Getting Ready for the Health Insurance Marketplace: Behavioral Health Treatment Providers

"Making sure that individuals with mental health and substance use conditions have health care coverage is a major priority for mental health and substance abuse treatment providers and the Substance Abuse and Mental Health Services Administration (or SAMHSA). The new Health Insurance Marketplace will provide opportunities for people without health insurance to sign up for the first time beginning in October 2013 for coverage beginning as soon as January 1, 2014." "SAMHSA has teamed up with national organizations whose members and affiliates interact with these individuals every day. Our goal is to help you let patients, clients and community members know about their new health insurance options, explain the benefits of enrolling in one of the new plans, provide basic assistance in helping them apply and connect them with trained assisters in their communities as needed. This toolkit will provide you with resources to learn more about health insurance; explain

it to your patients and clients, their families, and community members; and get ready for the Health Insurance Marketplace." “Our organization is participating in one of five different coalitions with which SAMHSA is working. SAMHSA is working closely with the Centers for Medicare and Medicaid Services (CMS) to coordinate and disseminate materials with current information on the Marketplace and on enrollment. We are partnering with many different national provider organizations who have local members or affiliates working together to reach our patients and clients.” "The toolkit is divided into three main sections. First we describe the health care law, how it works, and how it is important for mental health and substance abuse treatment providers and their patients and clients. Then we explain how you can use the Health Insurance Marketplace to get information about

and to apply for health coverage. Finally, we provide a wealth of communication ideas and materials to help you get the word out about who will benefit from this new coverage." "Before we begin, we will provide a brief overview about how to navigate through this information." How Do I Use the Toolkit? "The toolkit has several features that you can use to get the most out of the materials we will share. Besides the main presentation screen, there is a dock of widgets that you can use to directly access the resources described in each slide, move back and forth within the presentation and see a transcript of the narration. You can also share with others through social media channels. The next few slides show how to navigate the toolkit." “This is your presentation screen. You can use the media player in the top right corner shown here to pause and start the program.”

"If you minimize that window, it is available in the dock below. Just click the blue icon to re-open." “To the left of the presentation is one of several resource lists. Here you will find links and documents available as part of this toolkit.” "There are many resources, so only the first resource list is showing now. There are more below in the dock as shown in the green icons pictured with a folder. Click on one of those icons to see additional resources as they are discussed during the session." "To the right of this window is the chapters dialog box. If you want to jump to a particular section, you can click on the title of that section to advance the presentation to that point." "Again, you can minimize this window and open it again from the dock below when you need it." “The other icons available in the dock include this icon that provides instructions on how

to order printed CMS Materials; a transcript of this presentation that is synchronized with the presentation so you can read along; and icons that provide links to make it simple to share this presentation on social media sources.” Understanding How the Health Care Law Helps "Many Americans are currently uninsured or underinsured. When key parts of the Health Care Law, also known as the Affordable Care Act, take effect in January 2014, Americans will gain access to quality health insurance. About 25 million will be newly insured thanks to the health care law. This includes a significant number of individuals with mental or substance use disorders, which studies show make up nearly 25% of all uninsured people." "The Center for Medicare and Medicaid Services, known as CMS, has prepared an overview of the Health Care Law and the Health Insurance Marketplace for partners and stakeholders

that you might find useful. We’ve included it as Resource 1. If you would like to learn about statistics and characteristics of uninsured people with behavioral health conditions in your state or local area, click on Resource 2." "The Health Care Law expands access to health insurance by preventing the most common abuses by health insurance companies. Starting in 2014, the Health Care Law will prohibit health insurers from charging more or denying coverage to people because of pre-existing conditions; a chronic illness or condition; previous treatment for an illness, injury or other condition; or occupation. It will also prohibit denying coverage due to age, charging women more for insurance, or charging individuals higher premiums due to their health status." "The Health Care Law requires most insurance policies in the individual and small group

markets, including all Qualified Health Plans sold through a Marketplace, to offer a comprehensive package of items and services known as “Essential Health Benefits (EHB).” Essential Health Benefits must include items and services in ten specified categories including mental health and substance use disorder services. Resource 3 describes each state’s Essential Health Benefits.” "According to a recent report by HHS’ Office of the Assistant Secretary for Planning and Evaluation (available as Resource 4), there are 47.5 million Americans without health insurance and 25 percent of uninsured adults have a mental health or substance use disorders or both. Additionally, around one-third of those with health coverage through the individual market have no coverage for substance use disorder services, nearly 20 percent lack coverage

for mental health services, and many that do have coverage for these services are not provided comparable benefits with other medical services." "The Affordable Care Act will expand mental health and substance use disorder benefits and parity protections for 62 million Americans. Because of the new Health Care Law, there will be a significant increase in the number of individuals with mental and substance use disorders who are able to access the mental health and substance use services they need. In their report, ASPE estimates that 32.1 million Americans will gain access to coverage that includes mental health and/or substance use disorders that comply with federal parity protection and an additional 30.4 million Americans who currently have some mental health and substance abuse benefits will benefit from federal parity. The Health Care Law will accomplish this by:" "Improving consumer access to mental and substance

use services– New health insurance plans must offer coverage in certain “Essential Health Benefits,” categories which include mental health and substance use disorder services." "Providing comparable coverage- New parity regulations will provide coverage for behavioral health services comparably to other chronic health conditions like diabetes, asthma and hypertension." “Establishing new consumer protections- No individual can be denied coverage because their mental or substance use disorder is deemed a “pre-existing condition.” This is critical for the individuals seeking or in recovery.” Using the Health Insurance Marketplace "The Health Care Law creates a new way to get health insurance: Health Insurance Marketplaces. A Health Insurance Marketplace provides a way for individuals and families to identify the best coverage for their needs, and see if they qualify for a premium discount (also

known as a tax credit) or cost-sharing, or for public coverage options such as Medicaid." "A Marketplace will provide detailed information about health plan prices, benefits, and quality in clear, plain language. This way, individuals will be able to make meaningful comparisons between plans, and they can get a clear picture of what they’ll be paying and what they’ll be getting, before they make a choice." "Individuals will be able to use a single, streamlined application for coverage under a Qualified Health Plan that will determine if they qualify for premium discounts, also known as tax credits, and cost-sharing reductions to lower their out-of-pocket costs in the plan. The application will also show whether they may be eligible for programs such as Medicaid and the Children’s Health Insurance Program (CHIP)." "Qualified Health Plans are offered in four categories, called the bronze, silver, gold,

and platinum levels. All marketplace insurance plan categories offer the same set of essential health benefits. The category you choose affects how much your premium costs each month and what portion of the bill you pay for benefits like prescription medications. The Health Care Law requires that, within a Health Insurance Marketplace, insurers must offer at least one silver and one gold plan. " "The Marketplace application can be filled out online, by phone, by mail or in person" "There are many ways to get help in finding the best health care coverage. Resources are available for people who have questions or need help applying. These include a toll-free call center that’s open 24 hours a day, seven days a week, where individuals can ask a trained customer service representative questions about the Marketplace

and the enrollment process. Customer assistance is provided in more than 150 languages. Other resources that will be available to help people include a website with health plan comparison tools and live chat, and programs like the Navigator program, which provides in-person assistance with the process of enrolling and using health insurance." "Community-based organizations, like ours, and other third party assistors will also play a large role in helping people apply for health insurance coverage. The Health Care Law permits licensed agents and brokers, to help people enroll through the Marketplace, if the state allows it." "It is important to note that some of the assistance resources, such as the Marketplace call centers, websites and Navigators will be unbiased and impartial, while others like the insurers’ own websites and call centers, as well as agents and brokers who contract with them, will not."

"Resource 5 is a fact sheet that provides a brief message directing individuals to the Marketplace Call Center to get help and information regarding the Marketplace. The message includes the Call Center phone number, and is duplicated in 26 different languages to assist with widespread distribution. Resource 6 is a fact sheet that describes other types of consumer enrollment assistance, including Navigators and other trained and certified assistance personnel. As we get closer to October, we will provide you with more detailed information about how this will work and how your organization will be able to help." "The new premium discount (or tax credit) available through the Marketplace is generally available to individuals and families with annual incomes between 100% and 400% of the Federal Poverty Level or $11,490-$45,960 for an individual and $23,550 – $94,200 for

a family of four in 2013 who do not have access to certain other types of minimum essential coverage . People who qualify can use the premium discount to lower their monthly Marketplace health plan premiums starting in 2014. The payment will go directly to the insurance company. The premium discount will make health coverage more affordable." "In addition to the premium discounts, some people will qualify for cost-sharing reductions which apply to deductibles, coinsurance and copayments. An applicant must: 1) have an annual household income that is less than or equal to 250% of the Federal Poverty Level which is $28,725 for an individual and $58,875 for a family of four in 2013; 2) meet the requirements to enroll in a health plan through the Marketplace

and receive the premium discount; and 3) enroll in a silver-level plan through the Marketplace." "Certain American Indians and Alaska Natives who purchase health insurance through the Marketplace do not pay any cost-sharing if their annual income is under 300 percent of the Federal Poverty Level, roughly $34,470 for an individual and $70,650 for a family of four in 2013 (in Alaska, $43,050 for an individual and $88,320 for a family of four)." "There are four basic steps involved in the enrollment process. First, an individual must create a Marketplace account. Second, starting in October, they will complete a Marketplace application. They will then see all plans and programs for which they are eligible, and will find

out if they are eligible for premium discounts or cost-sharing reductions. After comparing plans side-by-side, the third step is to pick a health plan. The fourth and final step in the enrollment process is to enroll in the chosen plan, with coverage starting as early as January 1, 2014." "Resources 7-8 are English and Spanish versions of the above infographic, which can be handed out to patients and clients to inform them of the basic steps for enrolling through the Marketplace. Resources 9-10 are English and Spanish versions of the Marketplace Application Checklist (referenced in the infographic), which provides a short checklist of the information that needs to be gathered to apply for coverage." "The way the Health Insurance Marketplace will be implemented differs by state. States are able to choose whether they want to run their own Marketplaces or have the Federal government run their Marketplace, either with or without some state involvement.

States also may be expanding Medicaid coverage to 133% of the Federal Poverty Level. Every state must offer a comprehensive package of items and services known as Essential Health Benefits. Essential Health Benefits must include items and services within at least 10 categories, including mental health and substance user disorder services. To learn more about the health care law and how the Marketplace will operate in your state, click on Resource 11. You can also click on the map in the slide, which will open a webpage that allows you to click on specific states to learn more." "This toolkit consists of easy to use materials currently available and located in one place for your convenience so you can pick and choose what works best for your organization. This includes articles, fact sheets and brochures, digital and web content (widgets), videos, posters and postcards, events and outreach tools, and a glossary of terms most commonly used. All of these materials are available free of cost for you to download, print, use on

your website or incorporate in your social media strategies such as Facebook and Twitter outreach. Many materials for consumers are available in Spanish along with Korean, Vietnamese, Russian, and many more languages. " "In this next section, we’re going to walk you through what is available. As we progress throughout the materials you will notice a resource number on the lower left of most slides. These correspond to the numbers in the resource lists. At any time you may click on the “Resource List” button to access and download the materials directly. A file will be available with the entire toolkit for you to access and download. These materials also can be found on marketplace.cms.gov." "The toolkit has been prepared just for you and your organization to disseminate materials throughout your community and directly to your patients and clients. You may use any (and all if possible!) of the materials.

The materials have been designed to align with outreach efforts that your organization may be planning or already doing - such as posting updates in monthly e-newsletters or blogs, presenting at national and local conferences, conducting training webinars with your staff to update them on the latest information with health care law, and using educational materials during one-on-one sessions with patients and clients. The materials can be printed for distribution or posted on your website or Facebook sites. " "CMS also will be providing printed copies of some of the materials. If you are interested in being notified when these materials can be ordered, register at the web address provided in the CMS materials ordering widget." “Now let’s see what is available for you to use! Articles are available with content that can be used in your newsletters, website postings

of ‘what’s new’ or for creation of a ‘health care reform corner’ to provide updates." "You may want to include articles in your newsletters or emails about how to prepare for what’s coming in October. This article explains how the Health Insurance Marketplace will help individuals obtain quality and affordable health insurance. It also provides information about the enrollment process, as well as where to go for more information about the Marketplace and enrollment. General and customized versions for special populations are available in both English and Spanish. Click on Resources 12-19 to view the different versions of this article." "This article provides more information about the Health Insurance Marketplace, including how the Marketplace makes it easier to find and obtain insurance and what Marketplace health plan must cover. It directs individuals to healthcare.gov and to the new toll-free Marketplace call center

to obtain more information about how to get insurance through the Marketplace. For the full version of this article, click Resources 20-21; for a shortened version that can be used for drop-ins, click Resources 22-23. Both versions are available in English and Spanish." "These fact sheets and brochures are helpful products that can be used by your staff when working one-on-one with patients and clients and as giveaways at local community events or health fairs. They provide basic information on the benefits of enrollment, what health insurance is, and how this insurance can make health care more affordable. They can be easily downloaded. In the next few slides, we’ll show you what’s available for different groups of individuals and in different languages. Printed copies of several items are available free through CMS. Use the CMS ordering widget in the dock to learn which are available and how to order them. " "This brief brochure explains the benefits of Health Insurance Marketplace and describes what steps consumers can take to prepare before open enrollment begins in October. It is available in many different languages. Also, customized versions have been created for Alaska Natives and American Indians. Click on Resources 24-36 to access the brochures. You may be able to order printed copies of this brochure from CMS. Click on the CMS widget on the dock to learn how." "As a companion piece to the previous brochure, the Value of Health Insurance provides an introduction to what health insurance does, how much it costs and how it helps individuals pay for health care. The brochure is available in numerous languages and as in the earlier brochure, customized for Alaska Natives and American Indians. Click on Resources 37-49 to access these brochures. You also may be able to order printed copies of this brochure from CMS." "These fact sheets provide a quick, easy to understand overview of why different groups of individuals should consider applying for health insurance. Easy to print, they are available in both Spanish and English. They can be put in racks or on desks throughout your offices or handed directly to patients and clients when you meet with them. Click on Resources 50-64 to download these fact sheets." "This next set of brochures provides an overview of the benefits of the Health Care Law in simple language. To download these brochures in English and Spanish, click Resources 65-66. This content is also available in video and PowerPoint training formats so you can do group presentations or just have the video running in your office for patients and clients to view." "As we get closer to October 2013, you may want to begin using these fact sheets. They contain information about how to get ready to enroll in the marketplace, things to think about when choosing a health plan, and key dates to keep in mind. Available in both English and Spanish, these fact sheets will be extremely useful to distribute at community events. Click on Resources 67-72 to view these fact sheets."

"To help explain health care reform and the benefits and options offered through the Health Insurance Marketplace, there are several videos available for you to use with your organization’s staff and directly with your patients and clients. We’ll describe the various types and provide links in the next few slides." "In a series of short testimonial videos of “real life” experiences, people like Jaime describe life without health insurance and discuss their plans to enroll in the new health coverage options available this fall through the Health Insurance Marketplace. Click Resource 73 to watch Jaime talk about how she is looking forward to obtaining health insurance through the Marketplace." "Other real-life testimonials show people from all walks of life describing how different provisions of the Health Care Law will help them access and pay for health care. Click Resource 74 to visit the HealthCare.gov YouTube channel and watch people talk about how they will benefit from the elimination of exclusions based on pre-existing conditions, the elimination of lifetime limits on most benefits, the requirement that prevention services be provided free of charge, and other Health Care Law provisions. There are English and Spanish videos." "The Health Care Law and You video, available in English and Spanish as Resources 75-76, describes how the Health Care Law ends the worst insurance company abuses, makes health care more affordable, strengthens Medicare, and provides better options for coverage. The video runs about 11 minutes and provides a visual, storytelling experience that can be used during one-on-one sessions or to show in a waiting room setting." "This animated video presents information on the Health Insurance Marketplace, including how the Marketplace makes choosing a health insurance plan easier, and what health coverage requirements all plans in the Health Insurance Marketplace must meet. Click Resources 77-78 to view English and Spanish versions of this video." Trainings "As mentioned previously, this PowerPoint presentation contains information similar to that provided in the brochure of the same name. The presentation is customized for several different population groups and is available in both English and Spanish. It describes how the Health Care Law ends the worst insurance company abuses, makes health care more affordable, strengthens Medicare, and provides better options for individuals. You may want to use it when speaking to groups of patients and clients or specialized populations. Click on Resources 79-86 to view the different versions of this PowerPoint presentation." Cards and Posters Cards that provide information and resources can be downloaded for use. These items can be placed in your office for patients and clients to pick up and distributed on tables at community events. Click Resources 87-90 to access English and Spanish versions of these cards.” “This poster offers information on how to get updates about the Health Insurance Marketplace.

It can be hung in offices and in other places where patients and clients congregate. The poster is available in English and Spanish and can be accessed by clicking Resources 91-92.” Digital and Web Content “Widgets can be uploaded to your website or Facebook page that will automatically link your website or Facebook visitors to the Health Insurance Marketplace. We encourage you to contact your webmaster and add this to your website to enable users to access this enrollment information directly. You can reference this tool on your website when working with patients and clients seeking health insurance information as a place to go after meeting with you and if they need more information. Resources 93-94 provide multiple widget options in English and Spanish.” "You can sign up for email and text message updates to receive tips and alerts to stay on track and find affordable health insurance. Updates are available in both English and Spanish. To sign up for these updates, click on Resources 95-96. If appropriate, you may want to offer this link in your email communications." "Some organizations are using social media outlets such as Facebook, blogs, and Twitter to share information with their staff and their patients and clients. HealthCare.gov’s Facebook account contains the latest updates on the health insurance law – you can link to it from your own Facebook page and use motivational messages in your own posts or on your website. Click on Resources 97-98 to access English and Spanish versions of the HealthCare.gov Facebook account. HealthCare.gov also provides blogs about different aspects of the Health Care Law that you might want to feature on your website or in your newsletters to keep your staff and your patients and clients up to date with the latest information. These are available in English and Spanish and may be accessed by clicking Resources 99-100.” "Finally, your organization might want to follow HealthCare.gov’s Twitter account to get ideas for your own tweets or to re-tweet messages that you think might be of interest to your patients and clients. Click Resources 101-102 to view English and Spanish versions of the HealthCare.gov Twitter account. “There are resources to assist with your outreach efforts and to help promote your health coverage-focused events. The Marketplace Multi-Purpose Messages are short messages designed to be used for texts, in “on-hold” telephone scripts, on instructional handouts and for other purposes. They are divided into messages to be used during the summer and messages to be used after open enrollment begins in October. These Multi-Purpose Messages are available in English and Spanish and can be accessed by clicking on Resources 103-104." "Your organization may want to hold educational sessions or conduct community outreach in partnership with other organizations. This Customizable Flyer, available as Resource 105, can be used to promote enrollment events that provide information about the Health Insurance Marketplace and obtaining affordable

health coverage. The Flyer is available in English." “CMS has developed a program to create certified application counselors who can provide information to consumers and help facilitate enrollment in Qualified Health Plans and insurance affordability programs. All state Marketplaces must have a certified application counselor program. These programs assure consumers that they are receiving assistance from trained personnel who are overseen by organizations that are required to protect personally identifiable information. Your organization may want to explore applying for this program to help your patients and clients. Click on Resource 106 to learn more.” "As a quick reference tool, we have included a “glossary of terms” in Resources 107-110. This glossary provides, at a glance, the most commonly used words with health care reform and insurance and a basic definition. It is available in four different languages." “Want to stay informed with new materials being released by CMS for enrollment? Sign up with the CMS listserv for partners and educators at http://marketplace.cms.gov. You will receive email notices about new information and products available with the enrollment rollout. The SAMHSA Enrollment Initiative Coalition will continue to inform you about what’s happening with enrollment in the period leading up to October 1. CMS has provided instructions for how and when to use the Health Marketplace logo with your materials. Resource 111 offers directions for how to insert and size the logo if you are producing any of your own materials.” "Thank you for viewing this training toolkit. The PowerPoint slides from this presentation are available for you to use as Resource 112 on the resource list. Remember that all the resources listed on the slides are available in a single place, which you can access by clicking on Resource 113."