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Great News for the People of Illinois...Now What?

Yesterday, Governor Quinn announced that Illinois was awarded a $115 Million grant for its Health Insurance Marketplace (the online portal to enroll over a million adults and children into quality health plans). A large portion of this federal funding will pay for outreach activities and consumer assistance during the push to enroll the uninsured beginning on October 1 of this year.

This is great news for the people of Illinois.

With October 1 less than six months away, we need these federal funds to help get the word out about the availability of new insurance coverage options. According to Enroll America's research findings, the  majority  of  uninsured Americans  don’t  know the  health  reform  law  will  help  them:

  • 78% of  the  uninsured  don’t  know  about  the new  health  insurance  exchanges  
  • 83% of  people  who  could  be  eligible  for  the new  Medicaid  expansion  don’t  know about  it.  
Tremendous amount of work needs to get done to tell people about the new options and enroll them into a plan. 

Here's a timeline of what needs to happen to be ready by October 1, 2013. Since Illinois is running its exchange/marketplace in partnership with the federal government, we need to be mindful of activities by both the feds and the state:

Already Happened:
  • Illinois Marketplace Team Selects Training Vendor (UIC/Public Health)
  • Marketplace Team Releases Outreach & Education Plan & Conducts Outreach to Encourage Navigator & In Person Assister (IPA) Applications. (Read this fact sheet to learn about the different Consumer Assistance Entities needed).
  • Marketplace Team Receives Establishment Grant Funding
  • Illinois Marketplace Team Releases RFP for Media and Marketing Outreach Strategy.
  • CMS Releases Proposed Standards for Navigators and In Person Assisters (see here for a good summary)
  • Federal Government Releases Navigator RFP (Just released today, April 9, 2013; due June 7,
    2013; Expected Award Date - August 15, 2013). 
  • Advocates create the Illinois Consumer Assistance Matchmaking Spreadsheet to find partners in either the federal Navigator grant or the (yet to be released) Illinois Assister RFP.
Spring 2013:
  • Marketplace Team Issues RFP/Grant Application for IPA entities
  • Marketplace Team Approves IPA Training Materials
  • Marketplace Team selects firm for Media and Marketing Outreach Strategy (UPDATE: On 7/12/13 Fleishman Hillard is selected)
Summer 2013:
  • Federal Government Selects Navigator Entities (Due date for application: June 7, 2013)
  • Marketplace Team Selects IPA entities (see list here) 
  • Federal Government Takes Applications for Certified Application Counselors (sign up here)
  • Navigators, IPAs, Certified Application Counselors (CACs) Receive Training and Certification.
  • Media placement begins
October 2013 and beyond:
  • Navigators, IPAs & CACs Assist Consumers during Open Enrollment
  • Navigators, IPAs & CACs Provide Post-Enrollment Assistance & Assistance during Special Enrollment Periods
  • Program Oversight Conducted By Marketplace Team and Federal Gov’t.
The timeline is tight and we need all types of entities (community based organizations, hospitals, health departments etc.) to help with enrollment.

If you have any questions about  what this means for you or your organization, please don't hesitate to contact us at info@illinoishealthmatters.org.

Stephani Becker
IHM Project Director

Sign On in Support of SB 34 - A State Run Exchange in Illinois

Illinois Senate Bill 34 establishes a robust, pro-consumer and pro-small business Health Insurance Marketplace in Illinois. The Health Insurance Marketplace will be the one-stop insurance shop for more than a million Illinoisans. SB34 ensures that the Marketplace is governed by a diverse board that represents women, small businesses, communities of color, labor, public health, people with disabilities, and consumers.  It is scheduled to be heard in subcommittee of the Senate Executive Committee today.

Please help signal broad support for this important health care bill by taking these 2 actions:

1. Sign on to the list of organizations supporting SB34

Click here to add your organization to the list of supporters for the passage of SB34.

2. Call the toll-free Marketplace Action line, 1-888-801-4426, and ask your state senator to cosponsor SB34!

If your state senator is already a cosponsor, please call him or her to thank them for their support. Here are the current co-sponsors:


David Koehler, Heather A. Steans, Don Harmon, Toi W. Hutchinson, William Delgado, Jacqueline Y. Collins, Michael Noland, Emil Jones, III, Julie A. Morrison, Steven M. Landek, Dan Kotowski, Patricia Van Pelt, Iris Y. Martinez, Mattie Hunter, Kimberly A. Lightford, Daniel Biss, Ira I. Silverstein, Thomas Cullerton, Terry Link, Melinda Bush, Donne E. Trotter, Bill Cunningham, Kwame Raoul, Napoleon Harris III

Please especially ask Senators Trotter and Clayborne and members of the Senate Executive Committee to pass SB34 out of committee.

SB34 must first pass out of the Governmental Operations Subcommittee and then the Executive Committee before going to a full vote.

Advocacy Materials:

You can find these materials and many others on our Health Insurance Marketplace page:

  •     SB34 Fact Sheet
  •     Health Insurance Marketplace Q&A
  •     State Senator Co-sponsorship Form
  •     Template for Co-sponorship request letter to senator
  •     Template for Co-sponorship thank you letter
  •     Multiple briefing resources

Jim Duffett
Campaign for Better Health Care


The HHS Secretary Visits Chicago


This week, U.S. Health and Human Services Secretary Kathleen Sebelius visited Chicago to speak about the Illinois Health Insurance Marketplace, a key provision of the Affordable Care Act.

Secretary Sebelius, accompanied by Governor Pat Quinn, announced on Wednesday that the Illinois Blueprint Application for a State-Partnership health exchange had been accepted by the federal government. The exchange will run as a federal-state partnership model until 2015, when the state may take over operations, depending on the State Legislature’s ability to pass a state exchange bill. Enrollment in the partnership exchange/marketplace opens in October, only eight months (229 days!) away.

Secretary Sebelius speaks to a full house at the Chicago Cultural Center

On Thursday, Sec. Sebelius spoke at the Chicago Cultural Center. Preceding her was Bechara Choucair, Commissioner of the Chicago Department of Public Health, who presented an overview of the Healthy Chicago program and its impact thus far. Sebelius delivered a call to action to those in attendance, citing the need for affordable, accessible health insurance for all as a crucial step in the national public health strategy. With only eight months before the state health marketplace is open for enrollment, and ten months before it is fully operational, promoting awareness of the health insurance exchange is the focus of HHS. 

Navigators, Assisters, and Counselors, Oh My!

By now we know that upwards of 30 million Americans will have new, more affordable health coverage options available to them by January 1, 2014. But what many don’t realize is how incredibly difficult it can be to understand and choose the right health insurance on your own.

The Wizard of Oz’s Dorothy had guides along the way, and the Affordable Care Act (ACA) provides some as well – hopefully, with fewer pitfalls. But not everyone can counsel people about health insurance. There are complex public and private systems to navigate, and most people who will likely get insurance in the new Health Insurance Exchanges, or Marketplaces, will be more racially diverse, less educated, and earn lower income than people in private insurance now. Most will have a high school education or less, and as many as one in four speak a language other than English at home. So it matters that the people who guide consumers along the path to coverage are trusted members of the community and understand their circumstances.

Luckily, the ACA provides different options for guides along yellow brick road.

Navigators are outlined in the ACA as helpers for people to enroll in coverage through the Exchange, and refer or assist with Medicaid enrollment. Navigators are funded through Exchanges, and regulations from the Department of Health and Human Services (HHS) are clear that anyone who gets payments from insurance companies cannot be a Navigator. Navigators also must meet cultural competency standards and go through training and certification. States running their own Exchanges are developing Navigator programs now and must fund these with state Exchange dollars. For Federal Exchanges and Partnership Exchanges, HHS has said that it will fund Navigators directly through an upcoming RFP process. Be on the lookout for this announcement in the next few weeks.

To add even more help on the ground, HHS recently outlined in regulations another program,Assisters (or, In-Person Assistance). Like Navigators, Assisters must meet training and conflict of interest standards. They could fill in gaps in areas that need more enrollment assistance, or provide outreach and education about the ACA’s new options. Funding for Assisters is a key difference from Navigators. States running Exchanges or opting for the Consumer Assistance Partnership can apply for funds for Assisters through their Exchange Establishment grants. A number of states are applying now for these funds. Unfortunately, Assisters currently are not an option for Federal Exchanges.

And when you thought there were enough new health-related terms, HHS regulations added yet another helper to enroll people, Certified Application Counselors. Every Exchange must have a Certified Application Counselor program, with similar training and privacy standards as Navigators and Assisters. A difference in this program is that there is no funding mechanism. It is unclear who will serve this role – although the regulation suggests it could be community-based organizations or health care providers. Stay tuned for further clarification on this new option.

But even these multiple types of help will not be enough to spread the word about the ACA. Helping people understand and choose the right health plan, especially given the amount of misinformation in the media and elsewhere, is going to be a huge task. Nevertheless, these resources in the ACA provide a foundation to start building greater understanding of health care options to get people into the right coverage.


This post originally appeared on Health Policy Hub's the Community Catalyst Blog. 
Written by Christine Barber, Senior Policy Analyst

What is the Illinois Partnership Health Insurance Marketplace?

The Affordable Care Act requires each state to have a health insurance marketplace (otherwise known as a "health insurance exchange"). Originally, the plan was for each state to establish its own health insurance marketplace, or default to a federally-run exchange. After the ACA passed, the federal government offered a new “partnership exchange” model, which is to relieve some of the administrative burden on the state by providing federal assistance. Illinois sent the federal government a blueprint application in November 2012 to establish a state-federal partnership exchange in 2014, with plan to transition to a state based exchange after 2015. The state is waiting for final approval of the blueprint.

On January 3, 2013, the federal Center for Consumer Information and Insurance Oversight sent out guidance on how a partnership health insurance exchange will work. The guidance allows states like Illinois who plan to transition to a state based exchange to take on as much responsibility as possible for exchange activities such as administration, plan selection, and consumer assistance. This model is referred to as a State Plan Management Partnership Exchange.

A key role of a state exchange is to provide consumers assistance in enrolling in the exchange, understand their options for insurance coverage, make decisions about coverage, and coordinate with community based organizations. This consumer help will be provided by two programs, In-Person Assisters (IPA) and Navigators, which will be separate but closely coordinated. The Navigator program will be run by the Federal government, and Illinois will develop the IPA program. Since Illinois has historic connections in the community and their understanding of the state-specific insurance, Medicaid and supplemental state health programs, the IPA program will be the primary contact for consumers and for insurance companies.

Community Based Organizations, consumer assistance organizations, medical and social service providers will all play an important role in ensuring that the Illinois state federal partnership exchange is efficient and accessible. Consumer advocates should work cooperatively with the state and federal governments to ensure that whichever agencies are responsible for administering parts of the exchange, that the end result is a coordinated system that works well for the people who need insurance coverage, including the small employers who need to purchase insurance for their employees.

Stephanie Altman
Programs & Policy Director
Health & Disability Advocates

What Happens to the Pre-Existing Condition Plans on Jan. 1, 2014?

This post is the first in a series on the Illinois State Partnership Exchange Blueprint Application, which is pending approval by the Federal Government. 

For years, health insurance carriers refused to sell coverage to individuals with pre-existing medical conditions. The Affordable Care Act (ACA) created federally funded high risk pools across the country, including the Illinois Pre-Existing Condition Insurance Plan (IPXP) so that people denied for that reason would not have to go without health insurance. Starting on January 1, 2014, the ACA bans insurance companies from denying coverage based on pre-existing conditions. As a result, IPXP will no longer be needed, and coverage under the plan will be terminated.

So what happens to the enrollees of IPXP on January 1, 2014? 

The ACA dictates that anyone currently enrolled in IPXP will be transitioned into a private insurance plan via the state health insurance exchange. This transition process will happen at the end of 2013. According to the Illinois State Partnership Exchange Blueprint Application, the state has mechanisms in place to prevent lapses in health coverage, as follows:

  • Illinois will send at least three letters to IPXP enrollees containing information on the transition process;
  • The state will conduct proactive outreach to IPXP participants and update the IPXP website with relevant information; and
  • The Illinois health insurance exchange will have extra personnel at the call center specifically to assist with the IPXP transition.

IPXP will only extend coverage for health services until December 31, 2013, which means that all current IPXP enrollees will need to find an alternative health plan before January 1, 2014.  Claims dating from before December 31, 2013 will need to be filed in the close-out period, which will run until June 30, 2015. If deferral funding for the IPXP program has run out, however, even claims filed before that date will not be payable.

Open enrollment into the state health insurance exchange will begin on October 1, 2013, with insurance coverage beginning on January 1, 2014. If current IPXP enrollees purchase a plan during open enrollment, there should be no gaps in their health coverage. Since Illinois is still in the process of establishing its health insurance exchange, check back here for details on how and where to enroll in a health insurance exchange plan, as well as future updates on the IPXP transition process. If you have questions now, contact IPXP at (877) 210-9167, or e-mail your question directly to IPXPInquiry@healthalliance.org

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