Sept. 25—Hospitals are not generally embarking on comprehensive campaigns to enroll beneficiaries in new coverage options available next month, emerging evidence indicates.

Hospital organizations backed enactment of the Affordable Care Act (ACA) primarily because its new insurance coverage options promised to reduce the number of uninsured charity care cases at hospitals. But on the eve of the Oct. 1 launch of enrollment in new health insurance marketplaces, or exchanges, and as 25 states prepare to expand Medicaid programs, few hospitals plan broad coverage pushes in their communities.

In interviews with executives at 150 hospitals in 25 states this past summer, PwC’s Health Research Institute (HRI) found few hospitals had developed comprehensive strategies to identify, educate, and help enroll people in the coming health insurance marketplaces.

"A few health systems have energetically pursued innovative ways to reach the uninsured or underinsured in their communities who will soon be shopping for subsidized coverage via the new online exchanges," stated the Sept. 18 report. "Most, however, said they are in the early stages of adjusting to the ACA landscape and need additional time and staff to understand the ramifications of the new marketplace."

Common Assessment

It is an assessment that fits what other experts have heard from hospitals in the months leading up to the launch of the exchanges.

"We’re hearing that hospitals are focusing their outreach efforts to the uninsured who are frequent users of a hospital’s emergency department," says Chad Mulvany, director of healthcare finance policy, strategy, and development for HFMA. "Beyond efforts to reach out to frequent users, organizations need to think about expanding outreach to community groups that serve populations with high rates of uninsured."

The slow outreach start by hospitals was blamed by the HRI report on several factors, including hospital "fatigue" after fighting recent government payment cuts and the "slow trickle of information from regulators."

Mulvany said HFMA is waiting on clarification from the Centers for Medicare and Medicaid Services (CMS) on whether hospitals can purchase insurance for the uninsured in a similar manner as hospitals do under programs for Medicare beneficiaries.

The lack of a comprehensive enrollment push in new coverage options available under the ACA came despite the urging of hospital advocacy groups and the Obama administration.

Although the Obama administration has not detailed its full outreach budget, health policy experts said the hospital efforts may be critical to ensuring the marketplaces and Medicaid programs reach their enrollment goals of 37 million enrollees by 2020. Additionally, the coverage expansions may be key to hospitals financially surviving the $316 billion in ACA-mandated cuts over the coming 10 years.

Navigators Take the Lead

One enrollment initiative included $67 million in grants for so-called navigators, or entities that can help consumers enroll in health coverage, including seven hospitals and health systems.

Memorial Hospital of Laramie County, Cheyenne, Wyo., will use its $401,281 grant to train eight navigators at its own facility and eight others at different providers elsewhere in the state, said Tracy Brosius, the hospital’s community grants operations manager. Additionally, the navigators plan to provide information and enrollment assistance at meetings organized by the state’s 26 hospitals that aim to enroll Wyoming’s 89,000 uninsured.

The hospitals are coordinating with the navigators in part because they have the training to enroll consumers in the health insurance marketplaces. The marketplace plans will provide the bulk of the coverage expansion in the state, since Wyoming is not expanding Medicaid eligibility.

"The insurance exchanges are a very important piece for our hospitals," Brosius said in an interview.

Wishard-Eskenazi Health in Indianapolis, owned by the Health & Hospital Corporation of Marion County, plans to use its $590,985 navigator grant to hire 10 navigators "to provide information and answer questions on the new marketplace options available," said Todd Harper, public affairs manager at Wishard Health Services.

In addition, Wishard-Eskenazi plans a $200,000 community education and outreach campaign to promote the marketplace. The campaign launches Sept. 30 and will include radio, print, outdoor, bus, online, and poster advertisements.

In contrast, Cincinnati Children's Hospital Medical Center does not plan any enrollment efforts beyond the traditional efforts of its financial counseling office, said Terry Loftus, senior director of public relations at the hospital. The hospital returned a $124,419 navigator grant due to a new Ohio law that excludes any organization or person that receives any payments from a healthcare payer from becoming a navigator.

"We do all we can to assist patient families with their financial and insurance questions and concerns," Loftus said. "None of this changes as a result of our requirement to withdraw as a navigator."


Rich Daly is a senior writer/editor in HFMA's Washington, D.C., office. Follow Rich on Twitter at @rdalyhealthcare.

Publication Date: Wednesday, September 25, 2013