Endnotes
1. State Health Insurance Assistance Program (SHIP) counselors assist Medicare beneficiaries with enrollment in Part D drug plans and provide counseling on Medicare, Medicare Advantage, and Medicare supplemental policies. SHIP counselors also regularly assist Medicare beneficiaries with using the medicare.gov online tools to compare, select, and enroll in drug plans, and they help low-income Medicare beneficiaries apply for Medicaid coverage and subsidy programs. Health Assistance Partnership, Helping State Health Insurance Assistance Programs (SHIPs) Help Medicare Beneficiaries (Washington: Health Assistance Partnership, October 2009), available online at http://www.familiesusa.org/assets/hapnetwork/ships-helping-medicare-consumers.pdf.
2. 45CFR 155.210 (a-f) and Section II. Subpart C at 18330-18334, “Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers; Final Rule and Interim Final Rule,” Federal Register 77, no. 59 (March 27, 2012).
3. Families USA, State Responsibilities in a Partnership Exchange (Washington: Families USA, October 2012), available online at http://familiesusa2.org/assets/pdfs/health-reform/State-Exchange-Partnership-Responsibilities.pdf.
4. Center for Consumer Information and Insurance Oversight, Blueprint for Approval of Affordable State-Based and State Partnership Insurance Exchanges (Washington: Department of Health and Human Services, August 14, 2012), available online at http://cciio.cms.gov/resources/files/hie-blueprint-081312.pdf.
5. Families USA, Filling In Gaps in Consumer Assistance: How Exchanges Can Use Assisters (Washington: Families USA, November 2012), available online at http://familiesusa2.org/assets/pdfs/health-reform/How-Exchanges-Can-Use-Assisters.pdf.
6. Kaiser Commission on Medicaid and the Uninsured, A Profile of Health Insurance Exchange Enrollees (Washington: Kaiser Family Foundation, March 2011), available online at http://www.kff.org/healthreform/upload/8147.pdf.
7. Deepak Madala, Bridging the Enrollment Gap: The Importance of Providing In-Person Assistance (Washington: Enroll America, August 2012), available online at http://www.enrollamerica.org/best-practices-institute/publications-and-resources/2012/bridging-the-enrollment-gap-the-importance-of-providing-in-person-assistance.
8. Kaiser Commission on Medicaid and the Uninsured, Expanding Medicaid to Low-Income Childless Adults under Health Reform: Key Lessons from State Experiences (Washington: Kaiser Family Foundation, July 2010), available online at http://www.kff.org/medicaid/upload/8087.pdf.
9. California Coverage and Health Initiatives, A Trusted Voice: Leveraging the Local Experience of Community Based Organizations in Implementing the Affordable Care Act (Sacramento: California Coverage and Health Initiatives, April 2011), available online at http://cchi4families.org/cms-assets/documents/30167-92179.cchinewwpoutreachprint-1050411.pdf.
10. The Colorado Trust, Trusted Hands: The Role of Community-Based Organizations in Enrolling Children in Public Health Insurance Programs (Denver: The Colorado Trust, February 2010), available online at http://www.coloradotrust.org/attachments/0001/0489/TrustedHands_021010_FINAL.pdf.
11. Unpublished data analysis by the Lewin Group for Families USA. Data are on file at Families USA.
12. The Centers for Medicare and Medicaid Services has posted detailed Census data identifying geographic locations and demographic characteristics of uninsured populations, which may provide a useful starting point for developing state outreach strategies. This data is available online at http://www.cms.gov/Outreach-and-Education/Outreach/HIMarketplace/Census-Data-.html.
13. Interview among Cheryl Fish-Parcham and Elaine Saly, Families USA, and Mike Klug, consultant and former team leader for the Health Assistance Partnership’s Medicare Education Team, July 20, 2012. SHIPs typically have a central office at the state level that is housed in the office of the insurance commissioner or the state unit on aging that coordinates with local offices at the county level, where most SHIP staff and counselors work in community-based organizations that serve older adults and people with disabilities, such as senior centers and hospitals.
14. For example, the North Carolina SHIP established the “Community Superstars” program to recruit respected community leaders and prepare them to share information about Medicare low-income subsidy programs with potential beneficiaries and to provide referrals to the SHIP. See the Health Assistance Partnership’s best practices in LIS Outreach Project: “Community Superstars” online at http://www.familiesusa.org/assets/hapnetwork/north-carolina-lis-outreach.html.
15. See a survey developed by the North Carolina SHIP and administered by the Martin Department County of Aging online at http://www.familiesusa.org/assets/hapnetwork/north-carolina-lis-outreach.html.
16. See Simple Ideas for Outreach online at http://www.familiesusa.org/assets/hapnetwork/pilot-project-outreach-ideas.html; Rural Outreach Strategies—Building Relationships with Small Town Media for strategies from the Arizona SHIP, available online at http://www.familiesusa.org/assets/hapnetwork/arizona-rural-outreach.html; and media tools developed by the Florida SHIP, available online at http://www.familiesusa.org/assets/hapnetwork/florida-outreach-publicity.html. Also see Families USA’s tips on media basics, story banking, and online tools, available online at http://familiesusa2.org/conference/health-action-2012/toolkit/content/skills.html#basics.
17. SHIP programs develop specialized roles for staff and volunteers that help maximize expertise, provide options for volunteers with different strengths and skill sets, and make responsibilities manageable for new recruits. See the Health Assistance Partnership’s Guide to Volunteer Program Development online at http://familiesusa2.org/hapnetwork/assets/docs/vpd/hap-s-guide-to-volunteer-program-development.doc and the position descriptions developed by the Virginia SHIP online at http://www.familiesusa.org/assets/hapnetwork/virginia-2009.html.
18. Florida’s Department of Elder Affairs established a state-level Outreach and Publicity Team to support promotional efforts for local offices of the Florida SHIP program. See the team’s publicity and outreach strategies online at http://www.familiesusa.org/assets/hapnetwork/florida-outreach-publicity.html.
19. Interview among Cheryl Fish-Parcham and Elaine Saly, Families USA, and Mike Klug, op. cit.
20. To schedule assistance clinics during open enrollment, SHIPs often develop partnerships with local institutions, such as libraries, community centers, universities, and health care facilities. These clinics are well publicized, and consumers can call to schedule an appointment in advance or come during walk-in hours. Interview among Cheryl Fish-Parcham and Elaine Saly, Families USA, and Alice Ierley, SHIP and SMP Program Director, Colorado Department of Regulatory Agencies, Division of Insurance, August 2, 2012.
21. Kaiser Commission on Medicaid and the Uninsured, A Profile of Health Insurance Exchange Enrollees, op cit.
22. 45CFR 155.205 (a-e) in “Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers; Final Rule and Interim Final Rule,” Federal Register 77, no. 59 (March 27, 2012).
23. Training and Advocacy Support Center, National Disability Rights Network, Effective Communication and Language Access for Individuals with Disabilities (Washington: National Disability Rights Network, August 2007). The National Disability Rights Network is the nonprofit membership organization for state Protection and Advocacy (P&A) systems and client assistance programs (CAPs), which provide legally based advocacy services for people with disabilities. The network also provides training and technical assistance for P&As and CAPs through its Training and Advocacy Support Center.
24. The Center for Cultural Competence at the Georgetown University Center for Child and Human Development provides conceptual frameworks and practical checklists to help direct service providers assess and develop cultural and linguistic competence. See http://nccc.georgetown.edu/foundations/frameworks.html and http://nccc.georgetown.edu/resources/publicationstype.html#checklists.
25. Interview between Elaine Saly, Families USA, and Bonnie Burns, Training and Policy Specialist Consultant for California Health Advocates, the lead nonprofit agency for the California SHIP network, November 1, 2012.
26. For a list of what makes a translation good, see Enroll America and Maximus Center for Health Literacy, Translations that Hit the Mark (Washington: Enroll America, October 2012).
27. The Department of Health and Human Services translates into 12 languages many documents and fact sheets that are important for Medicare beneficiaries. These fact sheets are used by SHIP counselors. The translated documents are available on the Medicare.gov website at www.medicare.gov/about-us/other-languages/information-in-other-languages.html.
28. Interview between Elaine Saly, Families USA, and Heather Bates, Vice President, Client Services and Program Management, Medicare Rights Center, New York office, former director of the New York SHIP, November 15, 2012.
29. National Council on Disability, The Current State of Health Care for People with Disabilities (Washington: National Council on Disability, September 2009), available online at http://www.ncd.gov/publications/2009/Sept302009.
30. National Disability Rights Network directory of state Protection and Advocacy (P&A) Systems and Client Assistance Programs (CAP), available online at http://napas.org/en/ndrn-member-agencies.html. The Association of University Centers on Disabilities directory of programs by state is available online at http://www.aucd.org/directory/directory.cfm?program=UCEDD. The National Association of State Directors of Developmental Disabilities Services directory of intellectual/developmental disabilities agencies is available online at http://www.aucd.org/directory/directory.cfm?program=UCEDD.
31. Training and Advocacy Support Center, National Disability Rights Network, op. cit.
32. See United Spinal Association, Tips on Interacting with People with Disabilities (Jackson Heights, New York: United Spinal Association, 2008), available online at http://www.unitedspinal.org/pdf/DisabilityEtiquette.pdf; and Tips: Interacting with People with Disabilities online at http://www.familiesusa.org/assets/hapnetwork/interacting-disabilities-1.html.
33. Interview among Elaine Saly, Families USA, Elizabeth Priaulx, Senior Disability Legal Specialist, and Zach Martin, Disability Advocacy Specialist, the National Disability Rights Network, November 11, 2012.
34. Under the Assistive Technology Act of 1989, each state has an Assistive Technology Act Program that maintains an inventory of assistive technologies, provides training on assistive technology use, and loans assistive technologies to individuals and programs. A directory of Assistive Technology Act programs is available online at http://ataporg.org/states.html. The Registry of Interpreters for the Deaf provides an online database of sign language interpreters online at https://www.rid.org/acct-app/index.cfm?action=search.members.
35. Allies in Self-Advocacy, Accessible Meetings and Presentations, available online at http://alliesinselfadvocacy.org/accessible-meetings-presentations/.
36. Centers for Medicare and Medicaid Services, PRA for Single Streamlined Application Data Elements, notice and appendices available online in the Medicaid.gov State Resource Center and at https://federalregister.gov/a/2012-16508.
37. S. McMorrow, G. Kenney, and C. Coyer, Addressing Barriers to Health Insurance Coverage among Children: New Estimates for the Nation, California, New York, and Texas (Washington: Urban Institute, May 2012), available online at http://www.urban.org/url.cfm?id=412561&RSSFeed=UI_ChildrenandYouth.xml.
38. California Coverage and Health Initiatives, op. cit.
39. Conversation between Elaine Saly, Families USA, and Kate L. Bicego, Consumer Education and Enrollment Manager, Health Care for All, October 26, 2012.
40. 45CFR 155.705 (a) in “Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers; Final Rule and Interim Final Rule,” Federal Register 77, no. 59 (March 27, 2012).
41. Agents and brokers may become navigators in some exchanges, and they may be paid as they are now in others.
42. As of 2009, about two-thirds of states had established certification programs for SHIP counselors, and more states are in the process of developing such programs. Health Assistance Partnership, State of the SHIPs: A Summary of Results of the 2009 SHIPs Needs Assessment Survey (Washington: Families USA, January 2010), available online at http://www.familiesusa.org/assets/hapnetwork/2010.pdf. Methods of certification are described online at http://www.familiesusa.org/assets/hapnetwork/ship-certification-methods.html.
43. See the Volunteer Agreement in the Maryland SHIP volunteer orientation booklet online at http://www.familiesusa.org/assets/hapnetwork/md-ship-booklet.pdf.
44. Washington State’s SHIP program developed a task-based training method that focuses on providing volunteers with hands-on experience in performing the tasks required in their volunteer roles. See Volunteer Training: Shifting to a Task-Based Training Culture online at http://www.familiesusa.org/assets/hapnetwork/washington-volunteer-training.html. Also see skill-building tools and exercises developed by the Montana SHIP online at http://www.familiesusa.org/assets/hapnetwork/montana-ship-program.html.
45. Interview among Cheryl Fish-Parcham and Elaine Saly, Families USA, and Mike Klug, op. cit.
46. See SHIP best practices for update training and competency testing online at http://www.familiesusa.org/assets/hapnetwork/ship-certification-methods.html.
47. See training and certification best practices from the Maine SHIP online at http://www.familiesusa.org/assets/hapnetwork/maine-ship-summary.pdf.
48. T. de Jung, C. Tracy, and E. Benjamin, Connecting Consumers to Coverage: The Role of Navigators and Consumer Assistance Programs in Implementing Health Reform in New York (New York: New York State Health Foundation, September 2011).
49. See reference sheets and counseling tools online at http://www.familiesusa.org/assets/hapnetwork/manage-volunteer-programs.html and counseling tools developed by the Alabama SHIP and the Health Assistance Partnership online at http://www.familiesusa.org/assets/hapnetwork/alabama-ship-program.html.
50. Interview among Cheryl Fish-Parcham and Elaine Saly, Families USA, and Anne Smith, Medicare Rights Advocate, Legal Services for the Elderly, August 24, 2012.
51. SHIP counselors are assigned unique IDs through SHIPtalk.org, the federal technical assistance hub for SHIP programs. These ID numbers allow access to beneficiary information through a direct counselor line to 1-800-MEDICARE, where they are able to use a shorthand menu to reach customer service representatives with the appropriate expertise to resolve particular beneficiary issues. SHIP directors report that the unique ID numbers are the single most helpful tool for counselors, giving them more leverage to help consumers resolve problems with access to coverage. Interview among Cheryl Fish-Parcham and Elaine Saly, Families USA, and Alice Ierley, op. cit.
52. In addition to providing enrollment assistance, SHIPs help Medicare beneficiaries resolve problems by hiring expert staff and partnering with legal services and consumer assistance programs. In some states, these relationships are formalized through contract agreements with organizations that commit to serving a particular function. Interview among Cheryl Fish-Parcham and Elaine Saly, Families USA, and Alice Ierley, op. cit.; Interview among Cheryl Fish-Parcham and Elaine Saly, Families USA, and Anne Smith, op. cit.
53. Interview among Cheryl Fish-Parcham and Elaine Saly, Families USA, and Mike Klug, op. cit.
54. See Strategies for Success: Motivating Local SHIP Sites for strategies developed by the Michigan SHIP to help improve local SHIP program performance and promote communication among the state and local SHIP offices, available online at http://www.familiesusa.org/assets/hapnetwork/michigan-motivating-local.html.
55. SHIPs have reported that opportunities to meet with policy experts and programs in other states to discuss common challenges and share best practices are important sources of innovation in their work. Interview among Cheryl Fish-Parcham and Elaine Saly, Families USA, and Alice Ierley, op. cit.
56. Centers for Medicare and Medicaid Services, PRA for Single Streamlined Application Data Elements, op. cit.
57. Enroll UX 2014, A New Standard for Public and Private Health Insurance Enrollment: Policy and Implementation Considerations Supplement (Oakland: California HealthCare Foundation, June 2012), available online at http://www.ux2014.org/.
58. Conversation between Elaine Saly, Families USA, and Kate L. Bicego, op. cit.
59. Interview among Cheryl Fish-Parcham and Elaine Saly, Families USA, and Mike Klug, op. cit. MassHealth is Massachusetts’ Medicaid program, and Commonwealth Care is the state’s subsidized coverage option for adults with family incomes up to 300 percent of the federal poverty level.
60. SHIP counselors use reference resources, the web-based plan comparison tools on www.medicare.gov/, and state-specific eligibility screening tools for public benefits programs.
61. A 2007 survey of SHIPs conducted by the Health Assistance Partnership found that use of incompatible local and state-level databases resulted in counselors having to enter data into electronic systems twice, leading to inefficient use of local resources and greater potential for incorrect reporting. See the survey results in SHIPs’ Needs: Summary of Survey Results from SHIP Directors (Washington: Health Assistance Partnership, April 2007), available online at http://www.familiesusa.org/assets/hapnetwork/ship-needs-2007.pdf.
62. This number is about 31 percent of the estimated 95.9 million people who are expected to enroll in Medicaid or a qualified health plan with subsidies. Matthew Buettgens, Austin Nichols, and Stan Dorn, Churning under the ACA and State Policy Options for Mitigation (Washington: The Urban Institute, June 2012), available online at http://www.urban.org/health_policy/url.cfm?ID=412587.
63. Ibid.
64. 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 and the Robert Wood Johnson Foundation, November 2009), available online at http://www.urban.org/UploadedPDF/411987_massachusetts_success.pdf; conversation between Elaine Saly, Families USA, and Kate L. Bicego, op. cit.
65. Kaiser Commission on Medicaid and the Uninsured, A Profile of Health Insurance Exchange Enrollees, op. cit.
66. Interview among Cheryl Fish-Parcham and Elaine Saly, Families USA, and Mike Klug, op. cit.
67. SHIPs depend on a highly trained volunteer workforce to develop the capacity to meet consumer needs during open enrollment season. See the Health Assistance Partnership’s Guide to Volunteer Program Development online at http://familiesusa2.org/hapnetwork/assets/docs/vpd/hap-s-guide-to-volunteer-program-development.doc and program development tools online at http://www.familiesusa.org/assets/hapnetwork/program-development.html.
68. Department of Health and Human Services, Letter from Secretary Kathleen Sebelius to Governors, November 9, 2012, available online at http://www.modernhealthcare.com/assets/pdf/CH83821119.PDF.
69. Center for Consumer Information and Insurance Oversight, The Consumer-Mediated, Dynamic Eligibility and Enrollment Process, presentation for the Health Insurance Exchange System-Wide Meeting (May 21-23, 2012), available online at http://cciio.cms.gov/resources/files/hie-cmdeep.pdf.
[Back to Table of Contents] [Back to Families USA Home]
