States choose health plans

Social workers serve on committees that provide oversight.

Social workers are doing their part to help shape their states’ health insurance marketplaces, formerly known as health insurance exchanges.

A key component of the Affordable Care Act, health insurance marketplaces are being constructed so individuals and small businesses can shop for coverage.

As of May 2, 17 states and the District of Columbia were expected to operate state-based marketplaces, seven states were planning for a state-federal partnership marketplace and 26 states will default to the federal health insurance marketplace, according to the Kaiser Family Foundation.

At state-run marketplaces, committees are being created to provide oversight. Social workers are raising their hands to serve on these important groups.

Social worker Karin Moran, director of policy at the NASW New York State Chapter, is serving as a regional advisory member for one of the five committees established in the state, which is separated by region.

Each committee will provide advice and make recommendations on the establishment and operation of the health insurance marketplace, including factors that are relevant to the region.

As a social worker, Moran said she is representing and advocating on behalf of the profession.

“I see my role on the committee as a representative of the social work profession and as such, have taken every opportunity available to advocate that social workers play a strong role in the development and implementation of the (marketplace),” she said.

Another social worker serving his state for the health insurance marketplace is Jordan Wildermuth, the executive director of the NASW Kentucky Chapter. He is serving on the state’s behavioral health benefits subcommittee.

He said mental health and substance abuse services, including behavioral health treatment, are among the essential benefits to be provided by qualified health plans. His subcommittee will review and make recommendations on policy issues related to the provision of mental health and substance abuse services.

“It is important for me to be involved because this is a major move politically for the commonwealth of Kentucky and there is great opportunity to improve health outcomes,” Wildermuth said. “My main concern was that through this process only the insurance companies and primary care doctors would be involved and I wanted to make sure that we had a seat at the table.”

Health insurance navigators

Another way social workers can make a difference is by participating in health insurance navigator and in-person assistance programs. Navigators and IPAs will provide outreach during the first open enrollment period for individuals and small businesses needing assistance in selecting health insurance.

Open enrollment starts Oct. 1, and the U.S. Department of Health and Human Services is offering grants to train and fund navigators in federal and partnership marketplaces.

Stacy Collins, senior practice associate at NASW’s national office in Washington, D.C., said many NASW chapters are working with their state health care coalitions to apply for the grants. The grant application deadline is June 7. Awards will be announced Aug. 15 and training is expected to take place in August and September.

Moran noted that social workers are ideally suited to work as navigators.

“The first interface between the public and the (marketplace) will be during the enrollment period,” she said.

Social work should be the “go-to” profession for navigators, as their skills are proven to be effective in conducting public education campaigns, helping provide referrals and navigating cultural and/or language differences, Moran said.

Collins said social workers interested in serving as navigators should contact their chapter for information.


Regardless of the level of involvement, social workers need to educate themselves about the changes taking place in health care and how to potentially help clients, Collins noted.

“All social workers need to have a basic understanding of how this will work,” she said. “If a client comes in for therapy, you could say, ‘Here is some information to see if you qualify for health insurance coverage.’ This will be a huge help to our clients.”

Wildermuth said a fundamental understanding of the health insurance marketplace is necessary “because it will be somewhat complicated for clients to manage such a new system and it will be integral to ensure maximum enrollment.”

More states choosing Medicaid eligibility expansion

The Affordable Care Act calls for expanding Medicaid eligibility in 2014 for nearly all U.S. citizens under 65 whose incomes are up to 133 percent of the federal poverty level. Medicaid expansion is optional for states. NASW chapters have been active in petitioning their state lawmakers to support the expansion.

In early May, 28 states supported the Medicaid expansion, 20 opposed it and three were still weighing options.

Good news came to West Virginia residents on May 2 as Gov. Earl Ray Tomblin said he will implement the Medicaid expansion. In West Virginia, the governor has the power to expand Medicaid without approval from the legislature. An estimated 120,000 low-income residents in the state will be eligible for Medicaid, according to the West Virginia Economic Justice Project.

The NASW West Virginia Chapter was active in advocacy efforts for the Medicaid expansion, including co-hosting an April public forum on the topic.

In addition, NASW is a member of a Substance Abuse and Mental Health Services Administration-led coalition that is collaborating to disseminate materials to targeted populations, informing them that open enrollment to apply for health and behavioral health care benefits under the ACA begins on Oct. 1.

The targeted populations include those involved in criminal justice, persons with mental illness, the homeless and the consumer/recovery community. Most of those SAMHSA seeks to reach are low-income single adults who are either uninsured or underinsured.

NASW also is a member of the Criminal Justice and Mental Health Coalition. SAMHSA is expected to begin widespread dissemination of tool kits and other materials this month.