The following questions and answers came from the November 17, 2016 ACE TA Center webinar, Engaging Hard-to-Enroll Clients During Open Enrollment.
- Question to ACE TA Center: Is the required documentation for “vigorously pursue” required for only Certified Application Counselors (CACs) or anyone who assists clients?
Question to Isaac, Fredrick (Certified ACA Navigator at the South Carolina HIV AIDS Council): What are some particular challenges and experiences you’ve had in supporting young adults living with HIV in getting covered?
Question to Krieg Rajaram (State Organizing Coordinator for Young Invincibles): What are some strategies related to engaging young people around special enrollment periods that are relevant to them?
Vigorous pursuit is explained in detail in HRSA Policy Clarification Notice (PCN) 13-05, entitled “Clarifications Regarding Use of Ryan White HIV/AIDS Program Funds for Premium and Cost Sharing Assistance for Private Health Insurance.”
Generally speaking, HRSA HAB’s expectation is that RWHAP recipients and subrecipients will make every reasonable effort to ensure all uninsured clients are assessed for all options in both public and private health care coverage. Recipients are expected to maintain policies regarding their required process for the pursuit of enrollment in health care coverage for all clients. These policies must include how the process will be documented by the recipient. The expectation is that recipients have established these policies to ensure they are vigorously pursuing client enrollment in health care options and can document this process in a way that HAB would be able to monitor when a site visit is conducted.
In November 2014, HAB led a webinar that discussed how "vigorously pursue" may be implemented and how protocols can be integrated into organizations. It also illustrates how one RWHAP recipient successfully created, deployed, and documented their process for vigorously pursuing health care coverage for the clients they serve. View the archived webinar.
Find resources from the ACE TA Center to help track enrollment here.
2. Question to Isaac, Fredrick (Certified ACA Navigator at the South Carolina HIV AIDS Council): What are some particular challenges and experiences you’ve had in supporting young adults living with HIV in getting covered?
One of the biggest barriers when working with millennials living with HIV/AIDS is a lack of health insurance literacy related to the policies and terms associated with being enrolled in a health insurance plan. As a best practice at the South Carolina HIV/AIDS Council, we now offer educational seminars on health insurance that are available to individuals who we enroll into Marketplace coverage. The educational seminar provides information on basic elements of health insurance, such as deductibles, co-pays, co-insurance, etc. If a young person is unable to participate in the educational seminar during an enrollment outreach event, they can participate in the educational seminar at a later date.
Young people who participate in the educational seminar become much more informed and empowered consumers.
3. Question to Krieg Rajaram (State Organizing Coordinator for Young Invincibles): What are some strategies related to engaging young people around special enrollment periods that are relevant to them?
Special enrollment periods (SEPs) allow a young adult to sign up for health insurance outside of the annual open enrollment period. There are many groups of young people who may experience qualifying life events that trigger SEPs, including:
- Young people who work in the service industry or attend vocational school may experience a sudden change in income and become eligible for a SEP.
- Students who leave or graduate from school may no longer be covered by their school’s health insurance plan. This would trigger a SEP.
- Young adults who experience significant life events, such as pregnancy, job changes, housing relocation and marriage, that open a SEP for insurance coverage.
- Individuals having a birthday. People who turn 26 have an automatic 60 days before or after their birthday to enroll into a Marketplace plan.
Clearly, there are ample opportunities for young people to enroll or review their coverage during SEPs and it’s important for enrollment assisters to understand what qualifying life events trigger a SEP. As a best practice at Young Invincibles, we attempt to anticipate which groups of people might be eligible for an SEP and proactively conduct targeted outreach to those specific groups of consumers so that they know what is available to them.