Facilitating the Planning Process and Evaluating Success for the Implementation of NH’s Insurance Marketplace

Dates: 2013-2014

State: New Hampshire

Client(s): HNH Foundation

Service: Health Care & Public Health Planning

Technical Expertise: Health Care Reform

Website: http://nhaca.jsi.com/webmap.html

The Affordable Care Act (ACA) established health insurance marketplaces in all fifty states as a venue for consumers to shop for and purchase health insurance. NH House Bill 601 prohibited the NH Department of Insurance from accepting federal funding to begin planning the NH Insurance Marketplace. As a result, there was little effort to coordinate outreach and education efforts to link people in need of insurance to the marketplace. In September 2013, Healthy New Hampshire (HNH) Foundation contracted with JSI to facilitate an effort to coordinate the consumer assistance efforts in the state in advance of the October 1, 2013, start date for the marketplace.

JSI provided research and facilitation in support of a fast-paced planning process with key partners involved in implementing the NH Insurance Marketplace including the NH Health Plan, NH Voices for Health, NH DHHS, NH Department of Insurance, and both Navigator organizations (Bi-State Primary Care Association and Planned Parenthood of Northern New England). The “state of the state” was documented to identify current gaps in consumer assistance. The work performed included 1) an analysis of where the populations eligible for new coverage exist in NH, and key demographic statistics of those eligible populations; 2) documentation of existing efforts in NH to inform consumers about the marketplace; and 3) identification of evidence-based and promising strategies for consumer assistance as learned from other states and at the federal level. JSI conducted a comprehensive evaluation of the effectiveness of implementation efforts during the first quarter to support future outreach and education planning efforts.

JSI partnered with the Urban Institute, using their ACS-enabled Health Insurance Policy Simulation Model (ACS-HIPSM) to model the uninsured population in the state. The model uses the ACS Public Use Microdata Sample (PUMS), which provides access to a sample of the individual responses to the ACS questions within each of New Hampshire’s 11 Public Use Microdata Areas (PUMAs). The model produced detailed estimates of the characteristics of the following populations: 1) uninsured eligible for Medicaid/CHIP; 2) uninsured eligible for subsidized exchange coverage; 3) uninsured in families with a small firm worker eligible for employer-sponsored insurance (ESI), excluding the previous two categories; and 4) current uninsured not in any of previous categories.

According to the ACS-HIPSM model, an estimated 146,000 uninsured, non-elderly individuals were identified.

Second, JSI conducted an inventory of assistance resources in the state. The geographic location of assisters and the assumptions for estimating demand were used to map a comparison of supply and demand for in-person assistance. Based on this analysis, new assister resources were located in communities where there was greatest need. JSI developed an interactive on-line tool to support assister organizations in targeting eligible populations for outreach and education.

Third, JSI reviewed the national literature to identify best and promising practices for both the general public and specific populations: young adults (18-34), middle-age adults (34-49), older adults (50-64), people newly eligible for Medicaid, and small business employers and their employees. For each population and at the general level, evidence-based practices were identified for effective messaging, trusted messengers, potential partners, and promising strategies for outreach and education.

JSI prepared a comprehensive evaluation of the activities conducted during the first quarter of the implementation of the NH Insurance Marketeplace. Despite a slow start, technical difficulties and the late decision not to expand Medicaid eligibility, NH was one of the ten states that met the Center for Medicare and Medicaid (CMS) enrollments projected for the period.


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