AmeriCorps Healthcare Survey & Impact Report

July 2014

1

Table of Contents

Introduction…………………………………………………………………………………………….3

Overview of Results…………………………………………………………………………………5

Recommendations………………………………………………………………………………….10

Question 1 Detailed Results…………………………………………………………………….13

Question 2 Detailed Results…………………………………………………………………… 22

Question 3 Detailed Results …………………………………………………………………..29

2

Introduction

This report was created by the America’s Service Commissions (ASC) Healthcare Work Group, operating as part of the ASC Public Policy Committee. The Healthcare Work Group was formed to explore the impact of healthcare changes on AmeriCorps State & National programs and members as a result of the implementation and requirements of the (ACA). The goal of the group is to identify challenges, concerns and potential opportunities related to the ACA and AmeriCorps healthcare coverage.

The group is facilitated by Tom Branen, Executive Director of America’s Service Commissions with assistance from Rachel Bruns, Deputy Director of America’s Service Commissions and the Work Group Chair, Philip Kolling of SerVermont. Other members include (in alphabetical order by organization):

• Michael Ashmore, Maine Commission for Community Service • Benjamin Gulker, Michigan Community Service Commission • Jason Patnosh and Bethany Hamilton, National Association of Community Health Centers • Emily Steinberg, Miranda Spiro, Laura West, OneStar Foundation (Texas Commission) • Jessamyn Luiz, Volunteers • Kelly Martini, PennSERVE • Cara Cheevers, Serve • Jamie Orozco Nagel, Volunteer Iowa • Robyn Harris, Commission on National and Community Service • Chris Rooney, Willis of Seattle1

In order to learn about specific challenges and successes being experienced in the field, the Healthcare Work Group developed and administered a survey designed to gather feedback from those “on the ground” operating AmeriCorps programs. Although the survey was originally intended to inform the National Service Field’s responses to the HHS/CMS-9949-P Request for Public Comments (which were due on April 21, 2014), the group also welcomed this survey as an opportunity to collect and share AmeriCorps program feedback on current health care challenges and possible solutions for the Corporation for National and Community Service as well as Health and Human Services (HHS).

The online survey contained three open-ended questions designed to assess how the Affordable Care Act (ACA) and CNCS guidance related to its implementation may have impacted AmeriCorps programs and members across the country. The survey was sent to each state commission with instructions to distribute the survey link and instructions to each AmeriCorps program within the state. The survey was open from April 15-25, 2014 and 332 responses were collected during that time. Although the survey was designed for AmeriCorps program staff to complete, some members responded as well. Those responses were analyzed separately in order to provide member perspective on the effect and impact of healthcare changes. This report and survey analysis was compiled by Emily Shryock, Graduate Fellow with the OneStar Foundation, the Texas state service commission, with input from OneStar staff and

1 Neither this individual nor any representative of Willis of Seattle participated in the creation, distribution or analysis of the health care survey or this subsequent report. 3 input from the ASC Health Care Work Group. Survey responses were coded and analyzed by content and theme using MAXQDA software.

The overall goal of the ASC Health Care Work Group in publishing this report is three-fold:

(1) to improve our collective understanding of the current AmeriCorps program and member experience in obtaining and utilizing AmeriCorps health care coverage and benefits; (2) to improve the current AmeriCorps program and member experience in obtaining and utilizing AmeriCorps health care coverage and benefits, by minimizing administrative burden wherever possible and allowing for the sharing of innovative or best practices in AmeriCorps healthcare implementation across programs and states; and (3) to ensure that AmeriCorps programs and members have continued access to high quality healthcare and can make well-informed, compliant decisions about healthcare options throughout the implementation of the Affordable Care Act.

4

Overview of Results

Responses came from 41 states. States not represented in the survey results are indicated in red on the map below and include , Delaware, Florida, , Kansas, Louisiana, North Dakota, South Dakota and North Carolina.

Illinois had the majority of responses (91) with all other states having less than 25 responses.

Question 1. What have been your challenges and/or concerns related to AmeriCorps Member Healthcare implementation?

209 Program Responses

87 Member Responses 324 Total Responses 20 responses were NA 5 responses were not relevant to healthcare

5

180 programs reported challenges/ 29 programs reported no concerns challenges/concerns

Member confusion/anxiety (17) Insurance being provided already met ACA/MEC End of service does not trigger special requirements (8) enrollment (10) Members not eligible for (15) Members already have healthcare (parents, spouse, Administrave burden (15) Medicaid, etc.) (7) Cost (78) divided into several subcategories Current AC healthcare plans are not ACA compliant/providing MEC (115) None/NA with no further Recruitment (11) explanaon (14)

Timing/Short noce of changes (30) Confusion/lack of guidance about implicaons of changes for programs and members (55)

43 members 44 members reported challenges/ reported no concerns challenges/concerns

Members did not Finding providers in network (3) use/accept Time to get coverage/enrollment process (3) AmeriCorps healthcare (32)

Concerns about reimbursement/having to pay costs upfront (3) Concerns about dental/vision coverage Members reported "none/NA" (limited coverage, high costs) (8)

Confusion about insurance opons/coverage (18)

6

Question 2. What successes have you had related to AmeriCorps Member Healthcare implementation? What could other programs learn from your organization?

188 Program Responses

80 member responses 296 Total Responses

20 responses were NA 3 responses were not relevant to healthcare

49 programs reported 131 programs reported no successes/best success/best pracces pracces

Providing training/educaon to members about opons (33) Members have insurance (19) Members eligible for Medicaid/parent’s insurance (26)

Insurance providers were helpful (14) Price of insurance (12) Best Pracces (12)

7

52 members reported 27 members reported no success/best success/best pracces pracces

Members already have Having access to healthcare (parents, spouse, healthcare (9) Medicaid, etc.) (27)

Easy process to sign up/ Haven’t used their healthcare enroll (2) yet (6) Low prescripon/co-pay Members simply reported (4) “none” or “NA” (14)

8

Question 3. – OPTIONAL: Please provide an example/story of how a challenge or success related to healthcare implementation has impacted your program and/or a member?

84 Program Responses

139 Total Responses 43 Member Responses

8 responses were NA 3 responses were not relevant to healthcare

84 Program Responses 43 Member Responses

67 programs provided an example/ 15 members provided an example/story story

17 programs did not 28 members did not provide an example/ provide an example/ story story

9

Recommendations

The following recommendations were informed by survey results as well as observations and experiences of the ASC Healthcare Work Group. While these recommendations highlight actions that we believe CNCS could take, we also welcome a dialogue with CNCS leadership and recommendations from CNCS to ASC regarding steps that ASC and state service commissions can do to play our part in helping programs and members successfully adapt to the new healthcare requirements.

Special Note: Concerns expressed in the survey about the need for a special enrollment period option and the ability to request hardship exemptions have already been addressed due to the recent changes issued by HHS on May 2, 2014 as posted online at http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/SEP-and-hardship- FAQ-5-1-2014.pdf.

• To improve the experience of obtaining healthcare for programs and members, CNCS should: o Share with the field a summary of the information about healthcare and ACA implementation that was gathered from AmeriCorps applicants during funding clarifications. o With the help of an inclusive stakeholder group convened by ASC, move to align the AmeriCorps healthcare requirements as outlined in the AmeriCorps regulations and provisions with Affordable Care Act (ACA) requirements, while also ensuring that costs are kept affordable for both members and programs. Stakeholders should be selected not only from among CNCS and commission staff but also from experts in the field, those affected (including both AmeriCorps State and National programs and members) with state commissions charged with providing training and technical assistance. o Consider increasing the maximum allowable cost per MSY for programs with full time members if implementation of new healthcare requirements is shown to significantly increase program costs. o Provide universal training and technical assistance (TTA) to AmeriCorps programs and members related to health care rights and responsibilities, such as a short video (similar to the National Service Criminal History Checks illustrated video), webinar recordings, fact sheets, and a dedicated web page of resources and links) before the start of the 2014-2015 program year (starting July 2014). o In addition to the Healthcare FAQs and TTA, CNCS should consider holding conference calls with state service commission and national direct program leadership so that more nuanced and complex healthcare questions can be identified and discussed. o Minimize administrative burden on AmeriCorps programs by providing additional clarification on reimbursement options or providing sample templates/forms/policies or TTA related to how programs can allowably reimburse members for plans purchased through a Healthcare Exchange. 10

o Continue the use of a dedicated email address ([email protected]) in order to ensure streamlined communications with the field related to member healthcare and respond to questions and/or requests within 10 business days to ensure that programs have timely and adequate information to ensure compliance and responsiveness to member needs. o Develop a space on the CNCS website for healthcare providers who offer AmeriCorps-compliant plans to register their contact information and for AmeriCorps programs to find a list of these providers (similar to the process used for educational institutions that match the Segal AmeriCorps Education Award). o Ensure future communications directed to members related to healthcare changes are sent to state service commissions and national direct programs at least 1 business day in advance for optimal, streamlined communication with minimized confusion.

• To improve AmeriCorps member and program access to quality healthcare: o CNCS should clarify (by releasing revised FAQs or similar) that the AmeriCorps Provisions do not explicitly prohibit members from being dually enrolled in an Exchange-based plan that meets ACA/MEC requirements and AmeriCorps program health plans that do not meet ACA/MEC requirements. This is a critical point of clarification for CNCS to make, especially if the AmeriCorps Provisions are not updated to align with ACA by the start of 2014-15 program year. o CNCS should endorse or provide examples of innovative but allowable ways that programs could assist members with unintended consequences of the ACA, such as excessive out-of-pocket costs or deductibles (for example: AmeriCorps program medical emergency funds, program- sponsored deductible reimbursements, etc.).

In addition to the above recommendations, the ASC Health Care Work Group requests that CNCS consider the following two general notes based on the Work Group’s observations from the field:

o COMPLIANCE IMPLICATIONS: Many concerns have been brought to the attention of the ASC workgroup regarding the potential for grant compliance issues and findings for periods during which grantees of CNCS were without clear and unambiguous guidance. During these periods, grantees made their best efforts to ensure that their currently serving Members were provided adequate health care coverage under the AmeriCorps rules or the ACA and, when possible, strategically implemented changes to coverage to help Members avoid the ACA’s individual responsibility payment. Grantee programs expressed concern that their best efforts during this period may – at some future date –not be recognized as having met the Corporation’s compliance standards. Ideally, this group would like to see that there are no findings for programs that ensured the provision of health care coverage to Members which met the standards of at least the ACA, during the period preceding the publication of the provisions for the program year 2014 and training/technical assistance is provided by the Corporation to grantees. As an alternative, this group proposes no-cost findings and any associated risk assessed at very low to de minimis impact. In lieu of making such a decision on the impact and definition of non-compliance at this time, we would propose working with the field to determine the best strategy for prevention, detection and enforcement in the area of Member

11

healthcare. The ASC workgroup is willing to lend its assistance and outreach capabilities to the Corporation for this purpose.

o ACCESSIBILITY AND DIVERSITY IMPLICATIONS: Among the consequences of not providing AmeriCorps members easier access to affordable, quality health care is a potential but significant reduction in the diversity of AmeriCorps members serving our country nationwide – based on members’ age, socioeconomic status, and disability status. For members from underrepresented groups and/or disadvantaged backgrounds, staying on a parent or spouse’s health care plan is simply not an option and it is negligent to make an assumption that this is a solution. In addition, not improving members’ health care access and options is likely to result in an increased number of premature member exits for Compelling Personal Circumstances related to the financial impact of medical emergencies and health-related issues due to high deductibles and excessive, out of pocket member costs.

12

Question 1. Detailed Results

Q1. What have been your challenges and/or concerns related to AmeriCorps Member Healthcare implementation?

180 programs reported challenges/concerns

Reported challenges/concerns were broken into the following categories (some programs identified more than one challenge/concern):

A. Recruitment (11) a. Confusion about what to tell potential members about healthcare options during recruitment B. Member confusion/frustration (17) a. Not being able to provide members with answers b. Changing healthcare in the middle of their term C. Administrative burden (15) a. Spending staff time on researching answers, coming up with new policies b. Feasibility/questions about reimbursement option D. Cost (78) divided into several subcategories a. Concern about tax penalty for members in 2014 for non-compliant coverage (47) b. Concern about increased cost/affordability for compliant coverage (27) c. Concern about how to budget for future healthcare cost (12) E. Timing/Short notice of changes (30) a. Holiday notification left programs/members scrambling b. Not enough notice to plan or inform members in a timely manner before the individual mandate became effective F. Current AC healthcare plans are not ACA compliant/providing minimum essential coverage (MEC) (115) a. Providers dropped plans because they weren’t compliant b. Difficulty finding compliant plan G. Confusion/Lack of guidance about changes and implications for AC programs and members (55) a. Lack of answers b. Conflicting guidance (FAQs) H. Members not eligible for Medicaid (15) a. State did not expand Medicaid b. Members do not meet income requirements I. End of service does not trigger special enrollment (10)

13

Quotes from Survey Responses to Question 1.

A. Recruitment

“…we will have to tell potential AmeriCorps members (that we are trying to hire) that they may be subject to a tax penalty that they will ultimately be responsible for. This is difficult and cumbersome to explain to potential AmeriCorps members and we would not want to see this impacting people's decision to serve in our local communities.”

“My concern is that I can no longer feel comfortable telling candidates that AmeriCorps provides health care to members. Yes, I can provide some health care benefits, but what I can provide does not meet the Minimum Essential Coverage requirements, and if they chose to take my health care, they will likely be charged a penalty during tax time….Overall, my main concern is that the quality of the AmeriCorps program will suffer because of lack of clear guidance around this topic. I am a proud, two-time AmeriCorps Alum and now a Program Director. I love AmeriCorps, believe is a hugely beneficial program for all involved and would hate to see members having a bad experience because of this. When I conduct new member interviews/information sessions this fall, at this point I'm not comfortable saying that AmeriCorps provides health care to members. I see this as a huge step backwards for AmeriCorps and as a potential deterrent for candidates.”

B. Member confusion/frustration “Our Members know that Congress approved a MEC “The implementation of the ACA, and its impacts on current ACM has, in Volunteer 's opinion created a level of status exemption for anxiety with members utilizing the health benefit that just people serving in the did not need to occur….This violated the implicit trust that Peace Corps. There was a members have with the programs they serve within, and lot of anger and indeed put the ACM in a position that doing service would put them in a position of harm with a penalty and the frustration surrounding potential of not being able to enroll through an exchange this decision. They felt post AmeriCorps service due to exiting a service term not be that since they are serving a "qualifying life event".” IN their own country and “The representative explained [to members] the current not abroad that they health plan does not meet ACA minimum requirements. should have been given Some members panicked from the news while others did not have clear enough understanding about the eligibility the same MEC status consequences and their required actions to avoid related exemption. This also penalties. Knowing the potential impact of non- generated much distrust compliance with ACA, it was challenging to take such as reserved approach to communicating with members.” and anger.” 14

“The change [to a new plan mid-year] was needlessly chaotic for our members and partners, and for those members with medical concerns needing ongoing care, it was extremely stressful.”

“We have notified all members of the ACA requirements and that the policy provided by our AmeriCorps program doesn't meet the requirements. Most full time member enrolled in the AmeriCorps healthcare policy are confused and disappointed, feeling that the policy we offer is a waste. They don't understand why we would provide a policy that doesn't meet the requirements. It's difficult to provide a positive response to their question, since a feel we are wasting money by providing a policy that doesn't meet the regulatory requirements.”

“Members were very unhappy that they were faced with the situation of the current coverage not being considered insurance under the new healthcare law and facing a tax penalty if they did not take action on their own. Members did not want to spend the time required to research and decide on the best option for themselves when they thought their health benefit needs were adequately addressed when they enrolled in our program. One member was very angry and stated over and over again that she would not have become an AmeriCorps member if she had known about this issue.”

“Generally, the whole thing has felt very stressful and unfair to AC members. These are people who are giving a year of their lives to improve communities and solve problems….My program is valued by the federal government, but my members do not feel valued because of the contradictory rules and regulations put upon them by the federal government's health care laws.”

C. Administrative Burden

“Our staff members spent at least 40 hours learning about the new ACA law, fielding member questions and helping them navigate the online health exchange.”

“Lack of specific or broad based guidance regarding examples, templates, options and scenarios of best practices, etc. It requires time, energy and resources to commit to keeping to date with everything as it unfolds.”

“It has been challenging to gather information around changes in health care law and the implications for AmeriCorps programs. There is a steep learning curve around the health care exchange. Having to both learn about the health care exchange and implications when involving AmeriCorps members in that system, and then communicate this appropriately to members and applicants, while also creating new program policy around these changes is difficult indeed. There has been little support from the Corporation in navigating these changes, ensuring program compliance.” 15

“One of the largest challenges we've faced is that there is so little guidance on this issue from the Corporation for National and Community Service. We decided to offer Members the opportunity to get health care on the marketplace, but we've had to completely make up our own policies and procedures from the very little information given to us from the Corporation. While we ultimately made the decision that offering our Members a chance to enroll through the Marketplace was the best option for our Members it took significant time and effort on our end to research and develop a plan that meets the necessary regulations.”

Additionally, the paperwork and administrative effort on the part of AmeriCorps members to request a waiver (for example, in a state that did not expand Medicaid) is extensive, in addition to program staff struggling to appropriately communicate next steps to members without giving tax advice or making decisions for the corps member. A step-by-step process that is simple and comprehensive needs to be provided to members as soon as possible. Additionally, from a staffing standpoint, future directions and options for next service term for this issue are not clear. Please note that these AmeriCorps healthcare challenges have led to considerable effort and time spent by program staff, which could be better spent in a number of areas to strengthen program delivery and activities.”

“We've discussed the possibility of reimbursing members for policies they purchase in the marketplace, but processing monthly reimbursement requests from all full time members would be very cumbersome.”

“”By far the easiest solution for both the program and the Member would be if the Corps Network (or other health care provider) was able to get Minimum Essential Coverage approved and we could continue to purchase health insurance through those means. However, it looks like this may not be the most cost effective option and a reimbursement system may be cheaper. What will not be accounted for in the budget is the administrative time it would take to implement a reimbursement policy. I know, at a minimum, implementing a reimbursement system would involve writing and creating a policy and procedure for this, which would involve the time of anywhere from 4 - 8 employees, to process each reimbursement (best guess would be 8 - 15 a month) it would have to go through at least 6 people on the program's end. And this is just the hardships for the program. Additional work would arise from the Member's side, including tracking and submitting monthly reimbursements, researching and enrolling in the Open Market and there is also the undue hardship of the reimbursement system that would have a minimum of 2 week lag time, but more likely close to a month for the reimbursement to reach the AmeriCorps Member…. I think that the reimbursement option, although on paper seems to be more cost effective, actually is highly problematic and provides undue hardship to both the program and the Member.”

16

“My members all pursued different courses of action and I had to try to keep track of what they were doing and what I needed to do in response (e.g. cancel their current coverage through us, provide more education to assure they did address the issue, write policy to help them pay for an alternate plan etc.).”

“…Managers and members spent a considerable amount of time vetting options through the Health Exchange to ensure that members understood their options for health insurance.”

“… I think if we were going to offer the exchange or Medicaid insurance (which would meet the requirements) it would get confusing to outline all of the requirements/procedures for how to determine equitable coverage for members, and how to ensure reimbursement, etc. in a strategic way since there is no way to directly pay for it on behalf of members, etc.”

D. Cost

“An additional concern is just the unknown. As the coverage “The members are living in options are in the midst of being revised and figured out, it poverty, serving in a nationally has been really hard to plan and budget for future program years. However, we have had good discussions with the recognized program benefiting the Commission staff and they have helped with this area.” education system (government) “We tell members when they start their service that they will that has promised to provide them have coverage, and to tell them part way through their term, health insurance in exchange for when they are already making barely enough money to service. Then they are told mid- scrape by, that their insurance is not ACA compliant and they need to either drop it or be ready to pay a fine is year that their health insurance is unacceptable.” not up to standard and they'll owe “It is not realistic in many cases to expect a member to afford a penalty if they don't take action payment and be reimbursed for their marketplace insurance.” to find other coverage for “We have successfully used the Corps Network for our themselves. How can they afford AmeriCorps insurance for several years and we are very this? …A lot of them have pleased with them. However, the current policy is not in-line with the Affordable Care Act and therefore members who expressed they do not feel stay on this plan may face a penalty. We do not think this is appreciated by the government for fair, and we would like the minimum essential coverage to penalizing them while they are in match the requirements of the Affordable Care Act.” such a vulnerable financial “The challenge was understanding the options AmeriCorps members have at this time, explaining that their coverage position to begin with.” through The Corps Network did not meet the minimum essential coverage and can result in a tax penalty. We are

17 concerned that this will not change for the future and would like to be able to offer a coverage that meets the minimum essential coverage.”

“Informing service members of the potential tax penalty if they keep the…provided health care (The Corps Network). In our contract, we promise to provide health care. With the challenges that arose with the ACA, it seemed we were breaking our contract with them. I guess an earlier roll out of communication from AmeriCorps about how the ACA was affecting member health care would have been appreciated.”

“Challenges have been that AmeriCorps standards are not equal to the Affordable Healthcare Act. Concerns is what that price will be when the standard is raised and if health care is an actual option to offer members without sinking a program.“

E. Timing/Short Notice of Changes

“The lateness of the decision to provide members information. And program having to use the member information as their basis for planning. The lack of regular consistent guidance from CNCS gave members a very short time frame to find other coverage before the December or March deadline. “

“The lack of timely communication of information. We were not told that our health care plan would not meet the minimum coverage until late December 2013. This did not give us, as Project Directors, much time to find alternative plans or options for our members. We understand that this is a confusing a new process for all parties involved, but we also felt AmeriCorps (CNCS) was very silent about the whole issue. We would have liked more guidance about how to handle this (budget-wise) much sooner. Overall, we think the addition of the Marketplace will be great for our members moving forward but this transition time was confusing and not very successful.”

“Since CNCS didn't release guidance until mid-December, we were left with two weeks to contract with a new provider, educate our members about the changes, and switch members over to the new plan. It also was problematic that we, the grantee, and members were made aware of the guidance at the same time - instead of being able to be a resource for our members during this confusing time, we were learning about the impact at the exact same time that they were.”

“The other frustrating part for the AmeriCorps Members in our program was the timing and delivery of news about how changes in health care affected them. The first time news came out it was the day before our Members left for winter vacation. The second time news came out was after the program listened in on the Corps Network's webinar and found out about the lack of the special enrollment period was the day before our Members left for Spring Break. It made a stressful situation more stressful for both the Members and the staff supporting them because of this time crunch.”

F. Current AC plans not compliant with ACA/MEC

“We could not find an affordable product that met both AmeriCorps and ACA requirements. When we needed answers to questions, things seemed unclear. There was plenty of gray on what we could or could not do. Even with max coverage on an ACA plan (very expensive), the minimum requirements for 18

AmeriCorps were not met. Health insurance providers said it would be impossible to meet all AmeriCorps requirements AND ACA requirements at a reasonable rate.”

“We would like to offer coverage that meets the requirements set by “We are concerned the Affordable Care Act, but have not found a company offering that coverage. We are also concerned that any coverage that becomes that the CNCS does available might be prohibitively expensive for our program….It has NOT fully understand been frustrating, however, that there has been no guidance or assistance from the state or national levels. Our program has been NOR support efforts very confused with how the ACA applies to our program, but have not received any clear answers.” to have member “…we experienced quite a bit of uncertainty about which policies healthcare plans would continue to be available to AmeriCorps members once the exempt from the MEC health care law went into effect. The policy that we had been providing to members had been cancelled, and we weren't sure what requirement under other (affordable) options were going to be available. We are the ACA. “ somewhat concerned that the AmeriCorps minimum benefits package does not meet the minimum mandates of the Affordable Care Act.”

“Our full time AmeriCorps Members were a little bewildered that we were not providing ACA compliant health insurance to them, although it was explained at the beginning of the service year that this was the case. It seems so unfair that Peace Corps Members get an exemption from the ACA regulations and they are serving abroad, while our domestic volunteers are not exempt.”

“It was difficult to explain to my members that the coverage that they were offered through a government funded program (AmeriCorps) ultimately was not compliant in the eyes of the government (ACA).”

G. Confusion/Lack of Guidance

“There has been conflicting/confusing information regarding health coverage for AmeriCorps members. As I understand it, the AmeriCorps provisions outline a minimum required coverage plan for AmeriCorps members that does not meet the requirements of ACA, so our full-time AmeriCorps members (who are on the minimum AmeriCorps coverage plan provided by the Corps Network) may be at risk for a fine on next year's tax return.”

“It has been frustrating, however, that there has been no guidance or assistance from the state or national levels. Our program has been very confused with how the ACA applies to our program, but have not received any clear answers.”

“Not feeling informed enough of healthcare options when the member asks for guidance on what they should do, or what health care option they might consider. I don't claim to have the answers either.”

19

“I would say the biggest challenge is clear directive from CNCS. I still “Biggest challenge is feel like I am in the dark on how to handle our full-time member's health insurance.” all the unknowns.

“Our primary challenge has been navigating the information that has Many of the FAQs that been released by the CNCS regarding member healthcare for the 2014- come from the 2015 program year. Luckily, our state service commission has done a fantastic job of condensing and clarifying this information as it is Commission tend to released and then updated.” contradict each “One of the largest challenges we've faced is that there is so little guidance on this issue from the Corporation for National and other… We want to be Community Service. We decided to offer Members the opportunity to fair and equitable in get health care on the marketplace, but we've had to completely make up our own policies and procedures from the very little information what we offer but given to us from the Corporation. While we ultimately made the very unclear as to decision that offering our Members a chance to enroll through the Marketplace was the best option for our Members it took significant what we can and time and effort on our end to research and develop a plan that meets the necessary regulations.” can't do.”

“Based on the Corporation's published FAQ, in order to provide reimbursement to members who enroll in a marketplace plan, it must be the same amount of reimbursement. However, the cost for the same plan varies from member to member, based on their individual circumstances. Therefore, I'm not able to provide them all with the same amount of reimbursement, when one member's plan is $12/month, and another member's same plan is $115/month, for the same coverage. I'm not able to provide reimbursement to members and still be in compliance with the issued FAQ.”

“CNCS initially communicated to AmeriCorps members that they could be dual-enrolled with their AmeriCorps health insurance and a health care plan that they purchased through the online exchange. Months later, this was changed by CNCS. These mixed messages and inconsistencies were difficult to explain to members that had already acted on the initial information that they were given. The FAQ's provided by CNCS were not sufficient or specific enough in the details of signing up for a plan on the health exchange (i.e., how to designate the living stipend).”

“Another challenge has been the revision of rules or unclear establishment of rules around the healthcare implementation. KCR initially came up with a great plan to offer members up to $110 for their premium co-pay (the amount we are currently paying to BCS for coverage). This would have been a manageable way to budget for coverage, to help members, and to ensure they all had coverage. However, when the new FAQ's were released it said that programs cannot reimburse members in this manner. That caused our program to go back to the drawing board and we struggled with how to provide coverage.”

20

H. Medicaid

…the paperwork and administrative effort on the part of AmeriCorps members to request a waiver (for example, in a state that did not expand Medicaid) is extensive, in addition to program staff struggling to appropriately communicate next steps to members without giving tax advice or making decisions for the corps member.”

“While most of our members qualify for Medicaid, there are some with second jobs, spouses and/or children, etc. who do not qualify for free coverage, and working with them to find solutions has been a challenge.”

“Conflicting policies: Existing policies from Serve IL state that members on Medicaid must also receive AmeriCorps Insurance, while the CNCS FAQ says they must be removed from AmeriCorps insurance if they receive Medicaid.”

“Some members have expressed that they have not been eligible for Medicaid/care due to their term.”

21

Question 2. Detailed Results

Question 2. What successes have you had related to AmeriCorps Member Healthcare implementation? What could other programs learn from your organization?

131 programs reported having a success/best practice to share

Reported successes/best practices were broken into the following categories (some programs identified more than one success/best practice):

A. Best practice (12) a. Creating resources (handouts, training materials) b. Collaborating/sharing information with other programs/community partners B. Price of insurance (12) a. Members were able to find cheap plans on the exchange b. Programs were able to find ACA compliant plans at reasonable cost C. Providing training/education to members about options (33) a. Program staff provided education and training b. Outside trainers provided education/training on healthcare options D. Insurance providers were helpful (14) a. The Corps Network b. ACA Navigators E. Members have insurance (19) F. Members eligible for Medicaid/parent’s insurance (26)

“We have done our best to ensure that members are made aware of information and to provide the best leadership possible within the challenges to ensure our members have adequate health care. Our program greatly appreciates further examination into this matter, as we are committed to caring for our members as they care for the community. We feel strongly that as a program and a country, we are not doing right by them at present in regards to their health care coverage.”

22

Quotes from Survey Responses to Question 2.

A. Best Practices

“The only success I can report is the importance to dedicate a staff Member to Healthcare. I have found it helpful to educate myself on all the options and be able to share what I learn with our AmeriCorps Members. It is helpful to have a go to healthcare person in the organization, even if the guidance and information I can share is limited.”

~Jaclyn Remick, Travis County CAPITAL AmeriCorps Project, TX

“As an organization, we are much more informed about the Affordable Care Act and some of the intricacies associated with the implementation, particularly in terms of what it meant for AmeriCorps members, than we otherwise would have been. We are happy to share with other programs what we have learned during the process and share how we made switch for our members, if other programs would find that useful.”

~Sara Fung, The Child Abuse Prevention Center, CA

“We have been able to have dialogues among programs within our state that have been helpful.”

~Katie McKeown, Montana State Parks AmeriCorps

“We have successfully put together a fact sheet of health care options for enrolling members, still allowing us to offer the required FT health insurance option through Corps Network, but giving the opportunity to enrolling members to become informed on health insurance options that could give just as much, or more, coverage and not incur a penalty next tax year. We have already shared this document with another local AmeriCorps program and would be happy to share it with other NYS AmeriCorps programs.”

~Kate Sarata, The Service Collaborative of WNY, NY

“Sharing resources and interpretations of policies with other AmeriCorps programs. It would be good to coordinate communication sessions to encourage and facilitate discussion on the topic. It'd be beneficial to record and make assessable the conversations after.”

~Steve Frodl, NCCAP AmeriCorps Team, Greater Wausau Area, WI

23

“We looked very closely at our insurance and other products. We consulted with attorneys and insurance folks to learn more about coverages. We also networked with other AmeriCorps programs to learn what they were or were not doing.”

~Michael Figueroa, Kern County Superintendent of Schools/Building Healthy Communities

“As we neared the enrollment deadline, we finally had enough information to put together guidance for our members. It outlined the options available for insurance and steps to take in pursuing said options. A handful of members opted to enroll through the exchange and the monthly premiums have been less than $50. As a nonprofit that is solely an AmeriCorps program, we are in a unique position where it is fairly easy for us to reimburse members for the monthly premiums; in talking with other programs that are embedded within government agencies, it is not quite as simple.”

~Eric Antonson, Conservation Corps MN and IA

“When advising members to seek coverage through the exchange we make sure to communicate to them to NOT list our program as their employer. Many times they will be denied coverage or get approved for a higher priced coverage because they listed the program as their employer and then the exchange thinks we should be providing coverage to them under ACA. Though they may have to disclose their living allowance as income they need to do it in a way that does not list the program as their employer.”

~Julie Muklebust, Alliance with Youth

“Our program recently created a member contract addendum, explaining the health care changes and how it could affect them (these are being given out at regional meetings, in order to get signatures around the state as easily and as quickly as possible).”

~Mark Johnson, Oregon State Service Corps

B. Price of Insurance

“Most of our members who had health care with our Project decided to find a plan on the Marketplace. With their subsidies, these plans were cheaper or the same price as the one we had offered them. Overall, the Marketplace plans were much cheaper and offered the same if not better coverage.”

“We have been working with our current insurance brokers to receive quotes for ACA and AmeriCorps compliant healthcare plans for the next program year and it's been quite surprising 24 that so far, the quotes have come in lower than what we are currently paying for non-compliant insurance.”

~Bridget McFadden, College Now Greater Cleveland, OH

“Members who need healthcare have gone on the website and, due to their economic position, have found plans for as little as $2 a month. This is great for them, as the coverage is sometimes even better, and great for us, as it is much cheaper than what we had been paying as a program.”

~ Anonymous

“As a result of the ACA and the Corps Network coverage not meeting the MEC, the health coverage expense to our organization has decreased this year. (I guess that's a success.) This is not because of anything we've done specifically, but about half of our members have chosen to stay on their parents insurance or go through the health exchange. We were unable to provide a coverage option through our employee insurance provider since members are not classified as employees.”

~ Lisa Henry, Habitat for Humanity Seattle

C. Providing Training/Education to Members

“Our program asked professional insurance "navigators" to host working sessions to guide our members through enrollment in the national health exchange. Engaging "navigators" allowed members to ask experts directly. The navigators took on our members' "cases," hosted 3 working sessions, and served as a resource that program staff could call directly with questions related to members' healthcare.gov enrollment status.”

~Christin Marshall, Barnstable County AmeriCorps Cape Cod, MA

“We took a member-centered support approach in transitioning our members from the Summit Plan to a plan on the state exchange. We created a webinar which covered each step of acquiring insurance on the state health exchange and then conducted one-on-one advising with each member to ensure that they were able to get state coverage.”

~Colleen Holohan, Mass. Promise Fellowship

“Because our staff devoted so much time to learning about the ACA, we were able to support our members better than other AmeriCorps programs during this transition. We developed a

25 detailed PowerPoint that walked each member through the process of signing up for the health care exchange.”

~Jessica O’Mary, ACE: A Community for Education

“We had an ACA navigator come into an evening session with our members to help them understand their rights and responsibilities. It was very helpful to enlist a neutral third party for this hot-button issue.”

~Rachael Tachco, Rochester AmeriCorps, NY

“Our agency is an enrollment site for the Marketplace and we have a Certified Application Counselor. We utilized the CAC to hold a group meeting with our Members to educate them about health insurance. The CAC then met with Members individually to consult with them and enroll them in the Marketplace.”

~Jane Knirr/International Institute of St. Louis AmeriCorps Program, MO

“We held a mini-training and outlined health insurance basics, and an option for most of our members to apply for free Medi-Cal (to avoid the individual mandate penalty and ensure coverage post-AmeriCorps) while keeping their Corps Network insurance as a backup policy. This seems to have worked for most of our members, though not everyone.”

~Erin Ortiz, Monterey County United for Literacy AmeriCorps, CA

“We adapted the AmeriCorps coverage options from the national site into a "Health Care Options Form" that members were able to review, research the options, and elect for one of the available options. The members were given a firm deadline in conjunction with open enrollment periods.”

~Kayle Walls, College Access Now, WA

“We are lucky that RI is a small state with one health care portal that works closely with AmeriCorps programs. HealthSource RI presented the RI healthcare options to State Commission (SRI) staff, and to all RI program directors/staff at our monthly statewide AmeriCorps Network meeting. HealthSource RI then hosted an open enrollment session specifically for AmeriCorps members after one of our statewide events, so we were able to get all Corps members interested in enrolling through the exchange to do so in one day. Without this resource, I’m not sure what we would have done to adequately support our members.”

~ Lauren Kilcoyne, Serve

“My biggest success has been constant communication with the members. Thankfully, the Michigan Community Service Commission has been extremely open with communication to 26 program directors. As a result of this, I was aware that changes were coming in 2014 before I recruited members for the current program year. During their interview/information session, I told them that their health care benefits would be changing (though I did end up giving them some faulty information because of lack of communication at the federal level, I believe). The members knew that going into it, which made all of this transition a lot easier. Other program directors who did not alert their members about this prior to them coming on board have reported a lot of hostility around the changes. It's possible that those two things are not related at all, but I believe that consistent communication is key.”

~Rachel Diskin, CEDAM/Michigan Foreclosure Prevention Corps

D. Helpful Insurance Providers

“We currently only had one individual who elected into our AmeriCorps insurance. We were able to refer her to United way 2-1-1 to connect her with a navigator to help her figure out how to elect into insurance on the exchange to supplement. I would say figure out where a navigator is and connect your members to it.”

~Kelli Holubeck, Youth Achievement AmeriCorps (Iowa)

“The Corps Network's responsiveness to programs dealing with this issue. They alone provided guidance to this issue. Sadly, AmeriCorps was completely absent from this conversation.”

“Call insurance companies directly. Oftentimes, they won't have the information that programs require (since they, too, are reacting to ACA implementation and don't know what insurance packages will include 12 months out). However, after talking to the insurance company directly, programs are better prepared to report to funders and members. *Our program asked professional insurance "navigators" to host working sessions to guide our members through enrollment in the national health exchange. Engaging "navigators" allowed members to ask experts directly. The navigators took on our members' "cases," hosted 3 working sessions, and served as a resource that program staff could call directly with questions related to members' healthcare.gov enrollment status.”

~Christin Marshall, Barnstable County AmeriCorps Cape Cod, MA

E. Medicaid/Other Insurance Successes

“Our state, , has expanded Medicaid, and for the few members who were not on their parents’ plans or who had not already elected a plan other than the AmeriCorps plan, those 27 members met the income eligibility for Medicaid. I am not sure what we would do if we had a member that did not meet the income eligibility for Medicaid.”

~Kadie Schaeffer, Vermont Youth Development Corps AmeriCorps State Program

“Medicaid / AHCCCS was expanded and some members chose to enroll in that instead of the AmeriCorps offered plan.”

~Sharon Tewksbury-Bloom, NAU Civic Service Institute, AZ

“I was able to get all members enrolled into , 's health care exchange/marketplace. We covered 8 of 10 members. All but two are now on medicaid, free of charge to them and to KDVA.”

~Michelle Fiore, KDVA, KY

“We directed four members (who had insurance through The Corps Network) to access the NYS Marketplace. Three members qualified for Medicaid. RHSC is reimbursing one member for her monthly premium for private insurance that she accessed through the Health Benefit Exchange, as she does not qualify for Medicaid.”

~Danielle Berchtold, Rural Health Service Corps, NY

“having member income be low enough to qualify for MediCal / covered without any cost. (we don't pay anything toward their premium).”

Angela De Los Santos, Hope for the Homeless, CA

“We have had a few members already switch to the Oregon Health Plan, which has no premium and overall seems like a better plan than the one we have through the Corps Network. Our program recently created a member contract addendum, explaining the health care changes and how it could affect them (these are being given out at regional meetings, in order to get signatures around the state as easily and as quickly as possible).”

Mark Johnson, Oregon State Service Corps

28

Question 3. Detailed Results

OPTIONAL: Please provide an example/story of how a challenge or success related to healthcare implementation has impacted your program and/or a member?

67 Programs provided stories/examples 15 members provided examples

Many programs reiterated challenges/concerns or successes/best practices that were captured in questions #1 and #2.

Negative Examples/Stories From Programs

“Our program had one member who resigned from her position due to the healthcare changes. Since the program could not provide a healthcare plan that met both the AmeriCorps requirements and the Affordable Care Act requirements she was anticipating being charged a penalty on her 2015 taxes. The penalty was overwhelming to her and she saw that her best option was to leave her service term for another position and the opportunity to gain healthcare elsewhere.”

“Unfortunately the health care challenges with non-ACA compliant coverage has negatively impacted AmeriCorps’ public image amongst members. At a time when AmeriCorps is focusing on branding national service and increasing awareness and support, it has been especially challenging to encourage continued service/involvement with AmeriCorps as current members begin making post-service plans. The following feedback was collected from our AmeriCorps Members and Supervisors:

“I am very disappointed that AmeriCorps has not provided compensation to their members that work very, very hard to complete their term of service at the highest level of achievement. When we as AmeriCorps members sign on for our term of service we are promised health coverage, and now we are being subjected to fees and fines. We should be valued for our hard work to serve this country and make a difference in the lives of young children to better our country's future. We should be provided with the coverage promised at the beginning of our term of service.”

“I am incredibly disappointed that we have let down our AmeriCorps members in this way. To have people give a year of their lives for national service and then tell them with LESS THAN TWO MONTHS notice that their insurance coverage is not adequate is horrifying. It is disappointing not only because of the new requirements but to know that, all along, our members have been serving with less than sufficient coverage. This is irresponsible and a disservice to the young people who are learning from this as their first work experience.”

29

“When I took this AmeriCorps position, part of why I took it was the guarantee of health insurance. As I remember it, we didn't have a lot of choice in our health care. It was either Summit America or our own coverage. Because I make very little on my living stipend, I chose the free health insurance from Summit. It seems wrong now that we have to pay a penalty for Summit Health Insurance when we didn't know at the beginning that it was "non-compliant" with the ACA. On our living stipend, a $95 penalty is quite expensive. It seems like we are being penalized for having a plan that we didn't have a whole lot of choice around in the first place.”

“Below is a typical inquiry/comment received from many of our currently covered 300 AmeriCorps members by our WSC plan. The writers are almost apologetic in thinking they are unique, when in fact they are not. We guide and direct to as many resources as we have available and we clearly have stated and restated through communication the WSC plan benefits. The attempt to help members research and understand the options and their own needs. About 40-50 members left the plan to secure marketplace coverage. From a member.....

"I am writing concerning the need for WSC AmeriCorps members to obtain Affordable Care Act compliant healthcare. My situation as a WSC AmeriCorps member is somewhat unique in that I am married and, because of my spouse’s income, do not qualify for Medicaid or any discounts on healthcare policies. My husband works a full time job, but his employer does not provide healthcare since there are a couple of months each year where he works 36 hours a week instead of 40. Therefore, my husband cannot provide healthcare for me, but his income also puts us just above the threshold for getting assistance with our coverage. I have gone through the application at https://www.wahealthplanfinder.org/ and found that the cost for me to get my own plan would be about $200/month with a $5,000 deductible. If I stay with the plan that the WSC currently offers and end up getting fined when I do my taxes in 2015, it would cost me about $400. What I would like to know is if there would be any other long-term effects from being fined, such as a permanent statement on my records or other issues. If the only consequences are monetary, it may be worth it for me to stay with my current plan through AmeriCorps and just risk paying the tax penalty next year because it would still be cheaper than getting a new plan with monthly payments and a high deductible. Any clarification on the long-term impacts of this decision would be very helpful."

“Last year one of our members who was covered by the Summit America plan needed regular prescription drugs to treat a mental health disorder. Since the prescription plan is on a reimbursement basis, each month the member would almost reach the maximum spending amount on her credit card just to cover the costs until her reimbursement was received. This setup created a hardship for her that she could not avoid since she needed the prescription to be successful both on the job and in going through her day to day activities.”

“Members who have sacrificed a year for service believed that the AmeriCorps health insurance would be an incentive to serve. Members have voiced concerns of the lack of trust with the AmeriCorps brand. Members have also shared concern over the AmeriCorps supported healthcare coverage as being unrealistic for their healthcare needs. As an example, Corps Network, an AmeriCorps supported 30

Healthcare Program, reimburses member prescriptions. This poses as a challenge for members who are on a very modest stipend and cannot afford to cover a costly prescription on the front end. Therefore, enabling members form obtaining the necessary prescriptions needed to keep them healthy.”

“We have a full time member that turned 26 in mid-March, and needed to be discontinued from her parents' family policy. She inquired as to whether our AmeriCorps member health insurance policy meets the minimum essential coverage (MEC) requirements of the Affordable Care Act. We inquired by phone. Our provider informed us that the policy offered indeed does not meet the MEC as the maximum value is only $50K. The member has both an existing medical condition and family history, and also wants to remain with her existing medical provider, I believe a "preferred provider". Without going into greater detail... Suffice to say that she forced me to figure things out. In the end, we received the CNCS answers to questions that stated reimbursement by programs was allowed. The member enrolled for a very good gold level package on the Exchange. We'll reimburse most, but not all of the monthly premium. We capped the reimbursement amount at that which our AmeriCorps provider charges per member per month. The member appreciates the reimbursement. “

“We have a fourth year member who has really struggled since she joined her husband's health care. He has had to take a second job and she is looking for one as well in order to pay the additional cost. Our state did not expand Medicaid which really leaves our members hanging out to dry.”

“The Members were really confused and stressed that they needed to change health insurance. One member had to verify citizenship twice and her paperwork was lost. She was eventually able to get her coverage retro-dated, but the process was stressful for her.

“We had an applicant apply to our program last year that was truly an exceptional candidate. She had an Ivy League degree and had come from a particularly difficult area in our community. We had hoped she would serve as an inspiration to those in similar situations however, she had medical condition that required her to see a specialist multiple times per year. We tried exhaustively to work with her, her parents and her medical provider however the coverage we were able to offer was not adequate for her medical needs and she ultimately withdrew from the process. Before she left she explicitly said were it not for the lack of adequate medical coverage she would have loved to have continued on in the process.”

“We have one Member with a chronic blood condition. She receives ongoing treatment for this, which allows her to lead a perfectly normal life, but if she were to stop receiving treatment, she would die. Thus, it is imperative for her to always have health insurance. Unfortunately, she is one of our Members who does not qualify for Medicaid but cannot afford to purchase a plan on the exchange. She initially signed up for the Corps Network plan, but she is extremely worried about what will happen when she 31 completes her term of service in between open enrollment periods. We have another Member who enrolled in the Corps Network plan and, several months into the program year, was hit with several extremely serious medical emergencies. First, he was in a motorcycle accident. While in the hospital for that, the doctors discovered that he had a heart condition, so he had to have open heart surgery. We are very worried that with the $50,000 per cause maximum that is part of the Corps Network plan, this Member will now be bankrupt! We are thus very hopeful that, for next year, we will be able to offer better coverage that complies with the ACA to our Members. Thank you for taking the time to gather feedback on this critical issue!”

“We had a member leave our program specifically because of the healthcare issue.”

Positive Examples/Stories From Programs

“One member, in her fifties, with a previous existing condition, is very excited about having real health insurance “One member was coverage for the first time in her life through the ACA. She able to get her can actually go to the doctor and get prescription coverage for much medication.” cheaper that she had “One of our current members was struggling with prescription been paying. She is refills for a chronic medical condition and general access to care. As a result of the new insurance coverage provided this disabled and has lots member was able to access medical services and the of medical expenses. medications that enabled her to be here. If it hadn't been for She went from a change in coverage this member might have already exited having two plans to for personal compelling circumstances. The flip side to compliance is that currently we are providing an expensive one comprehensive option for our members which adds the financial commitment plan that meets her required to have an AmeriCorps program.” needs.” Negative & Positive Member Responses

“In addition to many other problems in the management of this organization and its AmeriCorps program, this healthcare business has been a source of stress that has severely affected my personal well-being. The thought that my only options were to either pay my own premium or pay a penalty, neither of which I can afford with an AmeriCorps stipend (which is already insufficient to cover the cost of living in the Washington, D.C. area), was so overwhelming that I seriously considered leaving the program and returning to Cincinnati to live with my parents.”

Member One: I have served 4 years in AmeriCorps. I had Summit America for the first 2 terms of service. I live in a very rural area of the Upper Peninsula and this insurance was not accepted by any of the physicians in my immediate area. I would have to drive hundreds of miles to find a physician to accept Summit Insurance. In my 3rd term of service we were lucky enough to receive Aetna Insurance that was

32 accepted and I was only responsible for the copay for medical visits. It also had minimum dental coverage and vision coverage. I used this insurance for much needed dental work and to have my eyes examined all within my home town. In January of 2014 the insurance went back to Summit America to meet the guidelines set by the Health Care Act. Then we were informed that the Summit America insurance does not meet these guidelines and the AmeriCorps members will have to pay the tax penalty on our 2014 taxes. Personally I would have rather paid the penalty on the Aetna insurance that I at least received medical benefits than the Summit America which covers nothing and I get to pay a penalty.

Member Two: This is a response for the health care issues under AmeriCorps and its effect on myself and my family. We were informed of the issues regarding our health care back in March 2014, after the Summit America plan took over Aetna as of January 2014. The information shared regarding our health care was a bit of a shock. Obviously, I had hoped that our health care would at least provide the minimum coverage as the federal law required. Given the fact that there are thousands of state and national community service members. I began my search and input on the healthcare.gov as of 3/30/14 however ran into extensive problems with getting back into the system. Due to scheduling and completing graduate school as of 3/31/14. I did not get back into the site until 4/15/14, which was the last stretch of the extended period, or so I was told, for those whom had issues getting onto the healthcare.gov site. On 4/16/14, I entered Michigan's healthy plan site under Mi Bridges received a denial and a barrage of paperwork which is confusing. I have reached out to the health care navigators at Wayne Metropolitan CAA, where I currently serve, to assist me with this process. My background is real estate and foreclosure prevention but health care is a different creature in and of itself. Under AmeriCorps, my experiences, development, and service learning has been a tremendous advantage. The issues with the healthcare have been discouraging to say the least. I truly wish there would have been more coordination with members as to maybe connecting us with navigators to help insure that some of these matters could be transitioned better. This would have been a great help. At this time, my hope is that the health care navigators can assist and that I will gain coverage. As the head of my household and two children, it is essential that I maintain this. Any lapse or additional cost at this time puts my children at risk.

Member Three: In my experience, I used the Aetna Health Care Insurance for dentistry in obtaining a single crown. Since it was my last chance of having dental insurance, I thought it would be a good idea to use it before it expired. I found that it didn’t pay much at all and now I’m stuck with a bill in which most of my AmeriCorps funds are going. I called the insurance company as I thought they were going to pay more, and they said I had $1,500 available which would’ve been great to use towards my bill, but only a small portion of the $1,500 could be put towards my specific procedure. The description I had been given about the insurance sounded better than it actually was. I am in the process of searching for a second job to pay off the bill. With the cost of rent, gas, and living expenses, it has been difficult to live on the AmeriCorps stipend. I had to buy new brakes, tires, and manual labor for my car which really set me back. I have been content with the stipend until all of the unexpected expenses came along. I think if AmeriCorps had more supportive insurance, it would make a big difference. I would feel like I’m being taken care of during my service to my 33 community. I understand there are limited funds, but I honestly feel that the amount of extra service required of AmeriCorps members should be adjusted until there is more stable support.

“Because of the late date in signing up for ACA Marketplace insurance, the payment was going to be due before the reimbursements would start from United Way of Greenville County. Fortunately I can be added to my husband's insurance since my insurance is being dropped, but this is now an extra expense for my family and we will not be reimbursed for it. It will make a difference as far as whether we can afford for me to sign up for another year as an AmeriCorps member.”

“I was getting sick with upper respiratory issues during this past winter which was linked to working with a young student population. I was able to visit the Dr. office without having to worry about the cost of the visit which helped me continue to serve in my role as an AmeriCorps member.”

“Due to the current health care plan with Summit America I will be required to get additional health insurance which will be a burden on my family. AmeriCorps

do not receive any income and the living stipend barely covers every day costs. If I am required to get additional insurance or pay a fee then this will be my first and last year serving. As someone who is from a poor family if I am required to

get additional health insurance then it will show me that this program is ONLY FOR YOUNG STUDENTS THAT HAVE THEIR PARENTS FINANCIAL SUPPORT ALL THE WAY THROUGH (or the privileged).”

34