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HealthCare Access Maryland

Central Region Connector

Sheila Mackertich

VP of Health Reform Initiatives

About HCAM

• Non-profit agency created in 1997

• Formerly Baltimore HealthCare Access– Renamed to reflect

expanded reach & focus

• Originally two core programs:– Eligibility

– Care Coordination

• Today: 19 programs/30 grants

• Areas of expertise:– Eligibility & enrollment– Navigation of health

care system– Care Coordination– Education & Advocacy

• Diverse and culturally competent staff

HCAM -- Central Region Connector

Central Region

•Baltimore City

•Baltimore County

•Anne Arundel County

•17 Partners/ Subcontractors

•Local Health Departments

•Department of Social Services

Central Region Partners/SubContractors

• Anne Arundel Medical Center

• Baltimore City Health Department

• Baltimore Healthy Start, Inc.

• Baltimore Medical Systems

• Charm City Clinic

• Chase Brexton Health Services

• Chatman, LLC

• Coordinating Center

• Healthcare for the Homeless

• Independent Marylanders Achieving Growth Through Empowerment Inc. (IMAGE)

• Maryland Medical Society (MedChi)

• Mental Health Association of Maryland (MHAMD)

• Mercy Hospital

• Mosaic Community Services

• Park Heights Community Health Alliance

• Planned Parenthood of Maryland

• St. Stephens African Methodist Church/ Office Management &Technology (OMT/SSAME)

Central Region Connector

• HCAM and our 17 partners will employ 107 certified Navigators & trained Assisters to:

– provide outreach and education

– eligibility determinations

– facilitate enrollment of the 217,000 uninsured central region residents into Medicaid, MCHP & subsidized/unsubsidized qualified health plans

Responsibilities

• Navigators will:– Conduct public education and

outreach as required by the Affordable Care Act

– Distribute fair and impartial information

– Facilitate enrollment in health plans

– Provide referrals for grievances, complaints and questions

– Provide information in a culturally and linguistically appropriate manner

– Maintain expertise in eligibility, enrollment and program specifications

– Refer insured small groups and individuals back to producers

• Assisters will:– Conduct public education and

outreach

– Facilitate enrollment in Medicaid

– Provide information in a culturally and linguistically appropriate manner

– Maintain expertise in eligibility, enrollment and program specifications

– Refer insured small groups and individuals back to producers

• Both navigators and assisters will receive training through MHBE

Application Counselors

• The Maryland Health Progress Act: – Application Counselor Sponsoring Entities:

• MHBE may designate community-based organization, health care provider, unit of State or local government, or other entities as ACSEs.

– Certified Application Counselors: MHBE may certify individuals as application counselors who:

• Are employed by or volunteer with a sponsoring entity;

• Are subject to the same requirements, restrictions, conflict of interest rules, and oversight applicable to navigators;

• Are not compensated by the MHBE, carriers, producers, or TPAs for consumer assistance services;

• Do not impose fees for consumer assistance services;

• Must disclose conflicts-of-interest; and

• Must act in the best interest of the consumer.

Application Counselors

• Application Counselor Training & Certification Standards:

– Certified Application Counselor may:

• Provide information to consumers about the full range of QHP and QDP options and IAPs;

• Assist consumers with the application process for determining eligibility for IAPs;

• Facilitate plan selection and enrollment of eligible individuals in QHPs, QDPs, and access to APTCs; and

• Provide to consumers uniform, factual, and unbiased information approved by the Maryland Medical Assistance Program about all participating MCOs and participating providers.

– Certified Application Counselors may not:

• Express a personal or professional assessment about, select or counsel an applicant about an MCO; or

• Hold an Individual Exchange Navigator certification or be an Assister.

Central Region Connector

Outreach/Education/Enrollment

•Health Departments/Social Services

•Faith-based organizations

•Community based organizations: clinics, food banks, libraries, supermarkets

•Civic Associations, clubs

•Health fairs, festivals

Central Region Connector: Where We Are

http://www.healthcareaccessmaryland.org/healthcare-reform/

Snapshot: First Two Weeks

Statewide stats (10/1-10/17)*

•Unique website visitors: 261,139

•Calls to call center: 25,149

•Accounts created with verified identity: 34,862

•Eligibility determinations completed: 23,141

•Enrollment into a plan: 2,393 * Source MHBE

Consumer Assistance

• Online at www.MarylandHealthConnection.gov

– Shop– Compare– Enroll

• In-person Assistance – Navigators (Certified)– Assisters (Non-Certified)– Insurance Producers

(Authorized)– Captive Producers– Application Counselors

• Consolidated Services Call Center – 855-642-8572 – 855-642-8573 – TTY– Customer Service– Application and enrollment

assistance– Language line/ translation

services– TTY for the hearing

impaired

• HCAM Call Center– 877-223-5201

Sheila Mackertich

Vice President of Health Reform Initiatives

410.649.0516

smackertich@hcamaryland.org

www.healthcareaccessmaryland.org