Health Insurance Enrollment and Navigation
Across the US, health insurance exchanges are being organized by states and the federal government under the provisions of the Patient Protection and Affordable Care Act (also known as Obamacare).
Minnesota’s home-grown exchange is called MNsure. While often described as an online marketplace for affordable, quality coverage, it’s really so much more! MNsure includes a broad network of consumer assistance programs where trained people are ready to help you understand your options. CHWs and others trained and certified as consumer application assistance staff will help you understand your coverage options and walk through the online enrollment process. Their priority is to point you to the information you need to make the best decision for you and any family members.
You can enroll in MNsure during open enrollment periods, which are set time periods each year when consumers can purchase (or renew) qualified health plans offered through the MNsure marketplace. The 2016 open enrollment period is scheduled to begin November 1, 2015, and end on January 31, 2016.
For more information visit the MNsure website.
CHW positions and programs are supported through a variety of ways:
- Government grants and contracts
- Foundation grants
- General operating dollars
In addition to these funding sources, Minnesota is one of two states with Medicaid coverage for specific CHW services. Alaska is the other state with Medicaid payment for its Community Health Aid role which is a title under the broad CHW umbrella.
Minnesota Health Care Programs (MHCP) including Medical Assistance (Medicaid) and MinnesotaCare cover diagnostic-specific health education services provided face-to-face to individuals and groups by enrolled CHW certificate holders under the clinical supervision of authorized provider types. This includes both fee-for-service as well as enrollees of managed care plans.
For CHW services to qualify for coverage, CHW supervision may be provided by physicians, advance practice nurses, dentists, certified public health nurses working in a unit of government and mental health professionals who are enrolled as Minnesota Health Care Program providers.
State legislation was introduced and passed in 2007 and then subsequently amended to include additional provider types as authorized CHW supervisors. The Minnesota Department of Services successfully sought federal approval for MHCP payment for CHW services through its state plan.
Our state’s standardized CHW curriculum was a key factor in the success of this measure. Another was effective advocacy efforts by CHWs and allies. In addition, the legislation was determined to be budget neutral.
To learn more about the statute and coverage guidelines, including how to enroll, read more below.
Minnesota Statutes, section 256B.0625 attachment
Minnesota Department of Human Services CHW Coverage Policy attachment
Payment reform is already underway with the roll-out of accountable care organizations and patient-centered medical homes known as health care homes in Minnesota. In order to better align incentives, global payment approaches based on value and performance will replace the current volume-based methods. Aligning payment with outcomes will favor the integration of CHW strategies which are an integral part of the solution to the major challenges facing our health care system.
Another funding source for CHW services is community benefit programs. Nonprofit hospitals are required to provide benefits to the communities they serve in order to maintain their tax-exempt status. New community benefit requirements under the Patient Protection and Affordable Care Act include community health needs assessments and improvement plans.
Community benefits go beyond health to include building community capacity and engagement. Hospital community benefit support for upstream CHW strategies will build individual and community capacity for better health, leading to stronger, healthier communities.
Robert Wood Johnson Foundation Issue Brief: What’s new with community benefit? Oct 2012.
CHWs Help Uninsured
How do CHWs help connect uninsured people to coverage? See how CHWs made a difference in Massachusetts where they helped thousands of uninsured people get coverage under that state’s health reform program. Read more about this program.