Enrollment Policy Corner
This August, GHF invited both advocates and enrollment assisters to the second annual Getting Georgia Covered summit. Bringing these two groups together was the first step in fostering ongoing conversations and partnerships to ensure that health coverage translates into meaningful access to care for Georgians. Through the summit, GHF collected feedback and input for a report that highlights how assisters and advocates can team up for consumers. We invite you to read and share Collaborating for Consumers: How Assisters and Advocates Can Inform Policy, in which you will find opportunities and best practices for collaboration to achieve our shared goals.
With three annual open enrollment periods completed and a fourth one just around the corner, the Health Insurance Marketplace has become established as the avenue for purchasing coverage for roughly half a million Georgians. This report builds on last year’s Getting Georgia Covered: Best Practices, Lessons Learned, and Policy Recommendations from the Second Open Enrollment Period and focuses on understanding the characteristics of the people who have enrolled in marketplace plans and the experiences of consumers and the enrollment assisters who helped them. Their insights can inform the work of advocates, stakeholders, and policymakers to reach shared goals of reducing the uninsured, improving access to care, and addressing affordability for consumers.
Inside you’ll find:
- Key themes in consumer and assister experiences during the 2016 open enrollment period
- Best practices for outreach, enrollment, and reaching eligible Georgians who remain uninsured
- Policy opportunities to increase enrollment, improve access to care, and address affordability issues
Health and Human Services & Out2Enroll
Friday, June 10
2:00 – 3:30 PM ET
With the implementation of section 1557 of the ACA, understanding the nuances of LGBT enrollment is more important than ever. Section 1557 prohibits discrimination based on sex – specifically gender identity and sex stereotyping – in all health programs and activities that receive federal financial assistance through HHS, are administered through HHS, or are established under Title 1 of the ACA. For more on the implications of section 1557, click here.
Friday’s webinar is a collaboration between HHS and Out2Enroll and will cover reaching and assisting LGBT communities. The webinar is open to Navigators, In-Person Assisters (IPAs), and Certified Application Counselors (CACs).
LGBT Health Factsheets
GHF is excited to continue our partnership with Georgia Equality for another year. We will be working together to better understand health care and health insurance discrimination that transgender individuals in Georgia have experienced. Additionally, through this partnership we’ve created a series of fact sheets for the LGBT community. We will be updating them in the coming months with 1557 information.
The weather is heating up and the official start of summer is just around the corner, but here at Georgians for a Healthy Future we’re already looking ahead to one of the hallmarks of fall: open enrollment! The fourth health insurance open enrollment period, known as OE4, will run from November 1, 2016 through January 31, 2017. Stay tuned for an announcement soon about our enrollment summit – an opportunity for Georgia assisters, advocates, and other enrollment stakeholders to reflect on OE3 and plan for OE4 – scheduled for this coming August.
Earlier this spring, new renewal policies and consumer shopping tools were announced (see a roundup of these changes from Georgetown University’s Center on Health Insurance Reforms) and health insurance plans released their initial rate filings (see Georgia Health News’s coveragehere, including comments from GHF’s Executive Director Cindy Zeldin), giving us early insights into what we might expect in the upcoming open enrollment period. It’s important to keep in mind that initial rate filings provide important information to regulators, stakeholders, and consumer advocates but they aren’t a good predictor of what consumers will actually pay for health insurance this fall. That’s because proposed rates must first undergo scrutiny by regulators and don’t take into account consumer shopping behavior or the availability of premium tax credits.
While we’re busy preparing for OE4, we also know that health insurance enrollment does happen year-round (if you are engaged in enrollment activities this summer, please tweet about them using #enrollment365). Life changes like marriage, moving, or job loss can happen during any season, triggering special enrollment periods (SEPs). Awareness of SEPs is low, and assisters play an important role in helping consumers who qualify navigate the process. Despite low enrollment during SEPs, however, the Centers for Medicaid and Medicare Services (CMS) recently issued a new rule further tightening them. GHF is concerned these changes could dampen enrollment among qualified uninsured individuals. If you are an assister and are finding that qualified individuals are having difficulties enrolling in an SEP, please let us know.
Finally, if you or your organization helps consumers navigate the health coverage or health care landscape, please consider joining GEAR, the Georgia Enrollment Assistance Resource network. GHF formed GEAR last year to help members of Georgia’s enrollment community learn from each other, share consumer-facing educational materials, and stay apprised of best practices from around the country. Joining GEAR is free, and through it we provide networking and learning opportunities for individuals and organizations that assist health care consumers. And it helps GHF keep our finger on the pulse of what consumers and assisters are experiencing so we can be better advocates. Learn more here.
On May 13, the U.S. Department of Health and Human Services (HHS) issued a final rule implementing Section 1557 of the Affordable Care Act, an important milestone in the movement towards health equity. Section 1557 prohibits discrimination based on race, color, national origin, sex, age, or disability in all health programs and activities that receive federal financial assistance through HHS, are administered through HHS, or are established under Title 1 of the Affordable Care Act. As a result, most health insurance plans, facilities, programs, and providers are covered under this rule.
Notably, Section 1557 marks the first time that sex discrimination in health care is prohibited and also clarifies that gender identity and sex stereotyping are included in this definition. Because of these provisions, LGBT Georgians have protections from discrimination in health coverage and care. For specific information on the gender identity and sex stereotyping provisions of Section 1557, see Out2Enroll’s FAQhere. For Georgia-specific information about health insurance options for LGBT Georgians, check out the series of fact sheets that Georgians for a Healthy Future teamed up with Georgia Equality and The Health Initiative to release this past fall.
Discrimination against individuals with limited English Proficiency (LEP) is also prohibited in the health care programs and activities covered by the rule (defined under national origin). More than 1.3 million Georgians have LEP. In addition, the final rule requires effective communications with individuals with disabilities.
If you believe you have been discriminated against, you can file a complaint online with the Office for Civil Rights. If you are an enrollment assister looking for resources to educate the consumers you help about their protections under Section 1557, you can access FAQs and fact sheets from HHS here.
We have been hearing from enrollment assisters that consumers have been receiving 0012C or 12C letters from the IRS after they file their taxes. With the tax deadline right around the corner, we want to make sure you understand how to explain these letters to consumers and what to do about them.
The IRS sends a 12C letter to people that are on file as receiving an Advanced Premium Tax Credit (APTC), but did not include Form 8962 when they filed their 2015 taxes. Without the Form 8962, the APTC has not be reconciled. It is very important that people complete Form 8962 to reconcile their APTC because if they DON’T they will lose their APTC and cost-sharing reductions for the following calendar year.
Here’s what you need to do if you are working with someone that has received a 12C letter:
Read the letter carefully and make sure the consumer responds in a timely manner.
They MUST respond to the letter, even if they disagree with the information in the letter. If there is a disagreement, the consumer should send the IRS a letter explaining what information they think is in error. If they didn’t purchase a health policy from the Marketplace, they need to let the IRS know.
Help them to provide the information requested in the letter. This includes:
- a copy of their FORM 1095A provided by the Marketplace
- a completed Form 8962
- a copy of the corrected second page from their original return that shows the “Tax and Credits” and “Payments” sections. You must complete either the line for “excess advance premium tax credit repayment” (line 56, Form 1040, or line 29, Form 1040A) or the line for “net premium tax credit” (line 69, Form 1040, or line 45, Form 1040A)
- If they did not receive a form 1095-A, have them log in to their HealthCare.gov or state Marketplace account or contact the Marketplace directly.
Note: If they originally filed a Form 1040EZ tax return, they must transfer the information from their Form 1040EZ to a Form 1040A and include it with their response. Form 1040EZ does not have the designated lines needed to carry forward amounts from a Form 8962.
How to respond to Letter 0012C:
The response can be sent by fax to the fax number on the Letter 0012C. It can also be mailed to the address listed at the beginning of the letter. Be sure to include a copy of the letter with the response. Detailed information on the Letter 0012C can be found here.
If you have any questions about this information, please contact Pranay Rana.
Note: If the consumer worked with a tax preparer, you should consider having them work with their preparer to fix the issue. You should share this information with their tax preparer.
Provider directories, or the listing of health care providers that are participating in a particular health plan, are intended to inform patients and consumers about which doctors are in their plan and how they can contact them to set up an appointment. For these directories to serve as the tool that consumers need, they must be accurate and up-to-date. A secret shopper survey conducted by the statewide consumer health advocacy organization Georgians for a Healthy Future, however, found these directories to be error-ridden, a problem that places consumers at risk when they seek to access an appropriate in-network health care provider. An analysis of four provider directories associated with plans offered by three of the state’s largest insurers found:
» Three-quarters of the listings had at least one inaccuracy (not in-network, not accepting new patients, not practicing at the location listed, inaccurate or inoperable phone number, or languages spoken inaccurately listed)
» One in five health care providers listed as participating in a plan’s network were not; in one directory forty percent of the providers listed were not actually participating in the plan » Among the providers who were confirmed to be in-network, thirteen percent were not accepting new patients; in one directory one in four confirmed in-network providers were not accepting new patients
» Fifteen percent of telephone numbers associated with providers listed in the directories were inaccurate or inoperable
These inaccuracies and usability limitations make it difficult for health care consumers, particularly those who haven’t had insurance before, to find and access an appropriate medical care provider. Setting basic standards for provider directories and protections for the consumers who rely upon them would go a long way towards making provider directories the tool that patients and consumers need when they shop for and use their health insurance.
Download the full set of findings here.
We want to hear from you – new SEP rules
At the beginning of last year’s open enrollment period, GHF created GEAR, the Georgia Enrollment Assister Resource Network (GEAR). GEAR is a coalition of enrollment assisters and those closely involved in the enrollment process. Now the open enrollment is passed, GEAR is turning to tax time and special enrollment periods (SEPs). Last month, CMS announced the new special enrollment confirmation process. Georgians will now be required to provide sufficient proof to the marketplace to determine their SEP eligibility. Failure to provide supporting documents may lead to the denial of coverage. At GHF we advocate for policies that make enrollment in health insurance more inclusive and fight policies that put up unnecessary barriers. We want to hear from you about this! If you’re an enrollment assister and are experiencing trouble enrolling consumers during a special enrollment period, let us know! If you’d like to join the GEAR network, you can do that here.
As consumers navigate the new landscape of increasingly narrow networks and high deductibles, they need the right tools and information to choose a health insurance plan that best fits their medical needs and their household budgets. Provider directories are the primary tool available to consumers to determine whether the plan they are selecting has a narrow or broad network and to identify which providers are in their plan. As such, these directories should be accurate, up-to-date, and should truly function as a tool. Despite the important role directories play, they are notorious for being rife with errors and for lacking the functionality to help consumers make optimal choices in the market. By drawing upon model legislation from the National Association of Insurance Commissioners (NAIC) and best practices from other states, Georgia can take steps to improve directories. This policy brief:
– explains the role provider directories play as a tool for consumer decision-making
– describes current provider directory provision in Georgia
– describes common problems with provider directories
– outlines recent policy activity around provider directories
– highlights other state examples of provider directory improvements
When consumers enroll in a health insurance plan, they gain access to a network of medical providers. This network must be adequate to ensure that consumers enrolled in the plan have reasonable access to all covered benefits. While network adequacy is not a new concept, it has a new urgency in light of the sheer number of newly insured Georgians enrolled in individual plans; the move on the part of insurance companies toward narrow networks and tiered networks, which limit the number of providers plan enrollees can access; new federal standards; and a new model act from the National Association of Insurance Commissioners (NAIC) that provides updated guidance for states. Georgia health care consumers need and deserve clear standards and protections that ensure their coverage translates to access to care without financial hardship. Georgians for a Healthy Future released today at a public policy form held in Atlanta a new policy brief on network adequacy. This policy brief:
– explains the importance of network adequacy for access to care
– outlines current network adequacy standards in Georgia
– summarizes recent policy activity around network adequacy
– sets forth consumer-oriented principles for network adequacy standards in Georgia
– provides policy recommendations to achieve network adequacy in Georgia.