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California exchange assisters: $58 per enrollment?

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Managers of the new California health insurance exchange program are taking applications now for a public outreach program

“Covered California” — the California Health Benefit Exchange — has about $43 million in outreach grant money to spend and has set a March 4 deadline for the first round of applications.

Exchange managers may take in a second round of applications starting in May, officials said.

The Patient Protection and Affordable Care Act of 2010 (PPACA) calls for state and federal agencies to have exchanges open and ready to sell coverage to individuals and small groups by Oct. 1, with the first coverage sold through the exchanges starting to take effect Jan. 1, 2014. The individual exchange programs are supposed to help eligible consumers sign up for Medicaid plans and other government health plan programs as well as for commercial health coverage.

The California exchange managers are especially interested in recruiting community groups, consumer advocacy groups, religious organizations, trade groups, labor unions, chambers of commerce, and other organizations that can help the exchanges reaches out to uninsured people and other people who might need help understanding their health insurance options, officials said.

The exchange managers also are recruiting “assisters,”  or “trained and certified” people who will “provide in-person assistance to help eligible individual consumers” apply for coverage through the exchange.

California exchange managers are expecting about half of the people who buy coverage through the state’s individual exchange program to need help with enrollment, and it expects each individual who asks for help to be applying for coverage for an average of two people.

Exchange managers are hoping to recruit about 3,600 “assister enrollment entities” and about 21,000 individual assisters

Members of the organizations that get the exchange outreach grants can serve as assisters, and individuals and organizations also can apply to serve as assisters without applying for outreach grants, officials said.

Covered California officials recently put out an outreach program overview paper in which they show how assister compensation will likely work and who can be an assister.

Assisters will get $58 per successful applicant for each new enrollment, officials said.

If the same individual fails once and then succeeds, the assister can get a $58 enrollment fee once the individual qualifies for exchange coverage.

An assister can get an additional $58 fee when a current exchange enrollee adds a dependent during a special enrollment period, or when an individual leaves the program and later re-enrolls in the program.

The exchange program would offer a $25 annual renewal fee for each successful renewal application.

An assister could get a $25 renewal fee for renewing an enrollee’s enrollment, or for helping an enrollee renew enrollment and add dependents during the normal renewal period.

An assister would get no compensation for “case management” tasks.

Case management would include tasks such as telling the exchange about changes in an enrollee’s income or the amount of PPACA health insurance premium tax credit subsidy money the enrollee was getting.

Exchange managers are estimating that each assister will need two to three days of training.

In the past, federal regulators have suggested that the precise language used in PPACA prohibits exchanges from using licensed health insurance agents and brokers as “navigators,” or PPACA exchange ombudsmen.

It is not clear whether the federal restriction on use of licensed producers apply to assister programs, but California is saying that the assisters it uses may not be insurance agents.

Other entities ineligible to participate in the assister program include county health departments that provide health care, hospitals and doctors.

Exchange officials have said that assisters need not have producer licenses because the assisters will not be making recommendations about coverage.

In the outreach program overview, officials said that, “under no circumstances” shall an assister ”direct or steer a consumer toward a specific health plan or provider, or refer to a specific health plan or provider as superior to its competitors.”

An assister also may not receive any kind of cash or non-cash compensation from a health insurance issuer, officials said.

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