Introduction to Effective Health Insurance Eligibility Determination Strategies

Selecting affordable health insurance coverage that meets clients’ clinical needs is critical to ensure sustained positive health outcomes. Access to health insurance for low-income individuals has been expanded through implementation of the Patient Protection and Affordable Care Act (ACA). Medical case managers (MCM) and other HIV program staff increasingly must help their clients understand their health insurance options. Considerable attention has been given to educating HIV program staff about ACA Qualified Health Plans (QHPs) and expanded Medicaid enrollment options. It is important for HIV program staff, however, to educate clients about other health insurance options through employers, spousal coverage, disability programs, Veterans Administration, and other sources. This webinar offers practical, effective strategies for assessing clients’ health insurance eligibility, helping clients find optimal coverage, using electronic verification systems to identify existing insurance enrollment, and applying Ryan White HIV/AIDS Program (RWHAP) payer of last resort policies. Best practices used by RWHAP-funded grantees and providers are discussed.

Learning Objectives

1) Enhance the foundational knowledge of HIV program staff about the key factors to consider in helping clients to assess the health insurance options.

2) Train HIV program staff in basic processes for assessing eligibility for commercial and publicly funded health insurance plans.

3) Increase the capacity of HIV program staff to apply key eligibility determination techniques. 4) Increase the awareness of HIV program staff about RWHAP payer of last resort policies related to the vigorous pursuit of insurance enrollment 5) Identify resources to assist providers in their efforts to help clients navigate the health insurance system.

Intended AudienceMedical and non-medical case managers, eligibility determination workers, their supervisors, program managers, and RWHAP grantee staff responsible for monitoring adherence to payer of resort policies for sub-grantees.

Watch the webinar below: