quality affordable health care coverage. For many, this will be the first time they have had access to private insurance,” said Mohammad Ahkter, M.D., the chairman of the Executive Board.  “The in-person assistance program will make sure experts are available to walk them through all of the key decisions they have to make to pick the right plan for them.”

Later this year, the Exchange Authority will issue a request for proposals from DC-based organizations wishing to serve as in-person assisters or IPAs. To be eligible for funding, organizations must demonstrate they have relationships with uninsured and underinsured consumers, employers, and workers who are likely to be eligible for enrollment through the Exchange. Grantees could include non-profit organizations, unions, trade associations, and other community-based groups. In-person assisters will also have to undergo rigorous training to make sure they can provide consumers with the help they need. The program will also be evaluated to assure it is effective.

Organizations receiving grant funding must:

  • Conduct public education to raise awareness about the availability of qualified health plans;
  • Distribute fair and impartial information;
  • Facilitate enrollment into health plans;
  • Provide referrals to the appropriate agency for consumers with a grievance, question or complaint; and
  • Provide information that is culturally and linguistically appropriate to meet the needs of the people being served by the Exchange.

In 2013, IPA grantees in the District will focus on uninsured and hard-to-reach populations, including those who may be eligible for tax credit assistance. The District has an estimated 42,000 uninsured residents; another 22,000 residents currently buy their own insurance; and about 75,000 work for small businesses. IPAs also will be asked to focus attention on people who would have difficulty filling out the online application, such as those with limited literacy or limited English proficiency and those who do not have easy or regular access to a computer or the Internet, as well as members of DC’s lesbian, gay, bisexual, and transgender (LGBT) community.

IPAs will work closely with insurance agents and brokers to provide help to small businesses. Many small companies work with brokers today to choose and purchase coverage for their employees. Brokers will also play an important role in helping small businesses that don’t currently offer coverage but choose to do so through the Marketplace Exchange.

The IPA program was designed by two advisory panels – the Consumer Assistance and Outreach Advisory Committee and the Producers Advisory Committee – made up of diverse stakeholders from the District including consumer advocates, brokers, insurers, and others.

In separate action, the Board approved a set of certification requirements for dental insurance policies for children based on consensus recommendations from the Dental Plan Advisory Working Group , chaired by Board member Leighton Ku and vice chaired by Katherine Stocks of the D\C Chamber of Commerce and Anupama Rao Tate, DMD, of the Children's National Medical Center. The Board also voted to limit annual maximum out of pocket costs to $1,000 for one child and $2,000 for two or more children in a family.

For more information about the approved policies, visit www.dchbx.com.