Affordable Care Act & Ryan White: Educate and Assist Your Clients

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Affordable Care Act & Ryan White: Educate and Assist Your Clients

July 2014
ACA and Ryan White Educate Your Clients

Develop a Transition Plan | Educate Your Clients: Insurance and Enrolling | Educate Your Clients: Changes in Care

Ryan White clients may need help in adjusting their health insurance coverage--be it Ryan White, Medicaid, Medicare or private health insurance. Specific issues to address include changes in eligibility screening and costs. A big issue for clients is being able to see specific agencies and doctors under their new coverage.

See HRSA HIV/AIDS Bureau guidance explaining how Ryan White service categories can be used to support Marketplace outreach, benefits counseling, and enrollment activities for Ryan White clients (for enrollment in private health insurance plans and Medicaid).

Below are key areas to consider when it comes to educating and assisting clients with health care coverage. Keep in mind that many of the mechanisms for educating and helping clients will be implemented in their state Marketplaces. As such, Ryan White agencies need to make sure their services and issues are fully and accurately addressed in Marketplace websites, eligibility screening systems, and patient outreach, education, and enrollment.

See resources on Enrolling and Accessing ACA Health Coverage. Ryan White clients: Talk to your care team first.

Develop a Transition Plan

Ryan White grantees and providers can keep abreast of ACA coverage changes over time by continuously reviewing their current client caseloads, projecting potential changes in client needs, and then updating plans for educating and assisting clients and staff. Key steps include:

  • Assess Current Client Population. Review client-level data to determine the income levels of your clients in relation to the federal poverty level. This information can be useful in determining, for example, how many and which clients will need education on specific insurance changes. Data can be used when establishing contracts with health plans and Medicaid managed care organizations, which will want to know the potential number of new clients your caseload will bring to their networks.
  • Establish Connections to the State Marketplace. Eligibility and enrollment systems (websites and enrollment assistance programs) have been established in Marketplaces. Access resources for enrollment assisters and outreach programs.
  • Prepare Your Staff. Educate all staff (clinical, administrative, clerical) on changes around eligibility, billing, referrals, etc.See HRSA HIV/AIDS Bureau information on how Ryan White can support outreach, benefits counseling, and enrollment activities as well as provide premium and cost-sharing assistance for private health insurance and Medicaid.
  • Determine Linkages to Eligibility Assessment Systems. Work with your information technology staff to determine how your health information technology/electronic medical records systems will need to interface with Marketplaces.
  • Educate Clients on Changes. See the next section on educating your clients.

Educate Your Clients: Insurance and Enrolling

Under ACA, coverage options have expanded. Some states are expanding Medicaid. Some are not. All states have new options for purchasing individual and small-group policies. Clients need to understand issues such as eligibility requirements, possible costs they may face, how to pick a plan, consumer rights and responsibilities, using their coverage, and making changes in coverage when necessary (e.g., when costs rise, when providers change participation in given health plans).

Educate Your Clients: Changes in Care

Clients also need to understand that the health care delivery system is changing in terms of the methods used to improve quality while managing costs.

  • Consumers as Partners in Care. Care reforms include expanded roles for patients in their own care. Examples include clearer communications, expanded patient access to health records, as well as no cost preventive services to help patients better manage their health.
  • Care Delivery. Models of care are designed to improve coordination of services, enhance quality, and manage costs. For example, a Patient Centered Medical Home (PCMH) is a health care setting that facilitates partnerships between patients and their physicians. Care is facilitated by registries, information technology, health information exchange, and other means to assure that patients get needed care in a culturally and linguistically appropriate manner. Managed care involves delivery of care using techniques to enhance quality and control costs, like use of a specific set of providers and review and approval to manage use of services. Most Medicaid services are delivered under Medicaid Managed Care.
  • Health Information Technology. Health IT helps providers better manage patient health through secure use and sharing of health information, such as Electronic Health Records. Access these Health IT resources and videos for patients and families explaining the benefits of information technology in health care, protection of privacy and security, and more.

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