Often families struggle to understand how their health insurance works and the services it covers. Some Title V programs and family leader organizations provide benefits counseling that helps families understand the full range of health insurance benefits, in- and out-of-network providers, and any additional insurance options available in their state, such as Medicaid buy-in programs or Medicaid waivers. These options can reduce underinsurance by acting as a secondary payer and provide additional benefits that other insurance does not cover, as well as reduce out-of-pocket costs.
The Connecticut Title V/CSHCN program contracts with an organization that does outreach, enrollment, and benefits counseling with families regardless of the type of insurance for which they may be eligible.
The Kentucky Family-to-Family (F2F) Health Information Center Co-Directors are employed by and housed within the Kentucky Commission for Children with Special Health Care Needs, which is the Title V/CSHCN program. The Co-Directors are Certified Application Counselors (CACs). The Commission Social Workers and F2F Co-Directors went through extensive training through the Federal Marketplace to become certified. They had worked since the beginning as “Kynectors” which was achieved through the state system. They provide information in an impartial manner to anyone who seeks their help. This includes assisting consumers with submitting the eligibility application, clarifying the distinctions among health coverage options including qualified health plans (QHPs), and helping consumers make informed decisions during the health coverage selection process. The F2F Co-Directors also help families with CHIP enrollment or a QHP offered through the Marketplace or Benefind (a web-based assistance and support program for Kentuckians) and explain the types of financial assistance for which a family might qualify. The F2F staff also provides comprehensive information about deductibles, coinsurance and copayments, coverage limitations or exclusions, and whether a specific provider or hospital is in the plan’s network.
The Rhode Island Title V/CSHCN program contracts with the Rhode Island Parent Information Network (RIPIN – home of the F2F and RI Family Voices) to solve health coverage problems. RIPIN serves as Rhode Island’s Resource/Call Center for children and youth with special health care needs (CYSHCN). The RIREACH (Rhode Island Insurance Resource, Education, and Assistance Consumer Helpline) Helpline is also part of the Call Center. Trained RIREACH advocates help consumers find and keep insurance, understand and use their health coverage, and respond effectively to benefit denials and other administrative headaches.
Family Connection, the Family-to-Family Health Information Center in South Carolina, contracts with the state Department of Health and Human Services (DHHS) to do outreach on behalf of South Carolina Medicaid and to provide families with the most up-to-date information about eligibility for services. They have two fulltime Healthcare Connections (SC Medicaid) employees who are trained by DHHS to assist families in understanding and responding to questions related to TEFRA, Medicaid waivers, and the new Autism services covered under the South Carolina Medicaid EPSDT benefit. Staff also address private insurance questions and provide information in plain language to help families understand the material. They will also meet one-on-one with families.
RESOURCES RELATED TO BENEFITS COUNSELING
- National Center for Family/Professional Partnerships: Find a Family-to-Family Health Information Center in Your State
- Health Insurance Benefits Advisors: Understanding Responsibilities, Regulations, Restrictions and the Relevance to Implementing the Affordable Care Act, Milken Institute, School of Public Health and Health Services, The George Washington University
- Managed Advocacy: Essential Elements, ABC for Health