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The Center for Consumer Information & Insurance Oversight

 

Consumer Assistance Program Grants: How States Are Using New Resource to Give Consumers Greater Control of Their Health Care

New Consumer Assistance Program grants will help make sure that consumers understand their new rights and receive their benefits under the Affordable Care Act by providing nearly $20 million in new resources to help States and Territories.  These new grants will help strengthen and enhance ongoing efforts in the States and local communities to protect consumers from some of the worst insurance industry practices. Below, you can find a summary of how each State or Territory will use their new resources:

 

Arkansas

Insurance Department, Consumer Services Division

Amount Awarded: $360,879

  • Increase the number of Affordable Care Consumer Assistance Program (ACCAP) staff dedicated to addressing consumer outreach, education and complaint resolution for health insurance issues
  • Expand and improve data collection, analyses, tracking, and reporting processes already in place in order to assist Arkansas policy makers and the Secretary of Health and Human Services in identifying marketplace problems so that enforcement may be strengthened and data driven improvements achieved
  • Design and implement efficient AACAP operations and reporting infrastructure needed to support the expected rapid increase in consumer services, and evaluate, improve, and sustain ongoing operations
  • Work collaboratively with other Divisions in the Arkansas Insurance Department to identify consumer needs and trends in order to efficiently educate and serve new and continuing health insurance consumers in Arkansas, including consumers in need of complaint resolution

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California

Department of Managed Health Care, in partnership with the California Department of Insurance and Office of the Patient Advocate

Amount Awarded: $4,635,952

  • Partner with non-profit community-based organizations to provide direct, local consumer assistance
  • Create appropriate, accessible health care consumer information and resources for seniors and Californians with disabilities
  • Expand existing resources and training materials for consumer assistance organizations;
  • Develop recommendations to standardize and improve data collection and reporting of consumer issues and their resolutions
  • Enhance Department of Managed Health Care and California Department of Insurance administrative and technical capacity to achieve the Project's goals

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Connecticut

Office of the Healthcare Advocate

Amount Awarded: $412,591

  • Enhance capacity to serve consumers by increasing staff
  • Reach Connecticut's numerous non-English/non-Spanish speaking and disabled populations through multiple outreach platforms including partnership with a nonprofit entity with a strong history of outreach and education through its large network of organizations

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District of Columbia

Department of Health Care Finance, Office of the Health Care Ombudsman and Bill of Rights

Amount Awarded: $200,000

  • Expand efforts to market the services of the Consumer Assistance Program to the public, targeting the District's Hispanic communities
  • Enhance staff knowledge and skills through training staff on changes to local laws and various aspects of the Affordable Care Act. The training will enhance the capability of staff to provide effective consumer assistance, and to conduct knowledgeable community workshops, as well as presentations via a new and innovative neighborhood outreach program that takes health education into non-traditional public and private locations. Staff will also be better prepared to train others in the community to become knowledgeable consumer advocates and consumer educators within their own organizations

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Florida

Department of Elder Affairs

Amount Awarded: $2,344,000

  • Assist clients with questions and problems regarding their health coverage, determining ways of resolving such problems, answering questions about their health insurance options, assisting clients in finding coverage options, assisting clients with filing appeals of claims denials, enrolling clients into health insurance coverage, and referring beneficiaries to other agencies as appropriate
  • Support a complex network of toll-free phone systems, necessary to support the one-stop-shop beneficiary concept
    Assist in the creation of a reporting system that will collect, track, and quantify problems and inquiries encountered by consumers. These reports will help identify patterns of problems
  • Develop a media and outreach campaign to educate consumers on the services that the Florida SHINE Consumer Assistance Program can provide
  • Educate consumers on other services that are available to them (i.e. CHIP and PCIP), and in cases where direct services and enrollment cannot be provided by the Florida SHINE Consumer Assistance Program, appropriate client referrals will be made to partnering state agencies

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Illinois

Department of Insurance

Amount Awarded: $1,208,195

  • Implement the Public Inquiry and Response Tracking System (PIRT) and upgrade its complaint system in order to better serve consumers and streamline processes
  • Install an automated phone system capable of measuring data and providing enhanced services for calls
  • Develop a consumer web portal
  • Produce materials to educate consumers and promote new and existing consumer assistance services

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Kansas

Insurance Department

Amount Awarded: $353,151

  • Collect new data on Kansas population segments to be reached by media
  • Create a media room and mobile A/V tools
  • Create content for distribution to Kansans using printed materials, TV/radio firms, Public Service Announcements, social media and digital content, in-person events in rural areas, and by other special means like outreach to faith organizations, healthcare providers, and consumer advocates
  • Conduct staff training via seminars and conferences to boost Kansas Insurance Department's ability to provide enrollment assistance, to educate consumers, track and resolve appeals, and provide expertise on other coverage matters

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Maine

State of Maine, under contract with Consumers for Affordable Health Care

Amount Awarded: $200,000

  • Expand outreach and education workshops will be available to more consumers and service providers throughout the state.
  • New proposed outreach activities include strengthening referral relationships with public and private legal organizations, enhancing internet outreach, and developing an innovative relationship with hospitals in order to assist consumers/patients with health insurance coverage issues
  • Enhance the online health care guide will provide easy access to information about affordable health care options and related issues, such as claims and appeals
  • Increase staffing as the demand from consumers increases

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Maryland

Office of Attorney General, Consumer Protection Division, Health Education and Advocacy Unit (HEAU)

Amount Awarded: $716,856

  • Conduct a mass transit outreach campaign and other outreach activities to educate consumers about their rights with respect to group health plans and health insurance options and coverage, new rights under the Affordable Care Act, and the HEAU's services

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Massachusetts

Executive Office of Health and Human Services

Amount Awarded: $588,130

  • Educate consumers about their rights with respect to group health plan and health insurance coverage
  • Enroll consumers in health care coverage of all types and payers, including assisting consumers' enrollment in existing
  • Massachusetts programs that help pay for group health plan and health insurance premiums
  • Track and analyze data along numerous data points and over time in order to identify and address systemic barriers to access and enrollment into affordable health coverage options
  • File complaints and appeals for internal or external grievances processes, and provide independent legal assistance to consumers as they navigate the appeals process with respect to group health plans and health insurance coverage
  • Conduct a targeted, culturally and linguistically appropriate consumer health care outreach and education campaign to non-and-limited English-speaking communities through ethnic media channels
  • Build greater capacity and more accessibility through additional access points for consumers through community-based organizations

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Michigan

Office of Financial and Insurance Regulation, Consumer Services Division

Amount Awarded: $878,300

  • Increase consumer hotline call center staff and provide staff training
  • Maintain and expand statewide consumer outreach and education activities, re-printing consumer publications as needed
  • Continue the interpreter services provided on the consumer hotline
  • Monitor and evaluate the success of the expansion of the consumer assistance services through quantitative measures’ data regarding the number of consumers contacting the Consumer Assistance Program from various areas and populations of the state

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Mississippi

Department of Insurance

Amount Awarded: $366,345

  • Expand consumer assistance program by adding an additional regional office in the Mississippi Delta Region of the state
    Partner with two non-profit organizations with strong ties to the Latino and Vietnamese population- growing communities in Mississippi with unmet health needs. These organizations have strong ties to these populations and will facilitate serving them.
  • Partner with a third non-profit membership organization representing the interests of several local community health centers will facilitate expanded assistance to the African-American population
  • Expand staff and other resources to provide consumer assistance to these special populations

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Missouri

Department of Insurance

Amount Awarded: $739,290

  • Assist consumers with health coverage complaints and with filing of their first and second level appeals, regardless of whether the consumer is covered under a fully insured or self-insured health plan. Staff will refer files with adverse determinations for an independent medical review
  • Increase staff to ensure the capacity and expertise exists to provide assistance to consumers for all health insurance complaints; assist with educational presentations and public relations duties; and to assist with the oversight of programs
  • Provide consumer education and outreach activities, assist consumers in finding and enrolling in health care plans best suited for their needs, and answer consumer inquires about health coverage options available and insurance company complaint indices

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Nevada

Department of Health and Human Services, Office of Consumer Health Assistance (GovCHA)

Amount Awarded: $334,958

  • Increase staff, including an English/Spanish bilingual staff person, to provide education about services and resources available to consumers as they attempt to maneuver the health care system in Nevada

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New Mexico

Public Regulation Commission, Insurance Division

Amount Awarded: $278,059

  • Website development and design
  • Leverage the expertise and capacity of a non-profit partner to conduct outreach and education to low income and underserved communities throughout New Mexico by traveling throughout the state and scheduling follow-up webinars to train attorneys and community-based organizations staff that work with low income communities on how to provide assistance to consumers and help applicable agencies prepare for inquiries as the Affordable Care Act continues to be implemented
  • Further assist and educate New Mexicans with a key focus on the rural, impoverished demographic

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New York

State Department of Health

Amount Awarded: $2,300,000

  • Enhance the capacity of partnering community based organizations (CBO) to strengthen their geographical reach, provide more services and increase helpline capacity
  • Deepen the CBOs presentation skills to educate consumers
  • Ensure that the CBOs have the capacity to determine the merits of and assist consumers with appeals and grievances
  • Strengthen technical assistance to CBOs in upstate New York

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North Carolina

Department of Insurance, Health Insurance Smart NC

Amount Awarded: $1,187,698

  • Increase staff serving consumers
  • Implement a statewide outreach program to reach special populations using radio, web, and print ads
  • Increase consumer education by participation in an increased number of speaking engagements, health fairs, and media events
  • Coordinate and hold train-the-trainer events across the state to educate key stakeholders on the Consumer Assistance Program and Affordable Care Act provisions
  • Produce posters and increased number of program brochures as well as informational fact sheets on health insurance provisions and changes to be distributed across the state

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Northern Mariana Islands

Department of Commerce, Office of the Insurance Commissioner

Amount Awarded: $200,000

  • Develop the Commonwealth of the Northern Mariana Island's (CNMI) Consumer Advocacy Office
    Provide a clear and simplistic interpretation of available health plans, eligibility criteria for public and private coverage, plan and rate options, as well as consumer and carrier rights and obligations
  • Provide public education about the Affordable Care Act and coverage options
  • Offer advocacy services which include assistance with filing applications, appealing denials, and filing and following established grievance paths
  • Work closely with various community partners, both government and non-government organizations, to ensure program continuity past the grant period, as well as to leverage synergies between organizations which advance the goals of the project
  • Collect and report on various data points to ensure effectiveness of the program

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Oklahoma

Insurance Department, Consumer Assistance Division

Amount Awarded: $387,500

  • Connect consumers with health insurance programs
  • Assist consumers with health insurance related issues through the establishment of effective outreach programs
  • Develop communication and educational materials related to consumer rights and responsibilities
  • Assist consumers with resolving problems with their health insurance plans and advocate on behalf of consumers
  • Identify issues, trends and problems that may require executive, regulatory or legislative intervention
  • Continue to partner with other statewide entities that can assist individuals with health insurance related issues

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Oregon

Department of Consumer and Business Services, Insurance Division

Amount Awarded: $451,354

  • Enhance capacity and quality by restoring and adding new services including appeals and grievances assistance and expanding program hours of operation
  • Increase enrollment activity and reduce health disparities through broadcast media marketing, particularly into rural communities and communities of color, and use web advertising to drive visits to the website
  • Develop a technical infrastructure that will facilitate better service to consumers through more robust case management, links to resources and service providers, and detailed data collection, management, and reporting

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Pennsylvania

Insurance Department

Amount Awarded: $1,098,000

  • Create mobile applications on the new stand-alone site, which will be focused on the consumer's ability to file complaints and questions using their smart devices and not just the internet, and allow consumers to verify the licensing status of a producer
  • Develop educational and social media production videos to talk and walk consumers through more complicated health insurance issues, including how to file complaints and appeals and understanding the individual protections under the Affordable Care Act
  • Employ live chat options on the new stand-alone website
  • Enhance triage of the toll-free number with new scripting and voiceovers
  • Promote new elements with on-line media buys

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Rhode Island

Department of Business Regulation

Amount Awarded: $200,000

  • Increase staff to support this program
  • Provide basic education about the state health insurance appeals process (what it is and when it is necessary), phone and in-person support for consumers seeking appeals, and referrals to legal resources when in-house staff cannot meet consumers' needs
  • Collect data on at least the following metrics: total number of cases opened, caller demographics, type of coverage involved, problem type, total number of cases involving appeals, total number of referrals, whether and how cases were resolved, whether issuers and providers were responsive in resolving consumer problems, number of outreach communications per month, and qualitative data on consumer stories
  • Educate consumers about their rights related to commercial health insurance coverage

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Vermont

Department of Health Care Regulation, Division of Health Care Administration

Amount Awarded: $200,000

  • Increase staff in order to expand services and better respond to the increasing number of consumers needing help with health care and health insurance issues
  • Address questions raised and challenges faced by health care consumers in light of the changes made by the Affordable Care Act

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Virgin Islands

Office of the Lieutenant Governor, Division of Banking and Insurance

Amount Awarded: $200,000

  • Increase staff to support the program
  • Provide training to staff involved in delivering services relative to the Affordable Care Act so that they would have the skills necessary to convey these concepts to the consumer
  • Support the extensive public education campaign needed to inform both insured and uninsured residents about the diverse options available to them as part of the health care law. This campaign is expected to utilize newspaper, TV and radio advertising, direct mail, and the publication and distribution of informational brochures, pamphlets, and other materials
  • Monitor progress in implementing the consumer assistance provisions of the Act by tracking the rate at which consumer complaints and inquiries are successfully resolved and by the numbers of residents who have gained access to the healthcare system through plan enrollment

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