Profiles in Exchanges—Part Three: Arkansas

States have two more months to decide whether they might want to host a partnership exchange in 2014. In the final installment of the “Profiles in Exchanges” series, we feature Cynthia Crone and learn how Arkansas is approaching these decisions as the state works toward a consumer-oriented exchange. Crone is Director of the Health Benefits Exchange Partnership Division within the Arkansas Insurance Department. Her state has been particularly focused on its role inconsumer assistance, so read on for lots of ideas on this front.
What considerations have been made specifically to try to facilitate application and enrollment processes for exchange consumers?
Cynthia: At this point, Arkansas is planning a partnership exchange. This means the federal portal will be used for federal tax credit and Arkansas Medicaid eligibility determinations, for enrollment in qualified health plans, and that our Medicaid program must engage with the federal portal to develop a seamless process for enrolling Medicaid eligible consumers. We’re really planning to allow consumers to use “two right doors” when they seek health insurance coverage–either through the federal exchange portal or through Arkansas’s Medicaid eligibility system–and permit them to move between systems without difficulty. Our goal is to make the transition between the federal portal and state Medicaid system as smooth as possible for consumers.
Are you planning any consumer assistance strategies that are innovative or unique to Arkansas?
Cynthia: As a partnership exchange, Arkansas won’t run its own navigator program. However, we’re working on strategies to educate and help our consumers understand the enrollment process, including an in-person assister (IPA) program that will be closely coordinated with the federal navigator program. We estimate 210,000 Arkansas residents will enroll in private health plans through the exchange in 2014. The in-person assister program will include over 500 well-trained “guides” who will help with the outreach, education and enrollment process. We estimate the guides will spend approximately 2.25 hours per enrollee unit [an individual or family]. We want this program to be population- and environment-specific so that it presents information in the most understandable way possible for each consumer using the exchange. For example, our state has a large Marshallese [from the Marshall Islands] community in Northwest Arkansas; we are working with this community to ensure they are provided with the information and assistance necessary to successfully enroll in quality health plans that best meet their needs.
A major barrier to consumer enrollment in Arkansas is limited broadband access and Internet familiarity. We can alleviate some of these barriers by making the application process available by mail, phone, and in person, in addition to the web portal. Our statewide education and in-person assister program will play a pivotal role in addressing this issue and we aim to reach 60 percent of exchange- eligible consumers face-to-face to help facilitate enrollment.
We also have state partners engaged in this effort. Hometown Health, an established program through the Department of Health, is working with us to launch an exchange education program in five regions across the state before our in-person assister program begins.
Has Arkansas made any strategic decisions related to the regulation of insurance plans in your exchange? How might these decisions affect Arkansas exchange consumers?
Cynthia: Arkansas has elected to conduct plan management functions in the exchange, and our advisory committees are currently working to develop our QHP certification process. We do not plan to utilize competitive bidding in the plan certification process, and our exchange will not impose standards above the federal floor in the first year of operation. However, we may explore imposing higher network adequacy and quality improvement standards in the future.
We would also consider limiting the number of plans offered by a carrier in each tier, and we feel this approach will prevent the number of plan choices from overwhelming consumers.
What important lessons have you learned about building an exchange? What advice might you offer your fellow exchange leaders?
Cynthia: It’s critical to have a broad and genuinely inclusive stakeholder involvement plan in place, and you have to take it seriously. This will allow you to develop trust among stakeholders and identify leaders from different groups over time. Be persistent in developing relationships and stay on message with your stakeholders and legislators.
We’ve also found that it’s incredibly useful to meet frequently with our multiple project contractors. Our project management vendor holds bi-weekly meetings with all staff and contractors to keep everyone updated on specific developments. This has helped to keep us informed on overall progress and identify newly emerging risks as well.
This blog post series is made possible through generous support from the Nathan Cummings Foundation.