Home energy costs can be a significant burden for low-income seniors and adults with disabilities, who may make dangerous choices between paying for heating/cooling their home, filling their prescriptions, or seeking needed medical care. At the same time, those who apply for assistance with their energy bills may not realize they also potentially qualify for other benefits. In Iowa, the State Health Insurance Information Project (SHIIP) is partnering with Community Action Agencies (CAAs) that administer energy assistance to reach more people who may be eligible for the Medicare Part D Low-Income Subsidy (LIS/Extra Help).
What did they do?
The SHIIP recognized a natural synergy between LIS and the Low Income Home Energy Assistance Program (LIHEAP), as income eligibility for both programs are the same, at 150% FPL. The SHIIP approached the CAA Association, which administers LIHEAP in Iowa, who coordinated an informational call for Executive Directors of agencies that serve the LIS targeted ZIP codes. There was significant level of interest from the CAA Directors in partnering with SHIIP IA to identify and process LIS applications for LIHEAP clients.
Together, the SHIIP and CAA directors identified two options for collaboration:
- Contracting with CAAs to process the LIS applications directly, and/or
- Doing a mailing to the targeted clients about their potential eligibility for LIS.
Significant consideration was put into identifying any differences between LIS and LIHEAP eligibility, the application process, and the role of the CAA staff. Eligibility for both programs is 150% of poverty. The LIHEAP application collects the majority of data needed to complete a LIS application, with the exception of resources and changes in income. Other factors that needed to be considered differently include counting of dependents, eligibility determination, and role of staff.
The pilot program
The SHIIP began by contracting with only one CAA. The partners created tools for screening, filing applications, record-keeping, and reporting. They trained outreach staff, and in between each session, the training methods were modified to incorporate the feedback they received from the staff. The CAA leadership implemented quality control measures to confirm that staff is consistently screening clients and to address the thoroughness of the application and recording process.
The CAA created a query database, which uses data elements to establish a list of targeted clients. Staff members contacted and screened these clients, and when a client indicated interest in LIS, the staff member filled out an application on the client’s behalf. The CAA then sent the Receipt of Submission from the SSA online application to the SHIIP for billing. A second copy went to the client with a letter explaining next steps and informing them they may get a call from SHIIP to explain the LIS / MSP benefits. SHIIP initiating the call was a proactive adjustment made after discovering clients did NOT call as prompted from the initial letter.
Scaling the effort
Once the pilot program was successfully launched, the SHIIP contracted with three additional CAAs to implement similar programs. Each agency implemented their own administrative operating procedures. SHIIP ensured that staff were oriented to Part D, the LIS benefits, the application process (both on-line and paper), and how to address common questions from clients.
The SHIIP has created a website where guidance questions and answers are available to CAA staff. This website can be used to address issues that slowed down the screening process for the first CAA. For some of these issues, SHIIP had to reach out to the Social Security Administration or the Center for Medicare & Medicaid Services to find answers. Having all of this information available on one website can decrease the time it takes to screen an individual while increasing communication between agencies that are having similar problems.
What was the result?
It was surprising that in some zip codes, a high percentage of clients indicated during their screening calls that they were already receiving extra help. The ratio varied across the agencies but approximately two LIS applications were submitted for every 30 clients contacted from the queried database.
Follow-up calls were made to individuals who were approved for LIS or an MSP. SHIIP was able to offer assistance by preparing a comparison and informing them of their Medicare Part D choices. Individuals appreciated that someone could explain the benefits and how it would work when they went to their pharmacy.
Part of the program’s success can be contributed to the fact that many seniors view their local CAA as a familiar resource, and are therefore more likely to trust the agency’s suggestions and guidance. It was helpful to make the connection during or soon after the LIHEAP season. In smaller communities, the client may personally know the calling staff member from previous interactions. This personal connection appears to have a positive impact on the number of applications that are submitted.
For more information
Iowa SHIIP Director