Marketplace Health Exchange Outreach and Enrollment Strategies for Arizona’s
Spanish-Speaking Population
Background:
Arizona is ranked the sixth state in the nation with the largest Hispanic population. In
2011, the U.S. Census reported that 30 percent or 1.9 million residents in Arizona were
of Hispanic descent. Of those, 70 percent were native born in the US. Hispanics are
often employed in blue collar jobs including agriculture, construction, service industry
such as hotels, restaurants and other job markets that do not offer health insurance.
According to the U.S. Census Bureau, 2011 American Community Survey approximately
28 percent of Hispanics in Arizona do not have health insurance coverage and
approximately 35 percent have public coverage. Also, according to the 2011 American
Community Survey, 1.2 million Hispanic Arizonans age 5 and over speak Spanish at
home, with an estimated 250,000 speaking English “not well” or “not at all.”
Opportunity:
The Health Insurance Marketplace presents opportunities for comprehensive outreach
and enrollment of the uninsured / underinsured Hispanic and Spanish-speaking
population in Arizona. Strategies should include collaborative approaches that are
targeted, cost effective and have high impact. Efforts should be made to engage
leadership from trusted, faith-based and community-based organizations (CBO) with
roots in community organizing, empowerment, and human development. Arizona CBOs
have a long history of successfully mobilizing the Hispanic population around social, civil
and humanitarian issues including voter registration, KidsCare (S-CHIP) enrollment,
immigration, farm workers’ rights, and Census Enumeration.
Approach:
Based on previous experience with public health campaigns in Arizona, five main
strategies are recommended:
1. Collaborative Partnerships - Utilize existing federally funded programs in Arizona as
a network for broad based information dissemination. Including but not limited to
programs such as Medicaid, Title V Maternal & Child Health Block Grant Programs &
Information line, WIC, Ryan White, Federally Qualified Health Centers, Homeless
Clinics and National Health Service Corp clinic sites.
2. Media Buys - Messaging should be simple, culturally sensitive and address the basic
question of “how will my family and I benefit from the Marketplace Exchange?”
Spanish media buys should include print, radio and television within local and
community-based publications / affiliates.
3. Social Media, Technology and Networks -The use of all social media avenues
(Facebook®, Twitter®, Pinterest®, etc.) can be a quick and cost effective method to
increase knowledge about Marketplace Exchange options, eligibility, sign up
locations, special enrollment events and send enrollment alerts.
4. Engagement – Work with Hispanic Professional Networks and Associations for
webinars and presentations to organizations such as Hispanic Chambers of
Commerce, Hispanic Nurses Association, Arizona Latino Medical Association,
Consulate Offices, Unions. Establish a local advisory board for strategic input.
5. Promotoras/Community Health Workers – Arizona CBOs have a long history of
engaging promotoras within public health. These same partners should be fully
engaged within new efforts an opportunities which are now available through the
Affordable Care Act Patient Navigator funding opportunities.
How the Health Care Law is Making a Difference for the People of Arizona
HHS: http://www.healthcare.gov/law/information-for-you/az.html
Health reform is already making a difference for the people of Arizona by:
Expanding health insurance coverage in every state
The Affordable Care Act will expand health insurance coverage by establishing a Health Insurance
Marketplace in every state and increasing access to the Medicaid program. 947,880 or 18% of Arizona’s
non-elderly residents are uninsured, of whom 866,366 (91%) may qualify for either tax credits to
purchase coverage in the Marketplace or for Medicaid if Arizona participates in the Medicaid expansion.
Establishing the Health Insurance Marketplace.
When key parts of the health care law take effect in 2014, there’ll be a new way for individuals, families
and small businesses to get health insurance. Beginning Oct. 1, 2013, individuals in every state will be
able to shop for health insurance and compare plans through the Marketplace.
Increasing Access to Medicaid.
The Affordable Care Act also fills in gaps in coverage for the poorest Americans by giving states the
option to expand Medicaid to individuals under 65 years of age with income below 133 percent of the
federal poverty level (FPL) (approximately $14,000 for an individual and $29,000 for a family of four)
beginning in January 2014. States will receive 100% federal funding for the first three years to support
this expanded coverage, phasing to 90% federal funding in subsequent years. In addition, Medicaid and
Children's Health Insurance Program (CHIP) eligibility and enrollment will be much simpler and will be
coordinated with the Marketplace.
Providing new coverage options for young adults
Health plans are now required to allow parents to keep their children under age 26 without job-based
coverage on their family coverage, and, thanks to this provision, 3.1 million young people have gained
coverage nationwide. As of December 2011, 69,000 young adults in Arizona gained insurance coverage
as a result of the health care law.
Making prescription drugs affordable for seniors
The Affordable Care Act makes prescription drug coverage (Part D) for people with Medicare more
affordable. It does this by gradually closing the gap in drug coverage known as the "donut hole." Since
the enactment of the law, 6.1 million Americans with Medicare who reached the donut hole have saved
over $5.7 billion on prescription drugs. Nationwide, drug savings of $2.5 billion in 2012 were higher
than the $2.3 billion in savings for 2011. In Arizona, people with Medicare saved over $102.2 million on
prescription drugs since the law’s enactment. In 2012 alone, 65,267 individuals in Arizona saved over
$44.9 million, or an average of $689 per beneficiary. In 2012, people with Medicare in the “donut hole”
received a 50 percent discount on covered brand name drugs and 14 percent discount on generic drugs.
And thanks to the Affordable Care Act, coverage for both brand name and generic drugs will continue to
increase over time until the coverage gap is closed.
Covering preventive services with no deductible or co-pay
The health care law requires many insurance plans to provide coverage without cost sharing to enrollees
for a variety of preventive health services, such as colonoscopy screening for colon cancer, Pap smears
and mammograms for women, well-child visits, and flu shots for all children and adults. The law also
makes proven preventive services free for most people on Medicare.
In 2011 and 2012, 71 million Americans with private health insurance gained preventive service coverage
with no cost-sharing, including 1,406,000 in Arizona. And for policies renewing on or after August 1,
2012, women can now get coverage without cost-sharing of even more preventive services they need.
Approximately 47 million women, including 916,996 in Arizona will now have guaranteed access to
additional preventive services without cost-sharing.
The Affordable Care Act is also removing barriers for people with Medicare. With no deductibles or copays, cost is no longer a barrier for seniors and people with disabilities who want to stay healthy by
detecting and treating health problems early. In 2012 alone, an estimated 34.1 million people with
Medicare benefited from Medicare’s coverage of preventive services with no cost-sharing. In Arizona,
434,397 individuals with traditional Medicare used one or more free preventive service in 2012.
Providing better value for your premium dollar through the 80/20 Rule
Under the new health care law, insurance companies must provide consumers greater value by spending
generally at least 80 percent of premium dollars on health care and quality improvements instead of
overhead, executive salaries or marketing. If they don’t, they must provide consumers a rebate or reduce
premiums. This means that 413,912 Arizona residents with private insurance coverage will benefit from
$27,868,667 in rebates from insurance companies this year, for an average rebate of $118 per family
covered by a policy.
Scrutinizing unreasonable premium increases
In every State and for the first time under Federal law, insurance companies are required to publicly
justify their actions if they want to raise rates by 10 percent or more. Arizona has received $3,000,000
under the new law to help fight unreasonable premium increases.
Removing lifetime limits on health benefits
The law bans insurance companies from imposing lifetime dollar limits on health benefits – freeing
cancer patients and individuals suffering from other chronic diseases from having to worry about going
without treatment because of their lifetime limits. Already, 2,091,000 people in Arizona, including
769,000 women and 570,000 children, are free from worrying about lifetime limits on coverage. The law
also restricts the use of annual limits and bans them completely in 2014.
Creating new coverage options for individuals with pre-existing conditions
As of August 2012, 4,861 previously uninsured residents of Arizona who were locked out of the coverage
system because of a pre-existing condition are now insured through a new Pre-Existing Condition
Insurance Plan that was created under the new health reform law. To learn more about the plan available
in Arizona, check here.
Supporting Arizona’s work on Affordable Insurance Exchanges
Arizona has received $30,877,097 in grants for research, planning, information technology development,
and implementation of Affordable Insurance Exchanges.
•
$999,670 in Planning Grants: This grant provides Arizona the resources needed to conduct the
research and planning necessary to build a better health insurance marketplace and determine how
its exchange will be operated and governed. Learn how the funds are being used in Arizona here.
•
$29,877,427 in Exchange Establishment Grants: These grants are helping States continue their
work to implement key provisions of the Affordable Care Act. Learn how the funds are being used
in Arizona here.
Preventing illness and promoting health (Last Updated: March 15, 2012)
Since 2010, Arizona has received $9,400,000 in grants from the Prevention and Public Health Fund
created by the Affordable Care Act. This new fund was created to support effective policies in Arizona,
its communities, and nationwide so that all Americans can lead longer, more productive lives.
Increasing support for community health centers and primary care clinicians
The Affordable Care Act increases the funding available to community health centers nationwide. In
Arizona, 17 health centers operate 139 sites, providing preventive and primary health care services to
408,737 people. Health Center grantees in Arizona have received $67,579,387 under the Affordable Care
Act to support ongoing health center operations and to establish new health center sites, expand services,
and/or support major capital improvement projects.
As a result of historic investments through the Affordable Care Act and the Recovery Act, the numbers of
clinicians in the National Health Service Corps are at all-time highs with nearly 10,000 Corps clinicians
providing care to more than 10.4 million people who live in rural, urban, and frontier communities. The
National Health Service Corps repays educational loans and provides scholarships to primary care
physicians, dentists, nurse practitioners, physician assistants, behavioral health providers, and other
primary care providers who practice in areas of the country that have too few health care professionals to
serve the people who live there. As of September 30, 2012, there were 274 Corps clinicians providing
primary care services in Arizona compared to 103 in 2008.
Strengthening partnerships with Arizona
The law gives states support for their work to build the health care workforce, crack down on fraud, and
support public health. These partnerships help ensure that health care providers are working where they
are needed most - in both urban and rural areas. They ensure that half a million people annually get access
to HIV/AIDS treatment and access to high quality primary care services.
Examples of Affordable Care Act grants to Arizona not outlined above include:
•
$200,000 to support the National Health Service Corps, by assisting Arizona’s State Loan
Repayment Program in repaying educational loans of health care professionals in return for their
practice in health professional shortage areas.
•
$6,000,000 for health professions workforce demonstration projects, which will help low
income individuals receive training and enter health care professions that face shortages.
•
$3,759,795 for school-based health centers to help clinics expand their capacity to provide
more health care services and modernize their facilities.
•
$287,100 for Family-to-Family Health Information Centers, organizations run by and for
families with children with special health care needs.
•
$26,017,217 for Maternal, Infant, and Early Childhood Home Visiting Programs. These
programs bring health professionals, social workers, or paraprofessionals to meet with at-risk
families in their homes and connect families to the kinds of help that can make a real difference
in a child’s health, development, and ability to learn - such as health care, early education,
parenting skills, child abuse prevention, and nutrition.
Last updated: March 18, 2013
State Exchange Profiles: Arizona
http://kff.org/health-reform/state-profile/state-exchange-profiles-arizona/
Updated as of December 4, 2012
Establishing the Exchange
On November 28, 2012, Governor Jan Brewer (R) informed federal officials that Arizona would default
to a federally-facilitated health insurance exchange.1
Prior to her decision to default, the Governor had established the Office of Health Insurance Exchange to
“organize the health insurance marketplace for easier evaluation by individuals and small businesses to
acquire affordable health insurance.”2 While legislation establishing a state-run health insurance exchange
failed in 2011, the Governor’s Office and legal counsel had researched non-legislative options for
establishing an exchange.3,4
The Arizona Health Insurance Exchange Steering Committee was established to coordinate exchange
planning activities across state agencies and met regularly. Members included Directors and senior staff
from the Office of Health Insurance Exchange, the Department of Insurance, the Arizona Health Care
Cost Containment System, the Department of Economic Security, the Department of Health Services, and
the Director of Health Care Innovation Infrastructure Management. Stakeholder feedback was gathered
through five work groups including, a health plans work group led by the Department of Insurance and
focused on plan management requirements; a health brokers and agents group, concentrating on broker
licensing and compensation; a tribal work group, which was developing outreach and education plans; an
information technology infrastructure work group led by the Arizona Health Care Cost Containment
System; and a legislative work group.5
On April 24, 2010, Arizona enacted a law prohibiting plans in a state exchange from offering abortion
coverage except in cases of life endangerment or severe health impairment of the pregnant woman.6
Contracting with Plans: Prior to defaulting to a federal exchange, the Department of Insurance took the
lead in researching and developing the plan management functions for the exchange, including
certification of qualified health plans, quality rating systems, risk adjustment and transitional reinsurance.
Their work was informed by the health plans work group meetings. Arizona expressed support for
adopting a market facilitator approach, whereby the exchange would contract with all qualified health
plans meeting certain criteria.7,8 In February 2012, the state released a Request for Proposals soliciting
subcontractor assistance with exchange management functions including, plan management, plan
selection, data management and reporting, consumer support services, and financial management.9
Information Technology (IT): Arizona had planned to design and build the individual and small business
exchange components, upgrade its Medicaid eligibility systems, and integrate everything into one
seamless system. Arizona submitted an Advanced Planning Document which was accepted by CMS,
indicating the state intends to make major Medicaid eligibility systems upgrades. In 2011, the state
released a Request for Information to identify viable available or proposed solutions for aligning its
Medicaid and Children’s Health Insurance Program (CHIP) enrollment and eligibility systems with an
exchange as well as estimated pricing.10 Arizona also participated in the “Enroll UX 2014” project, which
is a public-private partnership creating design standards for exchanges that all states can use.11
Essential Health Benefits (EHB): The Affordable Care Act requires that all non-grandfathered individual
and small-group plans sold in a state, including those offered through the Exchange, cover certain defined
health benefits. The Department of Insurance examined the state’s EHB options and solicited
subcontractors to complete an analysis on options for the final benchmark plan.12 The state selected the
State Employee Benefit- United Healthcare EPO with pediatric and vision coverage supplemented by the
FEDVIP plans as the benchmark package.13
Exchange Funding
In September 2010, the Arizona Governor’s Office of Economic Recovery received a federal Exchange
Planning grant of $1 million. In November 2011, the Governor’s Office was awarded a $29.8 million
Level One Establishment grant to further secure IT infrastructure and assist in finalizing plan
management functions for the exchange.14
Next Steps
The federal government will assume full responsibility for running a health insurance exchange in
Arizona beginning in 2014.
For more information on Arizona’s health insurance exchange planning, visit:
http://www.azgovernor.gov/hix/
1. Governor Jan Brewer letter to CCIIO. November 28,
2012.http://azgovernor.gov/dms/upload/PR_112812_CohenLetter.pdf
2. Office of Health Insurance Exchange: http://www.azgovernor.gov/hix/index.asp (Accessed February
16, 2012)
3. House Bill 2783. Arizona Health Insurance Exchange. Introduced February 8,
2012.http://www.azleg.gov/legtext/50leg/2r/bills/hb2783p.pdf
4. Arizona Exchange Planning Grant Final Report. January 5,
2012.http://www.azgovernor.gov/hix/documents/QuickLinks/ExchangePlanningGrantReportFinal.pdf
5. Arizona Exchange Planning Grant 4th Quarterly Report. October 15,
2011.http://www.azgovernor.gov/hix/documents/QuickLinks/ExchangePlanningGrantReportQ4.pdf
6. Senate Bill 1305. April 24, 2010. http://www.azleg.gov/legtext/49leg/2r/bills/sb1305h.pdf
7. Health Insurance Exchange and ACA Update. August 23, 2012. Arizona Health Care Cost
Containment System. http://www.azdhs.gov/diro/documents/forums/2012/health-insurance-exchange-
affordable-care-act.pdf
8. Arizona’s Options related to risk adjustment, transitional reinsurance and risk corridors (ACA
requirements). Arizona Department of Insurance. April 12, 2012.
Mercer.http://www.azgovernor.gov/hix/documents/Grants/AZOptionsRiskAdjTransReinsuranceRiskCorr
.pdf
9. State of Arizona Health Insurance Exchange. Notice of Request for Proposal. February 2,
2012.http://www.azahcccs.gov/commercial/Downloads/Solicitations/YH12_0023/AZ_HIX_RFPSoliticati
onNoYH12-0023.pdf
10. Request For Information Health Insurance Exchange Commercial Component/Interface. Issued
8/15/2011. http://www.azahcccs.gov/commercial/Downloads/Solicitations/Open/RFIs/YH120013/YH12-0013.pdf
11. Enroll America, UX 2014. http://www.ux2014.org/
12. Essential Health Benefits. Arizona Department of Insurance. June 1, 2012.
Mercer.http://www.azgovernor.gov/hix/documents/Grants/EHBReport.pdf
13. State of Arizona. Letter to CCIIO from Jan Brewer. September 28,
2012.http://www.statereforum.org/sites/default/files/az_letter_to_hhs_9-28-12.pdf
14. Level One Establishment grant application. State of Arizona Governor’s Office. September 30,
2011.http://www.azgovernor.gov/hix/documents/Grants/L1EstGrantApp_SubmittedNOTApproved.pdf