COLUMBIA, SC — Starting in October, you might be able to sign up for health insurance at a folding table outside your grocery store, in the waiting room at your hospital emergency department or at church functions.
The effort to cover nearly a million people in the state – about 750,000 uninsured and others who are underinsured – under the Health Insurance Marketplace will show up in places expected and unexpected.
DECO Recovery Management, one of the three groups who earned federal grants to help people navigate the new system, is borrowing from one of the nation’s most successful sales forces.
“It’s like the Girl Scouts (selling cookies), you go to shopping centers and set up tables to capture people as they come and go,” said DECO vice president Andy Foland.
DECO, a Maryland-based company that provides medical assistance eligibility management for hospitals, plans more conventional enrollment efforts throughout the state at libraries or community centers. It also will partner with The Benefit Bank of South Carolina, which connects state residents with government benefits.
DECO has working relationships with South Carolina hospitals in Aiken, Clarendon and Greenville counties, and it plans to train its employees in those hospitals as navigators. Signing up an uninsured person at a hospital might not cover them on the day they came in, Foland said, but they could be covered for any follow-up visits.
South Carolina declined to set up its own health insurance exchange, but policy options will be available through a federal exchange. Under the Affordable Care Act, everyone will be required to have health insurance in 2014 or pay a penalty. Some people with low incomes will be eligible for tax deductions to pay for the insurance purchased through the exchange.
DECO was awarded a $1.2 million grant to help South Carolinians sign up for what used to be called the insurance exchange and now is referred to as the Health Insurance Marketplace. The Cooperative Ministry ($500,000) and the Beaufort County Black Chamber of Commerce ($234,000) also received navigator grants.
Columbia-based Cooperative Ministry helps connect people living in poverty with aid programs. “A lot of people who can benefit from the Marketplace are our clients already,” said Wanda Pearson, who is coordinating the organization’s navigator program.
Cooperative Ministry is working out arrangements to set up navigators in the Regional Medical Center of Orangeburg and Calhoun Counties and at Palmetto Health facilities. The organization also plans to take advantage of its ongoing work through churches and in the guardian ad litem program.
Navigator training materials gained final approval only last week. Cooperative Ministry has 16 people in the navigator training pipeline, and it plans to have 40 to 45 trained. The organization will partner with the Greater Columbia Community Relations Council and the S.C. Progressive Network to cover eight counties in the center of the state.
The navigators must read and pass 14 online modules, which will take about 20 hours, Pearson said. There are modules on privacy regulations, and all the DECO and Cooperative Ministry navigators must pass background checks.
Several Republican state attorneys general, including South Carolina’s Alan Wilson, sent a letter in August to the U.S. Department of Health and Human Services raising the potential for security concerns by poorly trained or vetted navigators. They also worried about the lack of punishment under the Affordable Care Act for navigators who steal private information.
Foland say the Health Insurance Portability and Accountability Act was passed in 1996 for this sort of situation. It calls for a $25,000 fine for every health privacy violation. For a large, national company such as DECO, a navigator committing privacy violations could have huge ramifications.
“We understand that there is a stewardship involved in this that we take very seriously,” Foland said. “We have a large auditing component, and we have a background in health care.”
Federally qualified health centers in the state – including Eau Claire Cooperative Health Centers in Columbia – were awarded a $2.4 million grant to hire and train workers specifically to help their patients and residents of their surrounding communities through the process. Their workers will be certified application counselors, a designation that requires about five hours of training.
About 50 employees of S.C. Primary Health Care Association centers began preparing for the effort early this year, said association spokeswoman Becky Fowler. About 45 more counselors will be hired and trained by the end of September.
“The health centers will be ready to help their patients and people in their communities, but it might be a slow start,” Fowler said, noting that the actual cost for the insurance programs won’t be available until Oct. 1. “We’ve been doing this sort of thing for a long time.”