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April 2008

Update on Implementation of Coverage Expansions

Both Vermont and Oklahoma have reported recent success in enrolling new individuals in their coverage expansion programs—Green Mountain Care and Insure Oklahoma!/ Oklahoma Employer/Employee Partnership for Insurance Coverage (O-EPIC), respectively. As more states consider expanding coverage through the individual and small group markets, it is worth taking a closer look at the strategies of these two states.

On September 30, 2005, Oklahoma received approval from the Centers for Medicare and Medicaid Services (CMS) for a Medicaid program to provide premium assistance for individuals who are working for small businesses and earning incomes below 185 percent of the federal poverty level (FPL). The coverage can be purchased through the employer or by the individual directly. Individuals must pay 15 percent of the premium (capped at 3 percent of their income) and the employer pays 25 percent of the premium. The other portion of the funding for Insure Oklahoma! is provided by the Oklahoma tobacco tax along with matching federal funds.

The overall enrollment goal for the program is 50,000 individuals. By October 2006, the state had about 1,200 individuals enrolled. The state planned a marketing strategy that includes mailings, presentations by state staff, and reaching out to business groups and to insurance brokers. By October 2007, 4,439 individuals were enrolled. In October 2007, the state began an aggressive media strategy to increase enrollment (through an outside media firm at the cost of $1 million). They also increased the income eligibility level up to 200 percent FPL. The media strategy included television and radio ads along with media appearances by the Insure Oklahoma! spokesperson, who is a local media personality. Since then, visits to their Web site have increased by nine times and call volume at the call center is up 75 percent. Enrollment in the program has more than doubled to 9,416 (as of the end of March 2008).

Vermont began a similar media campaign in November 2007. This campaign branded the whole group of Vermont health coverage programs as Green Mountain Care. The state set aside $1 million for the outreach campaign, which was designed to get out the word about the range of Vermont health programs, especially the new premium assistance program for individuals with incomes between 185 and 300 percent FPL. ( Vermont had already provided Medicaid coverage for those with incomes below 185 percent FPL.) The individual portion of the premium ranges by income from $60 per month for those with incomes below 200 percent FPL to $135 per month for those with incomes between 275 and 300 percent FPL.

The state contracted with a media firm that helped them produce print, billboard, radio, and television ads. The media launch increased visits to their Web site by about four times and calls to their toll-free number by about 40 percent. By the end of February, 3,344 individuals were enrolled in Vermont premium assistance programs out of the estimated 10,341 who are eligible. In addition, 2,068 new individuals have enrolled in the existing Medicaid programs for children and adults. Now Vermont is regulating their use of advertising to keep enrollment at a manageable rate for state agencies enrolling new individuals.