Today, the first day of the new fiscal year, marks the end of state-appropriated funding for more than 500 outreach workers known as In-Person Assistant (IPA) guides, charged with education, outreach, and enrollment help for the new insurance options available under the Affordable Care Act. The Arkansas Insurance Department has closed contracts with the 27 organizations tasked with hiring and overseeing 537 guides throughout the state. The change comes because of an amendment to the private option adopted in last year’s fiscal session. In some cases, workers will be laid off and those guide positions will simply end; in other cases, organizations may seek private funding to continue the guides’ work or may continue to employ the guides themselves, adding the positions within their own scope of work.
The amendment to the private option sponsored by Rep. Nate Bell in this year’s fiscal session banned state appropriations for guides or any other outreach — advertisements, direct mail, etc. — related to the ACA, both state funding and federal money appropriated by the states (the IPA guides were paid for by federal grants in 2014, appropriated through the state budget). The amendment was intended to help the private option gain the needed supermajority for re-authorization (the private option is the state’s plan using Medicaid funds available via the ACA to purchase private health insurance for low-income Arkansans). Bell, who opposes the private option, agreed to vote for it if the outreach ban was included. The ban applies both to the private option itself and also to the rest of the Arkansas Health Insurance Marketplace, the regulated marketplace created by the ACA. Technically, the IPA guides did outreach and enrollment work for the non-PO Marketplace, but they were allowed to help private option enrollees too, and were often vital in helping beneficiaries navigate the process. (For the differences between private option enrollment and the rest of the Marketplace, see this post).
The Bell amendment was alarming for advocates concerned about informing Arkansans about their options for health insurance. The week it passed, Arkansas Advocates Health Policy Director Anna Strong said in a statement, “Eliminating consumer assistance workers who are ‘informal leaders’ within their communities means those who are disenfranchised often remain that way and may miss out on health coverage that could better their lives. The recent amendments to the Private Option appropriation do not further Arkansas’s efforts to maximize enrollment and improve the health and well-being of our state.” I’ll have more on this in the coming weeks, but one of the biggest things I found in reporting on the experience of private option beneficiaries was that guides played a powerful role both in informing hard-to-reach citizens about their options and helping them through a process that could often be extremely confusing. Not just the initial sign-up, but understanding how to use the program or dealing with glitches along the way. Licensed brokers and agents can still help consumers, but it’s unlikely they’ll be able to pick up the slack of guides working directly and intensively in local communities.
So what outreach resources will be available as Arkansas heads into Year 2 of the private option and the Health Insurance Marketplace? Again, there will still be private licensed insurance brokers and agents. There will still be “navigators” — outreach workers similar to guides who are directly funded by the feds. Because this federal money is not appropriated by the state, it won’t be impacted by the Bell amendment. There were about 30 navigators last year and federal funding will be available for around 30 again this year.
There will also be IPA guides this year; there simply won’t be any state/federal money available to fund them. Organizations may fund them on their own or seek private funding or grants. AID officials said that some organizations were planning to continue their guides programs and others will not; officials said they did not have numbers on this front, so it’s hard to know at this point how the number of guides in the field next year will compare to last year. It’s also possible that new organizations will choose to fund IPA guides. Individuals could also choose to volunteer.
AID will no longer be involved in overseeing or funding IPA guides, but they will continue to license and train them (AID also licenses agents and brokers, navigators, and other outreach workers tied to health care organizations or community health clinics). IPA guides go through federal and state training and a background check; all outreach workers licensed last year will go through a relicensure process. New and renewed licenses would be effective October 1. By then we’ll have a much better idea of whether the state has adequate outreach resources on the ground, with open enrollment beginning November 15 for the Marketplace (private option enrollment happens year round; needless to say, big questions for beneficiaries trying to navigate the system may pop up year round too).
I asked AID spokesperson Heather Haywood about the impact of eliminating the contracts for guide organizations and whether the agency had concerns for the enrollment process going forward. Here’s Haywood:
The IPA guide organizations were vital to our enrollment efforts this year. They worked in the communities. they serviced a population that was the uninsured population. They constantly worked in those communities. Their outreach efforts, their education efforts were vital to consumers getting enrolled. Certainly without guides we are concerned that consumers will be confused. … Now it will have to be a new type of process for where someone would go for consumer assistance. We are a little concerned about how we will move enrollment forward.
We anticipate that agents and brokers will continue to assist consumers throughout the state. We had a large base of those that were licensed this year and they will be more important than ever. We hope that organizations would include the enrollment effort in their scope of work. We hope that hospitals and medical providers will become certified application counselor organizations and allow their staff to assist with enrollment. Certainly it will be challenge but we are hopeful that with non profit organizations, licensed agents and brokers, and navigator grants that we can continue to assist consumers with enrollment in health insurance.