Implementation: Advocates' To Do List

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Grants for Consumer Assistance Offices or Health Insurance Ombudsman Programs
(Section 1002 of the Patient Protection and Affordable Care Act; Creates Part C, Section 2793 of the Public Health Services Act)

Grant funding will very soon be available for states to establish or support consumer assistance offices and health insurance ombudsman programs. These offices and programs assist health care consumers with filing complaints and appeals, collect and track consumer problems and inquiries, educate consumers on their rights and responsibilities, assist consumers with enrollment into health coverage, and will eventually resolve problems with premium credits for exchange coverage. The health reform law provides $30 million in funding for these offices and programs this year.

To do:

• Encourage your state to apply for grant funding. If your state already has a consumer assistance or ombudsman program, determine whether it would need to take on additional duties or change its structure in order to qualify for grants. Your state may want to talk with HHS about this. If your state does not currently have such a program, work with state agencies and legislators to create one.
• Perhaps a community-based organization in your state already assists consumers in resolving health insurance problems. Could your state contract with that organization for consumer assistance, and apply for federal funding to expand its services? Alert likely consumer assistance organizations to contact your state about potential funding.
• Once grants begin, advocate for continued funding. Let your congressional Representatives know that the consumer assistance or ombudsman program is doing great work and needs continued federal support.

Additional Resources: 

• From consumer representatives to the National Association of Insurance Commissioners (NAIC): Recommendations for Regulators and Lawmakers on Health Reform Implementation provides recommendations on how best to implement specific provisions in health reform, including grants for consumer assistance programs on page 9. (May 2010)
• Establishing a Consumer Health Assistance Program in Your Community (Web-based resources from Families USA)
• Examples of state and local laws establishing independent consumer assistance/ombudsman programs (Connecticut, District of Columbia, Maryland, Nevada, New York City, Vermont)
• Materials from Health Action 2010 Conference session
  • Betsy Dooley, Health Assist Tennessee
    • Health Assist Tennessee (Powerpoint)
  • Ellen Kuhn, Maryland Office of the Attorney General, Health Education and Advocacy Unit
    • Overview of the Health Education and Advocacy Unit (Powerpoint)
  • Priya Mendon, New York City Managed Care Consumer Assistance Program
    • Consumer Assistance Programs: A Vital Piece of the Health Care Reform Puzzle (Powerpoint)
    • Building Consumer Engagement in Health Care (PDF)
  • Cheryl Fish Parcham, Families USA
    • Asking Our Neighbors: Advice from CHAPs on Establishing a Successful Program (PDF)

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