3.4 Outage Probability
3.4.3 Multiple-Antenna ANs and CN
The identification of individuals who are potentially eligible for a private coverage buy-in program can be a challenge for states. To be eligible, individuals must meet two criteria (at a minimum):
■ They must be eligible for the public program (whether it is Title XXI, Medicaid, or a state-only program); and,
■ They must have access to employer-based or other private coverage.
In identifying such individuals, states have two options. They can start with public program eligibles and attempt to find out if private coverage is available to them. Alternately, they can start with low-income workers and attempt to find out if they qualify for the public program. A combination of the two approaches is probably best.
A. Public Programs as a Source of Potential Eligibles
In many states, applications for public programs include questions about applicants’ other available coverage. State officials designing a buy-in program should determine whether such relevant questions are already included in Medicaid or other public program applications. If not, they may need to add questions, keeping in mind that public program applications should be kept as short and simple as possible. At a minimum, an application should ask whether the applicant is employed and whether the employer offers health insurance as a benefit for the applicant and/or his dependents. The answers to these two questions will help state officials determine whether they need to follow up with the applicant to learn more about the employer-based coverage. Officials should recognize, however, that some applicants may be hesitant to be truthful about their access to employer-based coverage, for fear that having such access might jeopardize their eligibility for the public program.
State Example: Massachusettes
U
SING THEP
UBLICP
ROGRAMA
PPLICATION AS AS
CREENINGT
OOL The MassHealth program application asks whether the applicant has (or has access to) employer-based coverage. If the applicant answers in the affirmative, an “insurance investiga-tion period” is triggered, with the state contacting the employer to gather addiinvestiga-tional informa-tion. However, state officials do not rely entirely on applicants’ answers to questions about access to coverage. The state initiates the insurance investigation period for all applicants who indicate that they are employed, whether or not they indicate that other coverage is available.B. Employers as a Source of Potential Eligibles
An additional means of identifying potential buy-in program participants is to target low-income workers. States may develop materials that can be distributed to employers through business associations, chambers of commerce, or directly. Many employers will be appreciative of the opportunity to assist their employees in this way. On the other hand, some employers may not want to provide information about a buy-in program, because greater participation in the employer’s plan will mean the employer must make contributions for more people. In addition, some employers may not wish to be involved in marketing a service or benefit that is only available to some, but not all, of their workers.
Operational
as a tool to screen for access to privateC. Insurance Agents as a Source of Potential Eligibles
States may also wish to provide information or training to insurance agents. For many small businesses, the insurance agent acts as the human resource department and is well-positioned to provide an employer and his employees with information about the buy-in program. Because agents are often paid commissions (by insurance carriers) based on the number of people that enroll in a plan, they have a financial incentive to enroll as many people from the employer group as possible. It is, therefore, in the agents’ best interest to let employees know about the availability of a subsidy, thereby increasing the chances that more employees will be able to join the plan.
State Example: Oregon P
ARTNERING WITHI
NSURANCEA
GENTSThe Oregon Family Health Insurance Assistance Program (FHIAP) uses agents to market the program and to help participants enroll in individual coverage (when group coverage is not available). The FHIAP provides training for the agents and matches them with applicants who may need their assistance. All agents in the state can assist applicants with program enrollment, but only those who have undergone the FHIAP training can receive referrals from the state. As part of the training, agents learn about other programs for which individuals might be eligible, such as Medicaid, the Medicaid look-alike public Title XXI program, and the state’s high-risk pool. Agents are required to include information about these other public programs when they provide assistance with FHIAP enrollment. When a person purchases either group or
individual coverage using a FHIAP subsidy, the agent receives a commission from the carrier.
Oregon officials expect to have from 230 to 260 agents throughout the state working with the program. Early FHIAP enrollment data show that the majority of applicants are learning about the program from a health insurance agent or from a Medicaid or welfare case-worker.
D. Automated Data Matches
State officials may also use automated data matches to identify potential program eligibles. For example, a state could compare public program eligibility files to state income tax data to deter-mine whether public program participants are employed (and may, therefore, have access to employer-based insurance).
State Examples:
A
UTOMATEDD
ATAM
ATCHESTexas and Iowa. Texas’ Health Insurance Premium Payment (HIPP) program uses a system that matches state employment and Medicaid eligibility data. However, Texas program officials note that employment data are not always current, limiting the effectiveness of this approach. Iowa uses a similar computerized matching system to identify potential HIPP program eligibles, but officials in that state report that this method has not proven particularly useful.37
Wisconsin. In Wisconsin, all major insurance carriers are required to submit to the Badger-Care program a semi-annual report listing all currently enrolled individuals. The majority of carriers submit these reports monthly. State officials will use this information in a retrospec-tive process as one means of identifying adults and children enrolled in private coverage.
Wisconsin has not yet implemented this approach, so it is too early to determine whether it will be successful and/or useful.
Massachusetts. Under the MassHealth Family Assistance Program, officials use an automated data match as one of several means of determining whether program applicants have access to employer-based coverage. The MassHealth program receives monthly
eligibility files from several of the state’s largest commercial carriers. Using these data, officials can determine whether program applicants are currently covered by an employer-based plan.
They cannot, however, determine whether applicants have access to coverage (i.e., the employer offers it) but are not enrolled. In addition, carriers’ eligibility systems track social security numbers only for primary subscribers, not for dependents. As a result, officials cannot use these data to perform a match for children. Officials are currently working on improvements to the data matching system to eliminate some of these problems.