Consumer Assistance: A Guided Tour to Your New Health Care Choices

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By Christine Barber, Community Catalyst

We’ve all heard the recently-passed Affordable Care Act (ACA) provides a lot of new opportunities for improving health care coverage and access – but we also hear most Americans don’t understand what the law actually means for them. At Community Catalyst, we think a major opportunity created by national health reform is improving consumers’ access to clear information about their health care options from trusted sources. Consumer assistance programs (CAPs) are a critical way to make this happen.

The ACA included $30 million in grants for 2010 to fund state CAPs and ombudsman offices (Section 1002) to help real people understand their health care options. And the Department of Health and Human Services Office of Consumer Information and Insurance Oversight (OCIIO) just released the grant guidelines for the program late last week. Overall, we at Community Catalyst applaud the guidelines.

A few highlights:

  • The grant criteria take steps to ensure that the selected programs are independent. In particular, we are happy to see that the guidelines clearly welcome states to contract with non-profit organizations to provide consumer assistance.
  • CAPs must assist people with all types of coverage and provide assistance that is culturally appropriate. In addition, programs must collect data about any problems and questions, which we hope will provide real-time, on-the-ground information about what’s working and what’s not. Regular feedback to state and local policymakers can help improve health reform implementation.
  •  Each state is eligible for one grant award. Therefore, it is important that states know about this grant program, so consumers can get help, no matter their zip code.

Examples like Health Care for All Massachusetts’s Helpline, New York’s Community Health Advocates, and Health Assist Tennessee have shown us that strong consumer assistance programs can mean the difference between a failed attempt and successful reforms. The Helpline in Massachusetts saw their call volume increase by 400 percent after Massachusetts’s health reform law passed. People still call with questions, from enrollment assistance to help with paperwork to navigating the health system.

We hope that states will partner with community-based non-profits wherever possible to help provide consumer assistance. We have seen these models work, and know that they are trusted sources of health care information for communities and for families looking for help in understanding a system that’s about to get bigger and more complex.

The CAPs grants are an important step in making sure the public understands and can navigate the health system as it changes. Grant applications are due September 10, and year-long grants will be awarded to states this October.

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