CMS Announces $5 Million for Consumer Assistance Programs

By Jessica Burnell

Last month the Centers for Medicare and Medicaid Services (CMS) announced a new round of grants to fund Consumer Assistance Programs (CAPs). Applications for funding are due September 15, 2014.

With millions of consumers beginning to use their coverage for the first time in 2014, continued funding of CAPs can play an important role to make sure consumers have the resources they need to learn how to maximize the benefits of their health coverage and stay covered.

Established under the Affordable Care Act (ACA), the first round of CAP grants (nearly $30 million) were distributed in 2010 to help states create health insurance assistance or ombudsman programs. The latest round of grants, totaling $5 million, will be made available to the 40 states, territories, and the District of Columbia who received CAP funds in 2010.  This grant funding will help support CAPs through September 2015.

While Navigators and other in-person assisters provide consumers with invaluable enrollment help, CAPs are also vital resources that support and empower consumers both during and after enrollment in coverage.

CAPs serve as ombudsman programs and have a wider range of required consumer assistance responsibilities than other assister programs established by the ACA:

 Program Requirements
Consumer Assistance Programs (CAPs)
Certified Application Counselors
Provide QHP Enrollment Assistance Yes Yes Yes
Conduct Outreach and Education Yes Yes No
Handle Complaints and Appeals Yes No No
Collect Data/Track Trends in Complaints Yes No No
Resolve Issues with Tax Credits Once Enrolled Yes No No

CAPs can be operated by nonprofit community-based organizations, state governments, or private call centers.

Just one example of a successful CAP program comes from New York. After the first round of grant funding in 2010, the state of New York partnered with Community Health Advocates (CHA), an existing consumer assistance organization, to help consumers navigate their new options under the ACA. CHA used a “hub-and-spokes” model with a central live helpline for consumers and advocates in 27 community-based organizations all over the state to provide in-person help on the ground. With this system in place CHA was able to handle over 100,000 cases from 2010 to2012 alone. CHA helped consumers file complaints and settle disputes with insurance companies, access financial assistance for medical bills, and enroll in New York’s Bridge Plan for those with pre-existing conditions.

For the full funding opportunity announcement, click here.

For additional information about these grants, click here.

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