Texas Consumer Health Assistance Program,
Texas Department of Insurance

This program conducts targeted outreach to educate uninsured consumers about their health insurance options and resolves enrollment problems in new coverage programs.

Program Structure and Services

The Texas Consumer Health Assistance Program (Texas CHAP) was established in October 2010. The program provides assistance to all health care consumers, including consumers in public programs, those in private and self-insured plans, Medicare beneficiaries, and uninsured residents. Its staff includes a researcher, four insurance specialists, and two outreach specialists.

Texas has a long history of helping consumers with insurance issues, and the CHAP has significantly expanded the state’s consumer outreach and assistance efforts. The program helps consumers understand their coverage options and their rights under federal and state laws, resolve health plan complaints, appeal health plan denials of treatment or service, and enroll in coverage. It has also helped small businesses take advantage of the tax credits that are available under the Affordable Care Act that help pay for providing employee coverage.

Consumers contact the CHAP for a variety of reasons. Data from the Texas CHAP show that about half of the consumers who contact the program are either uninsured or need help securing continued benefits because of a change in circumstances. More than half of the consumers served in 2011 had a pre-existing condition, most commonly diabetes, heart disease, hypertension, or cancer. The program helps consumers who have been denied coverage in the private market because of a pre-existing condition enroll in the state’s high-risk pool, the Texas Health Insurance Pool, or the federal Pre-Existing Condition Insurance Plan (PCIP) that was established in August 2010. As of September 2011, 2,967 Texans had enrolled in the state’s PCIP, the highest number of any state. Enrollment in the Texas Health Insurance Pool was 25,119 as of November 2011.

Public Education and Outreach

The CHAP’s public outreach campaign focuses on reaching consumers in counties with the highest percentage of uninsured residents. As part of these efforts, the CHAP has built partnerships with public libraries, health centers, community health organizations, and advocacy organizations that help people with chronic conditions. In addition, it established monthly meetings with 60 different consumer advocacy groups, insurers, and state agency representatives.

Its public education campaign also involves strategic advertising in print and commercial media. For example, the group purchased ads in magazines with wide distribution among rural Texas households and in the coupon section of newspapers and magazines around Christmas and New Year’s Eve. This strategy is succeeding: The program has received calls from consumers who learned about the program through these advertisements, including consumers from small rural towns.

As part of its public education campaign, the program launched a website (http://www.texashealthoptions.com/) that provides a description of the program’s services; basic information about insurance for consumers; and fact sheets that explain coverage options, benefits, and insurance concepts. In addition, the program has developed outreach materials that are used in its statewide education campaign. These materials are translated into four languages: Spanish, Chinese, Vietnamese, and Korean.
The program is also better able to reach insured consumers thanks to the Affordable Care Act: Under the law, all health plans and insurers that operate in Texas must now provide enrollees with information about the CHAP in case they need help with the appeals process.

The Texas CHAP analyzes its own data and produces detailed reports that measure its reach in underserved areas and the types of consumer inquires it receives. From January through November 2011, staff participated in 165 public education and outreach events, including exhibits at schools, libraries, health fairs, and provider events. The program also records the issues that field offices are hearing from consumers at outreach events, and it regularly shares these data with the federal Center for Consumer Information and Insurance Oversight (CCIIO). For example, CHAP specialists found that many consumers qualified for PCIP coverage but could not afford the premium. The program brought this problem to the attention of CCIIO.

How Did Consumer Assistance Grant Funding Help the CHAP?

The Texas CHAP was established using the $2,792,180 consumer assistance grant that was awarded to the state’s Department of Insurance (a one-year grant for fiscal year 2011). This grant is currently the program’s only source of funding. The program received an extension to use the funds it still has under the grant through April 14, 2012.

Consumer Stories

The federal Pre-Existing Condition Insurance Plan (PCIP) has been a vital resource for Texas health care consumers, and the Texas CHAP has played an important role in getting Texans enrolled. One uninsured consumer who called the Texas CHAP had suffered a permanent spinal injury and needed surgery. An insurance specialist helped the consumer obtain insurance company denial letters and complete an enrollment application. During a follow-up call, the consumer said she had been able to get coverage through the PCIP and had recently come home from the hospital where she had received treatment. In another instance, the Texas CHAP enrolled a consumer in the PCIP who had been uninsured for more than 18 months. The woman had been diagnosed with cancer and could not wait for her husband’s open enrollment period to apply for coverage. She now has coverage through the PCIP and is receiving cancer treatment.

Sources

• Interview between Cheryl Fish-Parcham and Elaine Saly, Families USA, Melissa Hield, Associate Commissioner for Consumer Protection, and Audrey Seldon, Deputy Commissioner for Compliance, Texas Department of Insurance, June 9, 2011.
• Healthcare.gov, State by State Enrollment in the Pre-existing Condition Insurance Plan, as of September 30, 2011, posted on November 18, 2011, available online at http://www.healthcare.gov/news/factsheets/2011/11/pcip11182011a.html.
• Texas Department of Insurance, Commissioner’s Bulletin #B-0051-10 (Austin: Texas Department of Insurance, December 15, 2010), available online at http://www.tdi.texas.gov/bulletins/2010/cc50.html.
• See the “CHAP Toolkit” section of the Texas CHAP website for the program’s consumer education and outreach materials at http://www.chap.texas.gov/resources/index.html.

PDF of this profile is available.