Community Health Advocates, New York
This nonprofit program uses a hotline and a network of community organizations to reach and assist consumers throughout the state.
Program Structure and Services
The Community Health Advocates (CHA) program runs a toll-free helpline and a statewide network of 30 community-based nonprofit organizations that provide individual counseling, community education, and targeted outreach. Three other organizations provide the program with technical assistance and backup on public insurance coverage: the Legal Aid Society, the Empire Justice Center, and the Medicare Rights Center. In 2011, the program helped more than 28,000 insured and uninsured New Yorkers obtain health care services and learn about their rights and options as health care consumers.
CHA is a program of the Community Service Society, an independent, nonprofit advocacy organization, and it is funded through a contract with the New York State Department of Health. The Community Services Society houses the CHA helpline; represents consumers in appeals and grievances (with its own funding); provides policy expertise, program materials, and training; ensures quality of services through review of randomly selected cases and monthly meetings with counselors; and maintains the program’s centralized, secure online database. This database allows CHA staff in community-based organizations to record their interactions with consumers and communicate with CSS program managers. CSS uses these program data to identify systemic issues that consumers are facing early on and provide feedback to policy makers and program administrators before problems become widespread. For example, in 2009, after New York passed a law that allowed COBRA recipients to qualify for up to 18 months of additional coverage, CHA received calls from COBRA beneficiaries who were not being offered an extension of benefits. CHA gathered case data and worked with the state Department of Insurance to educate employers and benefits administration companies about the new law and inform consumers about their right to extended coverage.
CHA community-based organizations make in-person counseling available in diverse communities and play a critical role in facilitating access to health care services for underserved populations, people with disabilities, and consumers with limited English proficiency. These multi-service organizations, which are trusted resources for the people they serve, work with specific communities or populations that have particular health needs, providing culturally appropriate and accessible information and counseling in more than 10 languages in all 60 counties of the state. The community-based organizations help health care consumers understand their rights and responsibilities, appeal denials of coverage, address medical bills, determine eligibility, fill out applications for coverage enrollment or renewal, and find free or affordable coverage or care. The CHA network also educates consumers, community leaders, and health care providers about consumer rights, coverage options, and changes in federal and state health care laws through hundreds of educational and training sessions that it conducts each year.
CHA has played a key role in helping consumers take advantage of the new coverage options and protections that are available under the Affordable Care Act. For example, last year, CHA established a relationship with the state’s new Pre-existing Condition Insurance Plan, the NY Bridge Program. Through this relationship, it helped applicants who were not approved for coverage under the NY Bridge Program to obtain additional documentation and resubmit their applications or to find alternative coverage options. CHA also worked with NY Bridge Program administrators to add several medical conditions to those that had been pre-approved by the program, thereby making sure that more people with serious health conditions could get coverage.
How Did Consumer Assistance Grant Funding Help the CHA Program?
Prior to 2010, CHA operated a similar program, called the Managed Care Assistance Program, which served only residents of New York City. In November 2010, CHA received a federal consumer assistance grant of $2.2 million, which allowed it to reconfigure the program to serve the entire state through a hotline and an expanded network of community-based organizations. New community-based partners participated in a two-day training with CSS staff and continue to engage with CSS on a regular basis through monthly meetings. In addition to establishing contracts with new community-based organizations and opening up helpline services to all state residents, CHA serves consumers through a new website where requests for assistance can be submitted online. Through its enhanced network, CHA is meeting residents’ increasing needs, serving well over twice as many consumers in 2011 as it served in 2010.
As a result of CHA’s new statewide role, New York State now requires that health insurance plan notices and health coverage letters from employers provide contact information for the CHA program. This new form of outreach has resulted in an increase in the number of calls to the program helpline, especially from consumers in commercial insurance plans.
Consumer Story
One of the consumers helped by CHA had worked for the New York Department of Insurance and knew the industry well. But despite her thorough knowledge of health insurance, this consumer struggled to get her husband’s cancer treatment covered after his death. Even after having more than 50 conversations with plan representatives, she was no closer to getting CIGNA to pay for $30,000 in treatment that she believed was covered under her husband’s plan. She contacted CHA for help and brought a box filled to the brim with bills and contract statements from CIGNA to meet with a counselor. The counselor sorted through the box of statements, determined the terms of her husband’s coverage, and collected the appropriate documentation, which showed that her husband’s treatment was in fact within the scope of his benefits. When the counselor and consumer called CIGNA together to discuss the bills again, having a representative of CHA talk through the case made a huge difference. Within two days, CIGNA agreed to cover the cost of her husband’s treatment.
Sources
- Interview between Cheryl Fish-Parcham and Elaine Saly, Families USA, and Elisabeth Benjamin, Vice President of Health Initiatives at Community Service Society and Priya Mendon, former Director of Community Health Advocates, June 2, 2011.
- Community Health Advocates 2010 Annual Report, Community Health Advocates: The Consumer Voice for Health Care Access (New York, NY: Community Health Advocates, 2010), available online at http://www.communityhealthadvocates.org/sites/communityhealthadvocates.org/files/publications/2010/CHA_annual_report_FINAL_0.pdf.
- Data for fiscal year 2011 as reported by Community Health Advocates.
- Community Health Advocates’ consumer publications and community training materials are available on the program’s website at http://www.communityhealthadvocates.org/publications.
PDF of this profile is available.
