Finally Not Just Along for the Ride: New Grants Put Health Care Consumers in the Driver’s Seat

More funding is available for health care consumers who need help navigating the world of health care and insurance.  And honestly, who doesn’t need a little help with that? CMS has come to the rescue with a new round of funding to support state-based Consumer Assistance Programs that help consumers who have questions or concerns regarding their health insurance. Hundreds of thousands of consumers have already been helped by state consumer assistance programs funded by the Affordable Care Act and now the reach is even bigger.

HHS Secretary Kathleen Sebelius made the funding announcement, commenting that “the health care law is putting consumers, not insurance companies, in control of their health care… Consumer assistance programs provide a valuable tool for consumers who have questions or concerns about their health insurance.”

State agencies or local non-profits contracted by a state are eligible to become Consumer Assistance Program grantees, so that they may provide a wide variety of services for consumers. These agencies can help consumers find health coverage and file appeals against health plans. If an individual is having trouble with their insurance or is unsure about their rights, these Consumer Assistance Programs can educate them to take action.

In 2010, as a result of the Affordable Care Act (P.L. 111-148), almost $30 million in Consumer Assistance Program (CAP) grants was distributed among various states and Territories to provide a means to establish or enhance activities that will educate consumers about their health coverage options and to ensure consumer access to their rights under state and federal law, including the new rights provided under the Affordable Care Act.

CMS has collected data that demonstrates just how important these Consumer Assistance Programs are, not to mention the support system they have created for Americans in 38 States and territories across the country. HHS pointed out that, for example, as of October 14, 2011, Consumer Assistance Programs provided direct assistance to 210,000 consumers and assisted 25,000 consumers in filing appeals.

Thanks to the work created from the funding for these Consumer Assistance Program grants, HHS noted that consumers in 38 States and territories have consumer advocates to “serve and empower them in the private marketplace for the first time,” and “vulnerable and underserved populations in 26 states now have access to assistance not previously available.” Additionally, in some states, Consumer Assistance Programs have reached communities in rural and frontier areas that previously have not been served by health insurance consumer assistance advocates.

And believe it or not, there is money left over. HHS has indicated that approximately $2.5 million in grant funds were not spent during the first grant cycle, and these funds are now being made available again through a new limited-competition funding opportunity announcement. The funds will be made available to the 38 grantees that successfully completed the first Consumer Assistance Program grant cycle to strengthen their ability to help consumers with questions or concerns regarding their health insurance.

HHS notes that, with these funds, states and territories will have the financial support to continue expanding consumer assistance efforts, including: helping consumers enroll in health coverage, including group health plans and health insurance coverage; helping consumers file complaints and appeals against health plans; educating consumers about their rights and empowering them to take action; and tracking consumer complaints to help identify problems and strengthen enforcement.

So that they may continue to improve customer service, the Consumer Assistance Programs are required to track consumer complaints to help identify where problems exist and what can be done to develop workable solutions.  A website is available for consumers to find just what programs are available in their area.