Forty-eight million Americans live in food insecure households, meaning they worry about where and how to find their next meal. Many of these individuals and families are covered by Medicaid but are not receiving critical nutritional support. They are eligible for SNAP which could help support their nutrition and improve their health, but they are not enrolled.
What is SNAP?
The Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps) helps low-income households purchase adequate, nutritious food. Benefits are distributed monthly on an Electronic Benefits Transfer card, known as “Link” in Illinois, which acts much like a debit card. Money from SNAP can be spent at authorized retailers, and some farmers markets, on any foods that recipients prepare and eat at home. SNAP recipients nationally spend over 85 percent of benefits on fruits and vegetables, grains, dairy, meat and meat alternatives. Beneficiaries also increase the amount of money they spend on groceries each month, instead of simply replacing their food budget with SNAP dollars. By supplementing, not replacing, grocery budgets and allowing for the purchase of more nutritious food, SNAP reduces food insecurity in low-income households. This is particularly true of households with children.
Why Help Consumers Apply for SNAP Benefits?
Connecting more Medicaid recipients with SNAP benefits can address food insecurity and inadequate nutrition, which this population experiences at high rates, and improve health outcomes. In addition to helping a family afford healthier food, children who receive nutrition supports are healthier and more likely to finish school while participating in the program. A report recently released by the White House Council of Economic Advisers details the long-term benefits of this program, including: for mother’s receiving support during pregnancy, reductions in incidences of low birth-weights; and for adults who received support when they were children, reductions in obesity rates and metabolic syndrome, increased likelihood of having completed high school, and significant improvements in overall health and economic self-sufficiency among women.
New Opportunities in Illinois to Reduce the SNAP Gap
The Affordable Care Act has made it easier for low-income individuals and families to access public benefits by helping states pay for electronic systems to apply for benefits. In Illinois, the new Application for Benefits Eligibility enables applicants to submit a single application for both SNAP and Medicaid. However, despite this improved online application, we have not fully reduced the “SNAP Gap”—the number of Medicaid clients who are income-eligible for SNAP but do not receive this benefit. We need to work with medical providers, medical plans, social service organizations and other partners to make sure that everyone who is eligible for SNAP gets the help they need to pay for healthy food.
The newest change to the Illinois SNAP program is that on January 1, 2016, Illinois raised the gross income limit for SNAP from 130% to 165% of the federal poverty level, making nearly 40,000 low-income working families newly eligible for SNAP. With more families in Illinois now eligible for SNAP and the ability to submit a single application for both SNAP and Medicaid benefits, it’s time to close the SNAP Gap and make sure families have the food they need to stay healthy. If you’re not familiar with SNAP’s application process join us on HelpHub for more information and resources for both providers and consumers.
MacKenzie Speer
Advocacy Program Associate
Sargent Shriver National Center on Poverty Law
The Obamacare Lady: What made me want this job?
An Illinois Navigator's Experience Finding Lower Premiums in the Marketplace
I decided I might as well enroll myself with a Qualified Health Plan on the Marketplace before I sat down as an In Person Counselor (with a client) so I tried for a few days right after Oct. 1.
Since the site was so slow, I decided to wait until some of the excitement wore off and tried again in mid-October. I sat down after dinner and put in an hour on the computer. I quickly verified my identity, similar to the online process for requesting your free credit report. I answered simple questions about what streets I have lived on, former cities I lived in, etc. They were all multiple choice questions, and I got them all right!
Then I was able to compare the plans for my county and sort them based on certain features: metal, HSA eligible, out-of-pocket costs, etc. At that point there are fewer plans to choose from and I checked off the "compare box" on three that I thought seemed to be a good fit. After looking at the plans, side by side I was able to click on a link with each that took me to the website for each plan so I could do a provider search. I entered my current doctor and to see if my doctor was in-network. This made it pretty easy for me to decide. The pages did load slowly so I folded laundry while they loaded.
Once I enrolled in health coverage, I had to decide to elect or not to elect to access dental. I went through the same process with the dental coverage, but did find that the links did not work for all the dental plans. I eventually decided on a plan and enrolled. Then I put the laundry away while it loaded and waited.
At the end, I got the page where it said my application was complete. I printed out the page along with my application ID# and am excited to let people know that my premiums are going down!
I self-pay for insurance now and will still do so in 2014. I currently pay just over $340 a month for health and dental. Starting in January, I will only pay $185.10 for health and dental. I make too much money for any tax subsidy, so even without assistance I am seeing a huge benefit. I still get to see the same doctor and dentist that I have had since I was a kid and really cannot complain too much. Buying insurance before privately took more time as I would have to research and deal with the insurance brokers and then the underwriters questioning of any of my possible health issues.
I look forward to helping my clients find affordable options on the Marketplace, too.
Joann Boblick
Certified In Person Counselor
La Grange, IL
Primary Care Doctors Need Connections to ACA Information and to Navigators, Counselors
As the effort to promote the Health Insurance Marketplace and enroll consumers gears up, and clinics and community organizations hire, train and deploy the various “assisters” who will help patients and families get coverage, we shouldn’t ignore one of the most important touchpoints between the health care system and consumers – patient/physician interaction. Patients trust their doctors and may look to them for guidance about the Affordable Care Act (ACA). Unfortunately, many doctors haven’t been well educated about the ACA or what’s going to happen once the Marketplace is live.
The national American Academy of Pediatrics recently conducted a survey of its members and found that improvement is needed in pediatrician awareness of the Affordable Care Act (ACA). The survey, conducted in late 2012, showed that nearly half of pediatricians are vaguely or not at all familiar with key components of the ACA. Specifically, they lacked knowledge of some components that could directly benefit their practices – such as the temporary increase in payment from Medicaid to Medicare levels, and coverage of Bright Futures services with no cost-sharing for children enrolled in new insurance plans.
Pediatricians also cited low confidence in their ability to respond to parents’ questions regarding the new law. Only 5% of pediatricians reported that they are very confident in their ability, while 33% reported that they are not at all confident, with the rest somewhat or moderately confident. Clinicians such as pediatricians are not yet being asked many questions by their patients and parents, so they have not been motivated to learn their own key points or prepare their office staff to provide information. In the AAP survey, 86% of pediatricians reported that they are seldom or never asked questions concerning the ACA. Most of their knowledge to date comes from what they see in the media, so they are very much aware of aspects such as the ban on pre-existing condition exclusions, the requirements to have health insurance by 2014 or pay a fine, and the provision allowing young adults to stay on parents’ health insurance up to age 26. But once the Marketplace is up and running, and public relations campaigns about enrollment are in full swing, and assisters are everywhere, what will they need to know so they can effectively advise their patients?
Locally, two major primary care provider associations did an assessment of members which confirmed an interest in more support and information. In May 2013, the Illinois Chapter of the American Academy of Pediatrics (ICAAP) and the Illinois Academy of Family Physicians (IAFP) conducted an informal survey asking pediatricians and family physicians to estimate need for Marketplace information among patients, patient’s parents and family members, and clinic staff. Responses were received from nearly 40 unique medical practice sites employing over 500 physicians. Only 3 responded that they would not be interested in any education or services related to the Marketplace. Nearly all (85%) want information on the Marketplace to post or handout to patients, and almost as many (75%) want a counselor or assister to speak to their practice staff.
While the number of medical practices that are independent, small business is dwindling, and most staff have insurance coverage via a hospital or health system, staff may still need information for friends and family members or to make new choices if products through the Marketplace are better for their families. Only about a quarter of physicians responding expected their health system to provide information on the Marketplace for patients and staff, and most (65%) said their health system was definitely not planning to employ navigators or counselors, which may be more available in the safety net clinics than in private systems. But the need for information – even in private practices – is there! Many physicians attested to seeing their patients lose insurance due to the economy, and pediatricians regularly note that while their patients are insured via All Kids or private insurance, many of their parents or primary caregivers are not. Children also age out of All Kids or their parents’ insurance and so many young adults will seek help in securing coverage.
For the ACA roll out to work, consumers need to get quality, consistent messages about the need to enroll and how to use the health care system, no matter where they are. Targeting efforts in low income communities and in clinics that currently serve the uninsured makes sense, but the ACA effects everyone, and all primary care offices should be able to connect a patient or family who needs coverage to someone who can help them.
Scott G. Allen, MS, Executive Director
Illinois Chapter, American Academy of Pediatrics
Training for In Person Counselors and Navigators in Illinois
The State is preparing to award grants in early July to community based entities who will employ helpers to educate consumers about their new health care options under the Affordable Care Act and to assist people in enrolling in the new Medicaid expansion and Health Insurance Marketplace when open enrollment begins on October 1. These helpers will be called In Person Counselors (IPCs); however, there will also be other enrollment "helpers" called Navigators and Certified Application Counselors. The different names just refer to how the assister is funded; all of the assisters will help people choose and enroll in coverage.
In order to train these assisters, the State has partnered with the University of Illinois at Chicago School of Public Health to develop a curriculum and training program to begin by the end of July and go through the middle of September. The curriculum will consist of both online and in person learning modules. The training will be ongoing and will consist of a testing and certification process as required under state law. There will be continuing education and a backup technical assistance call center for individual questions.
In addition to the state training, IPCs and Navigators will also take a federal online Navigator training by the fall which will inform them about using the federal Marketplace portal. This is important, because all assisters in Illinois must be familiar with both the state Medicaid system as well as the federal Marketplace system since Illinois has chosen to be a partnership state and administer its health care reform programs jointly for the first year with the federal government. We are waiting on federal guidance regarding the Certified Application Counselors' training requirements.
Many other community based providers will help their clients understand and access health care coverage, even if they aren't designated "assisters" or "Navigators." These front line workers also need information on the ACA but may not need as intensive a training program as the certified assisters. There are training materials and presentations available to these organizations/ entities throughout the state including the Starting Strong Webinar Series and other events on the Illinois Health Matters events page.
Stephanie Altman
Health & Disability Advocates
The ACA is Coming – How Can I Help Enroll People?
The past few weeks have brought a flurry of activity from the federal and state government agencies who are reaching out to community-based entities to solicit their assistance in Affordable Care Act outreach, education and enrollment. In Illinois, it’s even more confusing because there are three possible “helper” groups: Navigators, In Person Counselors and Certified Application Counselors.
This blog is intended to answer some of your frequently asked questions about these enrollment helpers and how you can get involved.
What’s a Navigator and How Can I Be One?
“Navigator” is the term that has been given to people or organizations charged with providing guidance to individuals enrolling in the Health Insurance Marketplaces created by the Affordable Care Act. Many of you have been wondering how you can become one of these entities. Unfortunately, there are no actual “navigator positions” right now. This is because various entities have to apply for funding (grant application due June 7) to become navigators and receive training.
What do you mean by “entity”?
Many types of groups/entities can be Navigators. Self-employed persons and public or private organizations are eligible to apply for funding to operate as Navigators (see the FAQ here). In each Marketplace there must be at least two sub-sets of entities and at least one will be a community and consumer-focused nonprofit. There are some restrictions, however: navigators cannot have conflicts of interest. Therefore, navigators cannot be health insurers, have affiliations with health insurers, or accept any form of payment from insurers that is related to enrollment inside or outside of the marketplaces.
What if I don’t want to or am not eligible to apply for these Navigator grants?
If you don't think you or your organization would qualify for this funding alone, you could consider reaching out to another organization in your area that might be applying. Check out this consumer assistance matchmaking spreadsheet to meet up with other groups. Another option would be to wait until the grants have been decided upon and then reach out to see if the recipient organizations need any additional staff.
What is the In-Person Counselor (IPC) Program?
In-Person Counselors (IPCs) are the same as Navigators, in that they will educate people about the new system, help them understand their health plan choices, and facilitate their selection of the plan that is right for them. They are different than Navigators because funding for these entities comes from the state instead of the federal government and they will receive training directly from the state.
The IPC grant application just came out and applications are due May 30th. Entities in Illinois can apply for these funds and hire new personnel or use existing staff as In-Person Counselors in the community. Find more information and access to the application here. The Illinois Health Insurance Marketplace will be conducting a webinar for those interested in the IPC program on Thursday, May 9 at 10 am. You must register to participate.
But how is a Navigator and In Person Counselor different from a Certified Application Counselor (CAC)?
CAC's have been defined as “trusted community-based organizations, providers, or other organizations with expertise in social service programs.” CACs allow organizations that would likely aid consumers anyway (such as hospitals or clinics) be involved more formally in the process of finding health coverage. Unlike Navigators and IPCs, CACs are not eligible for public funding but the Marketplace will be required to certify CACs to help people apply for Medicaid and plans sold through the exchange.
So what should I do now if I want to be one of these helpers?
- Read the IPC application
- Look at the Illinois Consumer Assistance Matchmaking Spreadsheet to see who else wants to apply to be a Navigator or IPC
- Participate in the webinar on May 9th about the IPC program
- Stay tuned for more information about the CAC program in Illinois
Stephani Becker & Alexa Herzog
Illinois Health Matters
Update on SB 1194 (The Insurance Navigator Act)
Starting October 2013, an estimated 1.6 million Illinois residents will be eligible for new and affordable forms of public and private health insurance coverage under the Affordable Care Act. But the overwhelming majority of the newly eligible have no idea how to access these options. Many Illinoisans will need more information and guidance through the enrollment process.
The Affordable Care Act requires each state’s Health Insurance Marketplace to establish a Navigator Program that will guide these individuals through their new coverage and enrollment options. These Navigators will serve an important role in ensuring that individuals benefit from the ACA.
On January 30th, the potential efficacy of the Navigator program was threatened by the introduction of Illinois Senate Bill 1194, which would create overly restrictive criteria for organizations applying for and performing navigator functions.
Here are the issues with SB1194 (as it was introduced):
- SB1194 placed unnecessary restrictions on Illinois Navigators and In-Person Assistors, making it more difficult for low-income and hard-to-reach populations to connect to the application assistance that they need.
- Illinois is currently preparing a Navigator training and oversight system that makes SB 1194 unnecessary.
- Federal law already mandates some of what is outlined in SB1194, such as prohibiting Navigators from recommending specific insurance products. Once again, SB1194 is unnecessary.
- Language in SB1194 prohibited Navigators from facilitating enrollment in a Federally Qualified Health Plan, (QHP), one of the five Navigator duties already specified by the ACA.
Here’s what changed:
- SB1194 now includes the Navigator duties as spelled out in the ACA.
- SB1194 now includes a certification, instead of a licensure, requirement.
- SB1194 excludes all prior language that restricted Navigator duties, (such as the ability to facilitate enrollment in a QHP).
- SB1194 is now in alignment with Federal regulations regarding the training and responsibilities of Navigators.
- SB1194 now allows for the training of Certified Application Counselors, (another type of Navigator not directly compensated by the Exchange), to be defined at a later date. This means that CAC training will align with federal guidelines.
These amendments were filed on April 22nd, passed in the Senate on the 24th, and were referred to the House Rules Committee earlier today. You can follow SB 1194’s status here.Thanks to all of the advocates for raising your voices against restricting the navigators in this new health care system.
Nadeen Israel
Policy Associate, Heartland Alliance for Human Needs & Human Rights
Please contact Nadeen at nisrael@heartlandalliance.org for more information on SB1194.