Foundation / Corporation
District of Columbia Health Benefit Exchange Authority (DCHBX)
06/22/18 2:00 PM EDT
Grants to Washington, DC nonprofit and for-profit organizations to provide assistance to communities in navigating the District’s health care systems and options. Grantees will develop a qualified workforce that will educate consumers on their healthcare coverage and access options.
Assister Program Introduction and Background:
On March 23, 2010, the Patient Protection and Affordable Care Act (ACA) became law. This law put into place comprehensive reforms that improve access to affordable health insurance coverage for all Americans. It aims to protect consumers from unfair health insurance practices and allows all Americans to make health insurance choices that work best for them. At the same time, it guarantees access to care for the most vulnerable populations and provides new ways to lower costs and improve the quality of care.
As part of the ACA, all states and the District of Columbia have insurance marketplaces. The District established the DC Health Benefit Exchange Authority (“Exchange”) to set up an insurance marketplace for individuals and small businesses (those with 50 and fewer employees) to help them shop, compare, and purchase health insurance plans. The Exchange officially opened for business on October 1, 2013, and has been successfully operating since that date. The Exchange offers private health insurance to individuals and families and small businesses in the District of Columbia. Individuals and families who do not have access to employer-based health insurance or Medicaid may be eligible to receive tax credits to make individual health insurance coverage more affordable.
To successfully assist these individuals, families, and businesses to enroll in health insurance coverage, the District has been operating an Assister Program since 2013. The Assister Program is aimed at providing outreach, education, and enrollment services to uninsured and hard-to-reach populations to help consumers learn about, apply for, and enroll in an appropriate health insurance product, including a Qualified Health Plan, or completing an application for Medicaid.
The Assister Program offers services through “Assister organizations,” which are organizations that can perform the full range of Assister duties (see below). Assister organizations perform these duties with a range of staff, including both certified and non-certified personnel. Certified personnel, known as Assisters, will be required to complete an online training program offered by the Exchange and successfully complete a skills-based exam. Non-certified personnel can include administrative personnel and others such as Project Managers who support and enable Assisters to be successful.
Definitions to Note:
Assister Program: An all-encompassing term for the DC-based Assister program, inclusive of all the organizations providing services under the Navigator programs and their certified and non-certified personnel.
Assister Organizations: Organizations that receive grants from the DC Health Benefit Exchange Authority to perform the full range of Assister duties.
Assisters: Certified Navigator personnel who successfully complete training and a skills-based exam.
DC Health Benefit Exchange Authority (Exchange): The District’s health insurance marketplace offering transparent choices of private health insurance options for individuals and small business and premium tax credits to lower the cost of individual insurance.
Qualified Health Plan (QHP): A private health insurance plan certified to be sold on the Exchange.
Broker, Producer, or General Agent: A licensed insurance professional who acts on behalf of a consumer; can sell, solicit or negotiate insurance; and is compensated by the insurance company. Brokers and producers cannot charge individuals or small businesses a fee for their services.
Medicaid: An insurance program that provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities.
DC Healthcare Alliance: A locally-funded program designed to provide medical assistance to District residents who are not eligible for Medicaid. The Alliance program serves low-income individuals who have no other health insurance and are not eligible for either Medicaid or Medicare.
CoverAll DC: A program allowing District residents who do not meet eligibility requirements for on-exchange coverage, Medicaid, or DC Healthcare Alliance to enroll in private health insurance.
The Request for Applications: The DC Health Benefit Exchange Authority is issuing this Request for Applications (RFA) seeking applications from qualified entities to serve as Assister organizations in the District of Columbia. Under the Assister Program, the Exchange is making up to $650,000 in total grant funds available for no more than 10 competitive grant awards.
The Exchange seeks creative and innovative applications from a range of District organizations and community-based groups that have trusted and established relationships, networks, and experience working with uninsured and hard-to-reach population groups.
Once grantees are selected, there will be ongoing communication and coordination among the grantees. In some cases, an Assister organization may have a particular area of expertise, such as a language competency, that will make it desirable to refer some consumers to that organization. Thus, every grantee does not need to have expertise working with every population type, but they will need to actively work with other Assister organizations to ensure that every consumer’s needs are met.
Assister Program Goals:
The District’s Assister program will:
1. Reduce the number of uninsured individuals in the District through:
a. Raising awareness of coverage options;
b. Facilitating enrollment in qualified health/dental plans and insurance affordability programs; and
c. Promoting the retention of health insurance coverage.
2. Develop a highly knowledgeable Assister workforce that can educate consumers on their full range of health coverage and access options and support consumers to understand and use health coverage.
3. Coordinate with related programs and entities, serving as a one-stop shop with the ability to provide warm hand-offs to other health and social services.
4. Track performance to measure efforts and success.
Assister Program Target Population:
The Assister Program’s target populations are uninsured and hard-to-reach residents. While outreach efforts should be focused on the identified target populations, Assisters must be prepared to serve everyone who seeks help with eligibility and enrollment in private insurance offered in the Exchange, Medicaid, as well as with follow-up and referrals as appropriate for other programs such as the DC Healthcare Alliance.
While there are fluctuations in data from year to year, Assisters will be expected to focus their efforts on the following target populations in 2018-2019:
-Those who would have difficulty filling out an online application, such as those who do not have easy or regular access to a computer or the Internet.
-Those with limited English proficiency, including those who speak Spanish orAmharic.
-Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) communities.
-African Americans, particularly men, and Hispanic, African, and Asian populations as these groups are more likely to be uninsured than non-Hispanic Whites.
-Young adults aged 18-34 -- nearly half of the uninsured residents of DC are young adults.
-Low and middle income residents.
-Wards 1, 4, and 5, where a greater proportion of QHP-eligible uninsured may live, according to HBX data sources.
Successful applicants will demonstrate their ties to or ability to reach a particular community or communities and employ innovative strategies for reaching some or all of the target populations listed above. They will not rely exclusively on potential consumers coming to them; they will have to actively seek and reach out to people where they “live, work, shop, play, and/or pray.”
GrantWatch ID#: 183724
These Assister grants will cover the time period from October 1, 2018 – September 30, 2019. Additional grant option years beyond 2019 may be available, with funding amounts to be determined on an annual basis.
The Mandatory Online Training for Assisters (approx. 15 hours) will be available beginning October 1, 2018.
Open enrollment for individuals will take place November 1, 2018 – Jan 31, 2019.
Organizations Eligible to Apply:
This is an open call for proposals and varying types of organizations may be eligible to apply. Not-for- profit, for-profit, and other types of organizations are eligible. Some examples include, but are not limited to:
-Patient and Consumer Advocacy
-Legal Assistance Organizations
Organizations PROHIBITED from Serving as Assister Organizations:
-Health insurance issuers or stop-loss issuers and their subsidiaries.
-Associations that include members of, or lobby on behalf of, the health insurance industry.
-Entities that receive, or where an employee receives, any consideration directly or indirectly from any health insurance issuer in connection with the enrollment of any individuals or employees in a Qualified Health Plan or other health insurance plan.
-Provider entities (including, but not limited to, hospitals, clinics, and physician practices) that are directly or indirectly owned by or exclusively contract with a single insurer or its subsidiaries.
-Provider entities (including, but not limited to, hospitals, clinics, and physician practices) that directly or indirectly own a single insurer or its subsidiaries.
This Notice of Intent to Apply is optional and applicants that do not submit a Notice are still eligible to apply, though you are highly encouraged to complete this step of the process. Doing so also helps to ensure you receive any clarifications or addendums to the Request for Applications. The Notice of Intent to Apply deadline is June 6, 2018, 4:00 PM EDT.
The deadline for question submission is June 8, 2018, 4:00 PM EDT. Responses to all questions will be posted by June 13, 2018 at 4:00 PM EDT on the DC Health Benefit Exchange website at http://hbx.dc.gov/.
The application deadline is June 22, 2018, 2:00 PM EDT.
-RFA Release: June 1, 2018
-Optional Notice of Intent to Apply: June 6, 2018 by 4:00 pm EDT
-Questions Submission Deadline: June 8, 2018 at 4:00 pm EDT
-Answers Posted Publicly: June 13, 2018 at 4:00 pm EDT
-RFA Application Deadline: June 22, 2018, 2:00 pm EDT
-Grant Awards Announced: On or before August 1, 2018
Before starting your grant application, please review the funding source's website listed below for updates/changes/addendums/conferences/LOIs.
Fax: (202) 730-1658
USA: Washington, DC