Navigator Organizations to Deliver Outreach and Enrollment For

REQUEST FOR QUALIFICATIONS

Navigator Organizations to deliver outreach and enrollment for

Qualified Health Plan and Washington Apple Health participants

Contract October 1, 2015 – September 30, 2016

Goal and Purpose of the Navigator Program

With the passage of the Patient Protection and Affordable Care Act in 2010, the In-Person Assister program was established with federal grant dollars. The purpose of this program was to create an access point for people to sign up for health insurance on the new insurance marketplace.As the In-Person Assister program enters its third year, it will be transitioning along with the State Health Insurance Marketplace to a new funding stream. Now known as the Navigator Program, the goals of the program remain largely unchanged. However, the program must work to centrally address the needs of the State Marketplace (Health Benefit Exchange) and its established mandate to be self-sustaining by January 1, 2015. This means that the Navigator program will need to renew its commitment to actively engage with and serve theQualified Health Plan eligible population, while also remaining dedicated to creating community access for disadvantaged and at risk populations that are Washington Apple Health eligible.

Healthplanfinder

Healthplanfinder is an online eligibility determination and plan selection tool used to determine eligibility for health insurance plans being marketed for sale through Healthplanfinder. It is also used to determine eligibility for no cost insurance being offered through Health Care Authority to residents who meet the specific program requirements primarily determined by but not limited to income.All Navigators are required to work in Healthplanfinder to meet the requirements of their role.

Navigator Program Expectations

Certification Process– All Navigators will need to be certified through the Washington State Health Benefit Exchange. This means that they will need to pass testing and a background check, along with submitting all relevant formsthat the Exchange requires for a Navigator to remain active in Healthplanfinder. A Continuing Education (CE) model will replace the current education and training model used for In Person Assisters. The CE model works to meet training requirements by breaking the training down into more digestible components that allow for more flexibility in the time requirements to take and test on online learning. The CE model will better meet the varying training needs of new and continuing Navigators, while reducing redundancies. Individualized dashboards will give Navigators and Organizations easy access to materials, enrollment tracking tools and Healthplanfinder updates. A new Navigator has different training needs than a continuing Navigator for this reason the flexibility of a CE model will better meet this need and reduce redundancies in the current training model. The new CE model will allow Navigators to access training through an individualized dashboard. This secure online tool will provide Navigators access to testing and course materials. This system will allow Navigators to keep their certifications in Healthplanfinder current without the daylong or multi-day time commitments. Dashboards load required material based on training needs.

Enrollment – Since Open Enrollment is only 12 weeks of the yearlong contract that represents both Qualified Health Plans (QHP) and Washington Apple Health (WAH) enrollment, subcontractors will be expected to dedicate themselves almost exclusively to QHP enrollment from November 1st – January 31st. The Health Care Authority will periodically supply lists of people who are losing WAH coverage because they no longer meet the income qualifications for these programs. Subcontractors will be expected to use these lists to reach out and sign these people up in QHPs so that they can have a smooth transition of coverage. WAH and QHP have county-specific targets that must be met as part of contract fulfillment.

QHP: individuals who are eligible for a Qualified Health Plan are legally present in the United States and have incomes between 100%-400% of the federal poverty level (FPL). Some exemptions apply to this rule. Immigrants that have legal presence but are below 100% FPL are eligible for tax credits. Most people who will be determined eligible for a QHP will be above 138% FPL because Washington State has expanded Medicaid coverage to adults who are at or under 138% if the FPL.

WAH: Adults who are at or below 138% FPL can be determined eligible for WAH if they are legally present, have meet the five year bar (for immigrants eligibility if it applies). Children under 312% FPL are covered either through WAH or CHIP with cost sharing. WAH also covers children and expecting mothers who meet the FPL requirement regardless of immigration status.

Consumer Education - Part of the expectation of the enrollment process is to establish an ongoing consumer/client relationship that will help the people that you serve better understand how to use their health insurance and what steps they can take to best use the access to care they now have. Monthly outreach to Qualified Health Plan recipients to help improve Health Literacy and Health Insurance Literacy (HIL) will be a required component of this contract. The content will be developed by the Washington State Health Benefit Exchange. Outreach is designed around contacting the client at least once a month. The method that is used to communicate with individuals has not been limited to a specific avenue. Subcontractors may choose to use any outreach tools they desire including but not limited to: automatic calling services, email, phone calls, or other communication to share Health Insurance Literacy with clients. This type of consumer outreach can be included in monthly reporting, however outreach cannot be limited to Health Insurance Literacy outreach to QHP or WAH clients.Mandatory reporting around this client outreach will be required. If the subcontractor’s reporting mechanisms are deemed insufficient, the Lead Organization (CHOICE) may request additional documentation of the Health Insurance Literacy outreach activities.

Outreach Activities – Doing outreach in the community is a requirement of being a Navigator Organization. Outreach does not have to be a complex endeavor. Putting up flyers in community space or talking with local business owners about how they can refer non-insurance eligible employees could be an outreach activity. Other examples of outreach activities include, but are not limited to: social media engagement, staffing at events such as health fairs, enrollment clinics, mail/email campaigns, community events to raise awareness, presentations, community Q&A forums, engaging with community partners etc.

All community events should be centered around two primary focuses:

1)Driving referrals either by doing on-site enrolment or creating appointments with clients (follow-up around appointments is critical to get people in the door)

2)Creating health literacy so that your community views you as a resource for health insurance information.

However, simply having your doors open for business is not considered an outreach activity.

Reporting – The Washington Health Benefit Exchange is creating a statewide platform (dashboard) for Navigators to manage enrollment reporting and new Continuing Education requirements. This platform will enable Navigators to directly capture enrollment data.This process helps to capture enrollments and will be used to validate against data in Healthplanfinder. The role of the Navigator in this reporting process supports accurate reporting, and payment of performance-based metrics around enrollment goals. Monthly reporting of outreach will also be a requirement. This includes but is not limited to reporting the previous months outreach activities, planned future outreach activities, and reporting the number of QHP enrollees contacted to provide ongoing health insurance literacy information.

Qualified Health Plan Enrollment

Resources Commitment to QHPs:

Performing outreach and enrollment to QHP populations is critical to a successful open enrollment. As the Washington State Health Benefit Exchange program transitions away from being a federal grant based In-Person Assister program, it is critical that the mission and focus of the now named Navigator program mirrors the sustainability mandate of the Health Benefit Exchange. The Health Benefit Exchange has set a goal of balanced outreach and engagement with a goal of enrollments split 50% QHP and 50% WAH populations. For this reason, the 12 weeks of Open Enrollment will require that Navigator Organizations focus almost exclusively on QHPs in order to balance enrollment. Renewal of QHPs will count towards the established total enrollment targets.

The Navigator Program is still highly committed to reaching, engaging, and enrolling Washington Apple Health populations.

Compensation – Subcontractors will be paid monthly. Payment will consist of two components:

1)75% base payment will be awarded contingent on meeting all reporting requirements to the Health Benefit Exchange and the Lead Organization.

2)25% will be awarded monthly for meeting both the WAH and QHP enrollment targets as agreed to during any possible contracting process. Compensation target must be 50% QHP and 50% WAH. Any proposal that is considered will assume QHP enrollments, if a contract is awarded, will be equal to or greater than WAH enrollments. New and renewal of QHP enrollments will count towards QHP targets. Only new WAH enrollments will count towards enrollment targets. Payment will be authorized in the month following that of the work done and is contingent upon the subcontractor meeting all reporting requirements for that pay period. Compensation for QHP enrollments is contingent upon carrier receiving first month’s payment from the consumer.

*Payment of performance based compensation will not begin until February. Please see below for example of how compensation for enrollments will be awarded.

Enrollment Targets

Enrollment Target

County

QHP

WAH

County

QHP

WAH

Clallam

270

Mason

315

Gray Harbor

385

Pacific

Jefferson

110

Thurston

937

Lewis

322

TOTAL

2,411

*Qualified Health Plan enrollment targets have been set by the Washington State Health Benefit Exchange using data gathered by the Office of Financial Management. The QHP total target enrollment represents 20% of the total number of QHPs believed to be available in any one county.

Navigator Organization Profile

Please note that failure to provide a completed RFQ on time and/or answering questionsincompletely may result in your RFQ being dropped from consideration.Please submit your application in PDF form.

Name of Organization:
Contact Person
(Name, Phone, Email)
Counties/Areas Served
Purpose/Mission
How long has organization operated in proposed service area?
Organization’s Primary Services
Target Population(s)*
How can you reach QHP target populations with language and cultural barriers?
How can you reach QHP target populations with low wages?
How can you reach QHP target populations with disabilities?
FTEs to be Assigned to Navigator Work (# of certified Navigator /# non-certified navigator staff/managers)
Language certifications
(other than English)
Other expertise or special competencies
Navigator Organization availability (days/hours)
Do you have weekend and evening availability to support enrollment events?
Enrollment target*
Qualified Health Plan
(by county)50% / Clallam:
Grays Harbor:
Jefferson: / Lewis:
Mason: / Pacific:
Thurston:
Enrollment target*
Washington Apple Health
(by county)50% / Clallam:
Grays Harbor:
Jefferson: / Lewis:
Mason: / Pacific:
Thurston:

* Please indicate how many currently uninsured individuals you believe your organization will be able to identify and enroll, and in which county or counties. Please refer to the table to determine the total enrollment your organization would like to complete. Enrollment targets must be balanced. (50/50)

Required for Navigator Profile for the Lead Organization RFP:

Other Funding Streams:

Funding received from other public sources to perform Navigator-related work / Type of Funding / Public Source (federal/state/county/city or other) / Amount received per year / Purpose of funding

Navigator Profile:

Office/Clinic Location (City) / # of Navigators / # Bi-lingual Staff / Languages spoken / Enrollment target / Other specialized skills/knowledge / Days available for service / Hours available

Community Outreach Plan

Community outreach and awareness activities may include but are not limited to educational presentations, booths or presence at community events, targeted group presentations, kiosks, dissemination of information and material at various locations, etc.

Estimate the outreach activities to be held in the service area throughout the contract term. Include the following: (add rows as necessary)

Qualified Health Plans: During Open Enrollment the Navigator Organization will be expected to focus almost exclusively on helping people who are signing up for QHP’s. Please explain how you are situated to reach these populations or how you will perform outreach that can engage this population.Outreach activities are intended to be targeted to specific groups or populations and occur in a community-based location where the target group typically gathers. Application and enrollment assistance is usually available from a certified Navigator as a part of outreach.

Month / Population/group targeted / Estimated # of Events/Activities / Types of events planned
September 2015
(Example) / QHP (Small Business) / 8 / Distribute QHP materials to local businesses, hold Q&A info sessions, schedule and hold an enrollment clinic at targeted business.
October 2015
November 2015
December 2015
January 2016
February 2016
March 2016
April 2016
May 2016
June 2016
July 2016
August 2016
September 2016

Navigator Organization Criteria

Please briefly answer the following questions:

Provide background information about the organization.

Describe how the organization is well-established in the community, has positive regard among community members and is trusted by community members.

Describe how the organization has demonstrated existing relationships, or the ability to establish relationships, with potential users of Healthplanfinder.

Describe how the organization has access to and experience working with QHP populations. (Adults over 138% FPL or children over 312% FPL.)

How would your organization communicate information quickly and broadly to community members?Explain.

How would your organization conduct public education events or activities related to health care, health literacy, health care services or programs and/or health insurance plans? Explain.

Please state the Program Manager’s name and qualifications to run the program in your organization.

Please list program staff, navigators, and program manager names, titles, responsibilities, and FTE for program.

Employee Name / Title / Responsibilities / FTE
Elizabeth Weisdepp
(example) / Navigator / Enroll clients into QHP’s, outreach, and enrollment reporting / 1.0

Describe the organization’s staff have experience delivering effective services to (Explain):

Qualified Health Plan eligible populations
Hard to reach populations (139%-250%FPL)
Individuals with limited English proficiency
Individuals with disabilities

Questions / YES / NO / (If No) Explain
Organization has the technology and services needed to complete application enrollment activities in Washington Healthplanfinder.
The Organization is comfortable working with insurance and is comfortable talking with clients about complex concepts like formularies to answer client questions about QHPs.
Organization currently determines consumers’ eligibility and/or completes enrollment for Qualified Health Plans.
Organization has experience communicating complex programs, terms, and languages suited to target populations.
Organization staff is experienced and skilled using computer applications.
Staff has expertise in health insurance or health coverage programs.
Organization can adjust staffing level up and down to meet peak demand during open enrollment.
Certification of General Liability Insurance

Please disclose any conflict of interest your organization may have in completing this work.

Submission

Email a completed PDF request for qualifications to by August 13th 2015 by 5:00pm for consideration. All RFQ’s will be considered before any offers are made. Notifications will be made the week of August 17th, 2015. Potential contract duration is October 1, 2015 – September 2016.

If you have any questions please call James Brackett at 360.539.7576 x 104.

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CHOICE Regional Health Network

1217 4th Avenue East, Suite 200

Olympia WA, 98506