Health Care for All HelpLine, Massachusetts

This nonprofit program assists with enrollment and resolution of problems in the state’s exchange, as well as problems in the health insurance market outside of the exchange.

Program Structure and Services

Health Care for All is a nonprofit consumer advocacy organization that works through education, organizing, policy development, and lobbying to improve health care access, affordability, and quality for all Massachusetts health care consumers, especially the most vulnerable. The organization was established in 1985 and expanded to include a helpline in 1992. Its HelpLine program provides direct counseling, helping consumers understand coverage options, navigate issues that arise in using insurance, and resolve insurance complaints. The HelpLine also assists consumers through health care transitions, such as changes to enrollment periods, losing coverage in the renewal process, switching coverage because of a change in income, or changes to enrollment procedures. Through its casework, the HelpLine program is able to identify problems that are commonly experienced by Massachusetts health care consumers and address these issues through targeted consumer education (see the Consumer Story for more detail). The HelpLine refers consumers who need assistance with appeals, coverage denials, and grievances to Health Law Advocates, which is Health Care for All’s in-house public interest law firm that focuses on providing pro bono legal services to Massachusetts consumers.

The HelpLine is a vital resource for Massachusetts consumers, and its role grew significantly after the state passed its health reform law. As the law was implemented and hundreds of thousands of residents became newly eligible for health coverage and subsidies, the volume of calls to the HelpLine increased four-fold. The program received as many as 2,000 calls per week as consumers sought information about their coverage options and responsibilities.

In addition to providing education and counseling, HelpLine counselors use a web-based tool called ”HelpEngen” to quickly determine whether consumers are eligible for Medicaid or Commonwealth Care (the state’s subsidized insurance program) and submit enrollment applications on their behalf. Counselors are able to track applications as they are processed, and they receive copies of state requests if additional documentation is needed to establish eligibility. This allows counselors to follow up with clients to ensure that any additional steps are taken and that coverage is approved. In 2010, the HelpLine received 32,629 calls from consumers.

Health Care for All receives most of its consumer inquiries by phone, but the program also makes in-person and online assistance available. Counselors offer assistance in English, Spanish, and Portuguese, and approximately half of the consumers served by the program do not speak English as a primary language.

Public Education and Outreach

During the first year of Massachusetts’ health reform implementation, the state established Health Care Reform Enrollment, Outreach, and Access to Care grants, which awarded $2.5 to $3.5 million a year to community-based nonprofit organizations (including Health Care for All) and health and human services providers throughout the state to conduct outreach and enrollment assistance. MassHealth, the state’s Medicaid program, and the Office of Community Programs, a division of the University of Massachusetts Medical School, provide grant management, training, and enrollment to these groups through quarterly meetings, email updates, and web-based resources. More than half of the consumers who successfully enrolled in subsidized coverage programs during the first years of implementation submitted their applications through community-based organizations and health care providers.

How Did Consumer Assistance Grant Funding Improve the Helpline Program?

Despite the great need for the services provided by the HelpLine, limited funding has presented a challenge. In November 2010, the Massachusetts Executive Office of Health and Human Services selected Health Care for All to receive approximately $640,000 in consumer assistance funding through the state’s federal grant. This funding has enabled the program to serve more consumers, expand key capacities, and engage in its first independent public education campaign. Over the last year, the group’s direct outreach, along with the state’s requirement that all adverse coverage letters list the organization’s contact information, have resulted in an increase in the number of calls from consumers with private insurance.

Grant funding also allowed the HelpLine to expand its staff from four to six core members who take consumer calls and manage volunteers and interns. The new staff members include a bilingual caseworker and an additional full-time attorney in the Health Law Program. The HelpLine also hired a staff member dedicated to coordinating outreach and public education about the new opportunities and protections available under the Affordable Care Act. This staff member also focuses on advertising the new services the HelpLine provides. In the first six months of its grant, HelpLine counselors have assisted 10,580 consumers.

Massachusetts’ experience with its HelpLine is an example of the kind of role that a consumer assistance program might play in a state health insurance exchange, since the health reforms that Massachusetts undertook in 2006 are similar to the reforms that other states will be making under the Affordable Care Act in 2012 and beyond.

Consumer Story

The HelpLine identifies areas in which consumers are lacking information, especially when new benefits or coverage options are made available, and it develops materials or conducts targeted outreach to address these specific topics. In one instance, the HelpLine was alerted to confusion among Medicare beneficiaries about the free annual wellness visit benefit that is provided under the Affordable Care Act. Shortly after the benefit became available in January 2011, the program received a call from a Medicare beneficiary who misunderstood the difference between a physical exam and a wellness visit and was billed after her doctor completed a physical exam he thought she had requested. The client’s case was referred to an attorney in the Health Law Advocates arm of the program, who was able to work with the provider to significantly reduce what the client owed. The case underscored the importance of carefully defining new terms for consumers and ensuring that these terms are used clearly and accurately in outreach and educational materials.

In response to this issue, Health Care for All incorporated education about the Affordable Care Act’s new Medicare benefits into presentations for consumers, developed materials that provided clear descriptions of the new benefits, and brought the case to the attention of the federal Centers for Medicare and Medicaid Services (CMS). CMS has since disseminated additional educational materials about the new preventive care benefits in Medicare to providers, consumer advocacy organizations, and State Health Insurance Assistance Programs (SHIPs), and it has posted clear descriptions of the benefit on government web pages that are targeted toward consumers.

Sources

• Interview between Elaine Saly and Cheryl Fish-Parcham, Families USA, and Kate L. Bicego, Consumer Education and Enrollment Manager, Health Care for All, June 21, 2011.
• Health Care for All, Massachusetts: Leading the Nation, 2010 Annual Report (Boston: Health Care for All, Spring 2011), available online at http://www.hcfama.org/_data/global/images/HCFA_2010_AnnualReport.pdf.
• Community Service Society of New York and Community Catalyst, Making Health Reform Work: State Consumer Assistance Programs (New York: Community Service Society of New York and Community Catalyst, September 2010), available online at http://www.cssny.org/userimages/downloads/Making%20Health%20Reform%20Work%20Sept%202010%20final.pdf.
• Stan Dorn, Ian Hill, and Sara Hogan, The Secrets of Massachusetts’ Success: Why 97 Percent of State Residents Have Health Coverage (Washington: The Urban Institute: November 2009).
• Helpline consumer publications and outreach materials are available online at http://hcfama.org/index.cfm?fuseaction=Page.ViewPage&PageID=1334.
• The Massachusetts government website includes the training resources that are provided to the programs and groups that conduct outreach and enrollment assistance to the state’s health care consumers. Executive Office of Health and Human Services, Massachusetts Health Care Training Forum, available online at http://mahealthcaretrainingforum.ehs.state.ma.us/about.aspx.

PDF of this profile is available.