Come summer, at least 535 trained guides will start fanning out across Arkansas, knocking on doors, setting up folding chairs in community centers and handing out brochures to spread the word across Arkansas about the state’s health-insurance exchange, which will open in January.
And their job may have just gotten harder. If an emerging plan at the state Capitol to expand Medicaid by placing up to 250,000 more people in the private insurance marketplace passes, the expected pool of mostly uninsured consumers seeking health coverage will likely double.
Those who favor the “private option” for broadening the availability of government-subsidized health insurance say it won’t be much more expensive than expanding the existing $5 billion Medicaid program, which already covers about 780,000 Arkansans.
The increased volume will spur competition among insurance companies and drive down prices, advocates say.
The flip side? A whole lot more people to find, educate and sign up when enrollment starts Oct. 1. That means a far greater burden on the guides.
Those guides – or “in-person as sisters” in bureaucratese – will be the tip of the spear for implementing a key part of the Patient Protection and Affordable Care Act. Think of them as census workers – earning about $12 an hour for about a year – and putting their boots on the ground to educate nearly a half-million people about which insurance plans are best for them. Then helping them “navigate” how to sign up for coverage on the federally administered online portal. People will also be able seek coverage by phone or through the mail.
At recent exchange planning meetings, attendees asked planning director Cindy Crone how many more guides might be needed to handle the anticipated surge in the exchange numbers.
“Double?” she said, shrugging.
The real answer, she said Friday, is that no one knows, since additional guides can be paid only through federal funds because Gov. Mike Beebe has repeatedly said no state dollars will be used to set up the exchange’s infrastructure, the Arkansas Democrat-Gazette reports.
Because of the mandatory federal spending cuts produced when Congress could not agree on a budget, it remains an open question whether more money for guides will be available under the current “sequestration” scenario that has stalled the money flow from Washington, D.C.
But Crone isn’t worried. The Obama administration has signaled that it supports Arkansas’ Medicaid expansion plan.
“I have confidence that we will get the necessary federal support,” she said.
In all, setting up the consumer assistance part of the partnership exchange in Arkansas is expected to cost about $17.1 million. Arkansas is one of seven states that has chosen to partner with the federal government on its exchange, retaining control of components like the training and supervision of guides.
That local control will matter, said Sandra Cook, who leads the guide program. At a Thursday meeting, Hispanic and black prospective vendors complained that some draft brochures might not be useful in their communities. A Hispanic group pointed out seven grammatical errors in a draft promotional brochure that had been translated by a local Hispanic newspaper at the exchange’s request.
Cook told advocates and potential vendors that the department would consider allowing them to develop their own materials with the Insurance Department checking them for accuracy.
It’s important to convey a “consistent” message about the exchange as state officials reach out to diverse communities, Cook said.
Complicating matters is a $9 million federal grant designed to pay guides, their supervisors and their expenses through March 2014, the end of open enrollment for the exchange.
The Arkansas Democrat-Gazette reported this month that those funds are subject to sequestration, and that all or part of the money might not be released to the state. Planners should know more by early April, Crone said.
The state Department of Human Services, which will be paying the health-insurance premiums for those earning up to 138 percent of the federal poverty level, or $15,415 for an individual, will be involved in outreach and education, said Amy Webb, department spokesman.
“That’s part of the broader discussion we’re having. We want to be part of the process,” Webb said.
But Department of Human Services officials say their agency, already burdened with administering much of the expansion population’s needs, is still waiting to see if lawmakers agree to the “private option” deal before bending further into the weeds of exchange operations.
For Medicaid expansion to move forward, 75 House members and 27 senators must sign off on it, a tall order in the GOP-controlled statehouse. The state constitution requires a super majority on most appropriations.
“Until we get the green light ‘Yes, expansion will happen,’ it’s still just possibilities,” Webb said.
Meanwhile, the insurance department, which administers the exchange, is recruiting insurance brokers and agents, nonprofits and other groups to submit plans by April 11. Those deemed qualified by the state procurement office will be reviewed by the Insurance Department.
Once selected, those groups will undergo federal and state training this summer. In October, they’ll shoulder their laptops, brew up pots of coffee in library meeting rooms and start helping people sign up on the exchange.
Training the guides properly is important. Attorney General Dustin McDaniel’s office has voiced concerns that fraudsters posing as guides – or corrupt guides themselves- could try to fleece a consumer population that is expected to be unschooled in insurance practices.
The health-care law states that guides can educate consumers about their choices but can’t steer them toward a particular plan, another concern that has been expressed by insurance executives in previous exchange planning meetings.
Tight background checks and a certification process should provide sufficient safeguards, Crone said.
Aaron Sadler, McDaniel’s spokesman, said his office is comfortable with the steps already taken.
“We do not foresee any problems, but we will work with the Insurance Department to make sure there are not, and educate consumers accordingly,” Sadler said.
It won’t be only state agencies that will recruit consumers to the exchange. The private sector will chip in, too, said Matt DeCample, Beebe’s spokesman.
Even if money for more guides can’t be found, he said, the higher reimbursement rates offered by private insurance will give more incentive for hospitals and other providers to sign people up.
“I think we’ll find no shortage of options to get people enrolled,” DeCample said.