Below are best practices from selected state consumer assistance programs that received federal consumer assistance grants in 2011.

 

Helping with health system transitions

Consumer assistance programs help people when states expand or change health coverage options, and they help states implement new policies and catch glitches that harm consumers before they become widespread problems.

• The Consumer Services Division in the Georgia Department of Insurance helped resolve enrollment issues and developed new enrollment scripts for the state’s Pre-Existing Condition Insurance Program.
• The Massachusetts Health Care for All Helpline provided enrollment help to consumers who became eligible for coverage and subsidies after the state passed its health reform law in 2006.
• Community Health Advocates in New York helped COBRA beneficiaries keep their coverage by educating employers about changes in state law.

 
Reaching vulnerable populations

Consumer assistance programs conduct targeted outreach so that resources and services are accessible to underserved communities.

• The Connecticut Office of the Healthcare Advocate conducted outreach and advertised program services through local health fairs and bus ads.
• The Consumer Assistance Program in the Office of the Montana State Auditor provides counseling in rural communities through a statewide tour of underserved areas. 
• Community Health Advocates in New York partners with community-based organizations to make in-person counseling available to diverse populations.
• The Texas Consumer Health Assistance Program targeted outreach to areas with high numbers of uninsured people and people with chronic conditions, and it used media outlets to reach consumers in rural areas.

 
Public education

Consumer assistance programs answer health care questions, explain health coverage options and legal rights, and inform consumers about community resources and changes in the health care system. They also educate community-based organizations, employers, providers, and public program administrators about health care issues and consumer rights.

• The Massachusetts Health Care for All Helpline identified confusion among Medicare beneficiaries and providers about the free wellness exam benefit under the Affordable Care Act and developed educational materials to help consumers understand it.
• The Michigan Health Insurance Consumer Assistance Program has developed a section on its website that answers frequently asked questions about health insurance.
• Community Health Advocates in New York provides counseling and education through community-based organizations that are trusted resources in their communities and that have expertise on issues affecting specific constituencies. 
• Smart NC in North Carolina developed web resources and fact sheets that explain common health care issues, consumer rights, and new coverage options under the Affordable Care Act.
• The Texas Consumer Health Assistance Program produced fact sheets about coverage options in four languages and disseminated these materials through community outreach events. 
• The Consumer Advocacy Program in the Washington State Office of the Insurance Commissioner held multilingual community-based forums on the Affordable Care Act for the growing Latino and Chinese communities, and it produced a consumer guide to the state appeals process. 

 
Statewide helplines

• The Michigan Health Insurance Consumer Assistance Program established helpline standards to improve efficiency and purchased a translation line to enhance language services.
• The Consumer Advocacy Program in the Washington State Office of the Insurance Commissioner purchased new database technology that enables multiple staff members to work on a single case concurrently.

 
Enhancing expertise to expand capacity

Using federal grant funding, consumer assistance programs built the capacity to serve more people and provide in-depth assistance to consumers with complex health care issues. 

• The Connecticut Office of the Healthcare Advocate enhanced its work on mental health appeals by developing relationships with government agencies and advocacy groups and by hiring staff with clinical and social work expertise.
• The Health Education and Advocacy Unit in the Maryland Attorney General’s Office uses a computer system to streamline appeals processing.
• Smart NC in the North Carolina Department of Insurance takes a proactive role in case management to resolve coverage disputes.

 
Influencing policy to improve services

Consumer assistance programs help states and the federal government identify systemic problems and use casework to inform policy solutions.

• The Connecticut Office of the Healthcare Advocate successfully represented consumers in hearings on insurer proposals to raise premiums and worked on landmark state legislation to prohibit post-claims underwriting. 
• The Health Education and Advocacy Unit in the Maryland Attorney General’s Office used casework to identify policy and enforcement issues in their state appeals process and strengthen appeals notice requirements.  

See the State Best Practices Table for state-by-state information.

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