GEAR

PREPARATIONS FOR OE-4: TIPS FOR ENROLLMENT ASSISTERS

Keeping it Simple for Consumers:

Not all consumers can translate the Federal Poverty Level (FPL) and the percentages easily. You can keep it simple for your consumers by explaining income and eligibility with the example table given below.

For example, instead of saying, “You can qualify for tax credits if you fall between 100% and 400% of the FPL,” you can say, “For your family of two, you qualify for tax credits if your income is between $16,020 and $64,080 per year”.

KEEPING IT EASIER ON YOURSELF

As you know, there are people that come to you for help that have specific needs that require extra time and resources. Some consumers may have language needs, some may have specific needs related to health conditions or identity such as, people living with HIV/AIDS, refugees and immigrants, and those that identify as LGBTQ. In such cases, you can refer them to organizations that have more experience working with these types of cases or seek these organizations’ technical assistance. Below are some such organizations and their specialty areas:

For consumers who need application assistance over the phone 

Insure Georgia: 1-866-988-8246

For enrollment concerns related to Asian-American immigrants, consumers with Limited English Proficiency (LEP), and refugees 

Center for Pan Asian Community Services (CPACS): 770-936-0969

Boat People SOS (BPSOS): 770-458-6700

For enrollment concerns related to LGBTQ and people living with HIV/AIDS 

The Health Initiative: 404-688-2524

GAPHC Navigator Vincent Spann: 404-291-5302

You may also email Pranay for help finding resources. He can be reached at 404-889-5673 x4. You may also find more information on our GEAR page.

MARKETPLACE RESOURCE HIGHLIGHT

Changes to Exemptions Based on Tribal Membership, Incarceration Status and Participation in Healthcare Sharing Ministry: In-the-Loop 

This resource provides details on the Marketplace updates for the above-mentioned exemptions. As of September 1, 2016, the Marketplace will no longer process these requests. Consumers are required to request these exemptions while filing their taxes. For more information on eligibility and how to apply, please us the links below:

Exemption for American Indians, Alaska Natives, or people eligible for Indian health services

Exemption due to incarceration

Exemption for members of a health care sharing ministry

MEET THE GEAR TEAM

Pranay Rana is a certified enrollment assister and is GHF’s Consumer Education and Enrollment Specialist. Whitney Griggs is our Outreach & Engagement Manager. Together they manage the GEAR Network. Have a question you’d love to see GEAR address? Let them know!

THANK YOU FOR ATTENDING OUR 2ND ANNUAL ENROLLMENT SUMMIT!

Georgians for a Healthy Future would like to thank everyone who attended our 2nd annual enrollment summit, Getting Georgia Covered: How Consumer and Assister Experiences Can Increase Enrollment and Inform Policy. We had individual breakout sessions for both assisters and advocates and each group discussed best practices for informing policy. The enrollment breakout enjoyed a lively conversation and we appreciated everyone’s feedback on the collaborating roles of assisters and advocates. At the event, GHF released our new policy report, Getting Georgia Covered: What We Can Learn from Consumer and Assister Experiences During the Third Open Enrollment. This report identifies key themes in consumer and assister experiences during the 2016 open enrollment period; describes best practices for outreach, enrollment, and reaching eligible Georgians who remain uninsured; and identifies policy opportunities to increase enrollment, improve access to care, and address affordability issues.

KUDOS TO THE TEAMWORK ON SECTION 1557 ACRONYMS: NOC-DARS AND SILVER

Section 1557 of the Affordable Care Act prohibits discrimination based on race, color, national origin, sex, age, or disability in all health programs and activities that receive federal financial assistance through the Department of Health and Human Services (HHS), are administered through HHS, or are established under Title 1 of the Affordable Care Act. Kudos to veteran navigator Vincent Spann with GAPHC who introduced these acronyms at the enrollment assister and direct service provider breakout session during this month’s enrollment summit. These acronyms can help assisters understand and identify the discrimination types and report the incident correctly.

NOC-DARS: Discrimination Types 

NO – National Origin
C – Color
D – Disability
A – Age
R – Race
S – Sex

SILVER: Reporting Discrimination

S – State where the event took place
I – Institution involved
L – List details
V – Violation Type
E – Evidence
R – Representative involved

If you know someone who has experienced discrimination, please let us know. GHF has partnered with Georgia Equality and the Health Initiative to help Georgians who have faced discrimination and prevent it from happening again. Click here for more details.

RESOURCE HIGHLIGHT

Healthcare Value 101: An Introduction or Refresher on Healthcare Cost and Quality Issues
Healthcare Value Hub; September 16, 2016
This webinar from Consumers Union will explore the major drivers of healthcare, how healthcare costs can be minimized, and value increased. This will be a good resource for enrollment assisters to learn more about healthcare value and how it affects consumers. Assisters may also be able to identify healthcare cost related issues and potential ways to work with advocates for addressing consumer concerns and inform policy.

Get Insured. Stay Insured Videos
Georgians for a Healthy Future 
GHF recently released this five-part video which walks through questions consumers may have when enrolling in health insurance such as why is health insurance necessary and what plan is the best. It also goes through post-enrollment questions such as how to use health insurance and how to find a doctor. This is a great tool for enrollment assisters to use for outreach.

MEET THE GEAR TEAM

Pranay Rana is a certified enrollment assister and is GHF’s Consumer Education and Enrollment Specialist. Whitney Griggs is our Outreach & Engagement Manager. Together they manage the GEAR Network. Have a question you’d love to see GEAR address? Let them know!

REMINDER – PLEASE JOIN US FOR GETTING GEORGIA COVERED: HOW CONSUMER AND ASSISTER EXPERIENCES CAN INCREASE ENROLLMENT AND INFORM POLICY

August 16, 2016, 8:30 AM – 2:00 PM
Sloppy Floyd Building
20th floor, Floyd Room 200 Piedmont Ave.
Atlanta, GA 30334 

This will be our second annual enrollment summit and this year we are focusing on strengthening relationships between the health policy community and the enrollment assistance community. Confirmed speakers include:

• Dr. Pamela Roshell, Region IV Director, US Department of Health and Human Services
• Dr. Bill Custer, Director of the Center for Health Services Research and Associate Professor, J. Mack Robinson College of Business, Georgia State University
• Health Bates, Deputy Director, Enrollment Assister Network, Families USA
• Sandy Anh, Associate Research Professor, Georgetown University Center on Health Insurance Reforms
• Whitney Griggs, Outreach & Engagement Manager, Georgians for a Healthy Future

Enrollment assisters will be able to hear from national partners, discuss ideas on how to reach the remaining uninsured, and other topics related to open enrollment. New for this year, there will also be a session just for advocates to discuss how enrollment trends and consumer experiences with enrollment can inform health policy in Georgia. Lunch will be provided for this free event. RSVP here.

UPDATES FOR JULY

Georgia Navigator License Renewals 

Just a quick reminder that Georgia navigator licenses expire at the end of August 2016. Make sure you check with your program manager for organization specific requirements. Renewals can be done using this form. For more information visit www.oci.ga.gov/navigators. This is different from the federal licensing requirement, which you can learn more about here. If you have specific questions about renewal requirements please reach out to Pranay.

Advancing Health Equity for LGBT Georgians

Georgians for a Healthy Future is working with Georgia Equality and The Health Initiative to help Georgians who have faced discrimination in health care report it so we can help stop it from happening again.

If you encounter someone who believes they have been discriminated against, send them to this link to file a complaint online with the Office for Civil Rights. Please also tell us about your experience so we can help them navigate the complaint process and identify systemic issues that should be addressed through public policy advocacy.

Calculating Modified Adjusted Gross Income (MAGI) – A Refresher

We all know how hard estimating, entering, and verifying income can be. Perhaps one of the most difficult tasks is understanding exactly what counts as income. Fortunately, the team at In the Loop has created a number of resources to help you understand how to calculate MAGI. This includes their newest resource, MAGI 101, a great refresher for both new and old assisters. They also have a MAGI expert on staff to help you with your really complex issues!

Families USA Enrollment Assister Resource Center

While we’re on the topic of reminders, it’s a great time to go back to the Families USA’s Enrollment Assister Resource Center. There you’ll find tips, tools, resources, and webinars that will make your job easier. As you’re preparing for the next open enrollment period, check out their resources and see if there’s anything that you can use!

MARKETPLACE RESOURCE HIGHLIGHT:

Complex Cases: Assisting victims of Domestic Violence: CMS
This resource describes the eligibility criteria for victims of domestic violence to enroll into the Marketplace during a special enrollment period (SEP). This SEP can be requested by calling the Marketplace at 1-800-318-2596 and is not accessible via healthcare.gov.

Immigrant Eligibility for Health Coverage: In the Loop
This is a detailed resource which takes a deep dive into ACA questions for immigrants including eligibility, APTC, mixed status families, undocumented immigrants and more.

Ambetter Contact Information
Do you have a consumer enrolled in Ambetter that has a complex issue? You can reach out to Jeremy Gillespie at 1-312-619-3033 or email him at jegillespie@centene.com to get assistance.

MEET THE GEAR TEAM

Pranay Rana is a certified enrollment assister and is GHF’s Consumer Education and Enrollment Specialist. Whitney Griggs is our Outreach & Engagement Manager. Together they manage the GEAR Network. Have a question you’d love to see GEAR address? Let them know!

SAVE THE DATE FOR GHF ENROLLMENT SUMMIT

August 16, 2016 8:30 AM – 2:00 PM
Sloppy Floyd Building, 20th floor Floyd Room
Atlanta GA

Please join us for our second annual enrollment summit Getting Georgia Covered: How Consumers and Assister Experiences can Increase Enrollment and Inform Policy. This summit will highlight the relationship between advocates and enrollment assisters and how they can inform each other’s work. Speakers include representatives from the Georgetown Center for Health Insurance Reforms, Families USA, and Region IV Health and Human Services. Enrollment assisters will learn from national partners, discuss how to reach the remaining uninsured, and other open enrollment topics. Learn more and RSVP here.

CONSUMER COMPLAINTS TOOLKIT

This resource from Community Catalyst covers a wide variety of consumer complaints topics and provides tips for enrollment assisters, advocates, and health care providers to understand the complaint process, help file complaints with relevant state agencies, and engage in state-based advocacy to improve the complaints process. The toolkit includes the following resources:

1. Using Complaints to Address Discrimination in Care for Mental Illness and Substance Use Disorders
2. Filing a Consumer Complain About Health Insurance: A Step by Step Guide
3. Working with Your Department of Insurance (DOI): Tips for Advocates
4. Working with Your Attorney General’s Office (AG) on Parity: Tips for Advocates
5. Advocacy Priorities on Health Care Consumer Complains

CLARITY ON MEDICAID AS MINIMUM ESSENTIAL COVERAGE (MEC)

It is important to understand the intersection of Medicaid and MEC when helping consumers enroll and avoid fines. This article from Georgetown Center for Children and Families provides key information on this topic. Certain Medicaid coverage that only provides limited benefits such as family planning (Planning for Healthy Babies), emergency Medicaid, or Tuberculosis services are not considered MEC. Those that count as MEC include Medicaid coverage for premium assistance, coverage for disabled children and adults, PeachCare for Kids, and Age-Blind-Disabled Medicaid.

MARKETPLACE RESOURCE HIGHLIGHT

Jobs you Don’t See Every Day: In the Loop

This In the Loop weekly update from June 21, 2016, includes a collection of tips and tricks from enrollment assisters working with consumers who have irregular jobs including self-employed, family business, truck drivers, temporary workers, migrant workers, and school employees. This tool helps enrollment assisters to determine the eligibility for some of these groups and can help calculate income for the others.

MEET THE GEAR TEAM

Pranay Rana is a certified enrollment assister and is GHF’s Consumer Education and Enrollment Specialist. Whitney Griggs is our Outreach & Engagement Manager. Together they manage the GEAR Network. Have a question you’d love to see GEAR address? Let them know!

UNINSURED RATE FALLS TO HISTORIC LOW – THANKS TO YOU!

As you may have heard, the uninsured rate has fallen to a historic low. This is due in large part all of YOUR hard work helping people enroll in health insurance. 

All about SEPs

While much of the open enrollment heavy lifting has died down, we know that there is still a lot of work to be done outside of open enrollment, especially around Special Enrollment Periods. As we have mentioned before, Centers for Medicare and Medicaid Services (CMS) has tightened the documentation requirements for SEPs, which may cause consumers to have problems enrolling. If you have encountered this, we want to hear from you! Please reach out to Pranay if you come across any instances of documentation requirements preventing someone from enrolling during an SEP. CMS is still accepting comments on the new SEP rules, so it is important to hear from enrollment assisters about what you are experiencing. If we do get feedback from GEAR members, Families USA would like to hear from us and incorporate that feedback as they draft their own comments.

Another SEP change going into effect in July is the “permanent move” requirements. To be eligible for this SEP, consumers must have had minimum essential coverage for at least one day in the 60 days prior to their move. This is a change from the current rule that allows any consumer to enroll in coverage if they move to a new service area, regardless of prior coverage. Exceptions apply for consumers who are moving from another country, were previously incarcerated, or are moving from a non-expansion state and are newly eligible for tax credits.

This updated SEP fact sheet from CMS details the new guidelines.

Resource Highlight – Rural Area Fast Facts from CMS

Do you work in rural Georgia? Much of the state is considered rural and these areas come with unique challenges for outreach and enrollment. Consumers in rural areas may be hard to reach, face limited choice and access to care, have concerns over affordability, face barriers to communication, and lack transportation. CMS has released a fact sheet to help address the needs that consumers in rural areas may have.

New Marketplace Resources

When a Bill Becomes a Coverage Appeal: A Basic Overview
Webinar – Families USA

Healthcare Eligibility for Justice-Involved Individuals
In the Loop

UPDATES AND CHANGES IN THE MARKETPLACE

Assister Help Resource Center (AHRC) Closed for the Season

The AHRC, a platform provided to enrollment assisters for post-enrollment assistance, is closed for the season as of April 15, 2016. We will let you know when it opens back up.

SEP for Consumers Moving out of the Coverage Gap 

Under CMS eligibility rules that began in April 2015, consumers moving out of the coverage gap because of income changes have 60 days from the date of income change to apply for coverage. This SEP is only available via phone request and cannot be done online. Enrollment assisters may need to take the consumer’s SEP application to the Marketplace supervisors if the first line of Marketplace representatives seem to be unfamiliar with this type of request.

Tax Filing and Reconciliation: Helping Consumers with IRS Letter 12C

Wait! Tax related work isn’t over yet. Tax filing period may be over but consumers may still need follow-up assistance. Enrollment assisters have been reporting that some consumers have received 0012C or 12C Information Request letters from the IRS after filing their 2015 taxes. 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 Information Request letter to those people that received an Advanced Premium Tax Credit (APTC), but did not include Form 8962 (Premium Tax Credit) with their 2015 taxes. Without Form 8962, the APTC cannot be reconciled. If consumers do not complete Form 8962 as part of their 2015 taxes, they will lose their APTC and cost-sharing reductions for the 2016 calendar year.

RESOURCE HIGHLIGHT

New Retiree Coverage 

Do you assist new retirees? This flowchart developed by In-the-Loop helps simplify the health insurance choices for new retirees who are not yet eligible for Medicare.

NEW MARKETPLACE RESOURCES

Assister Guide to the Immigration Section of the Online Marketplace Application 
CMS

Lessons Learned from the Third Open Enrollment Period 
Families USA

THANK YOU FOR MAKING OUR DEBRIEF A SUCCESS!

Thank you to everyone who joined GHF, HHS, and Enroll America for the OE3 debrief! We appreciate everyone’s feedback on what went well, what can be improved upon in the future, and plans for OE4. We had great participation from all the partners in attendance and look forward to continuing to work with all of you. If you have any questions or comments about the debrief, please contact Whitney at 404-567-5016 x 5.

NEW SEP REQUIREMENT AND A DEEP DIVE INTO TAX FILING

New SEP requirements – We want to hear from you!

CMS recently announced new requirements that require enrollees to provide proof for SEP enrollments. Failure to provide supporting documents may cause the Marketplace to deny an SEP. At GHF, we want to make sure that this new requirement is not putting up unnecessary barriers for consumers. If you are experiencing problems enrolling consumers during a special enrollment period due to the new requirements, we want to hear from you! Please use this SEP story collection form to let us know about any issues you may be experiencing. Once completed, please return the form to Pranay.

Say what??? Do you know how to allocate and reconcile premium tax credits for shared policies? 

Buckle up – we’re going to deep dive into a complex issue that has been popping up for enrollment assisters: shared policy allocation. What is that? Shared policy allocation is when consumers who receive tax credits as a household (i.e. a married couple or a family) need to split up their tax credits because they are now filing taxes separately. If allocation is not done properly, it may lead to tax filing complications and a delay in tax returns.

Here’s what you need to know: Allocations are reported on Part IV lines 30 – 33 of the form 8962. Allocation can be done in three different ways: (1) agreement based (2) non-agreement based and (3) 100% allocation. For more information please check our new resource.

We know this is tricky! If you have any questions or would like more information please contact Pranay at 404-567-5016 x 4.

POST ENROLLMENT EDUCATION

As we all know, enrollment is a year round activity. However, once tax season is over you may have a bit more time on your hands. The months between open enrollments are a great time to do post enrollment education. Our GEAR resources provide a wide range of post-enrollment assistance materials for enrollment assisters.

Finding a Primary Care Provider

Health Insurance Complaints and Appeals

ACA and Taxes

If you have any questions regarding post-enrollment assistance and resources, let us know!

RESOURCE HIGHLIGHT

Guidelines on Overlapping Medicaid and Marketplace Enrollment

Have you dealt with consumers that have had overlapping Medicaid and Marketplace coverage? It can be tricky, but the IRS has finally released guidelines on how to handle these situations. Fortunately, our friends at the Georgetown University Center for Children and Families have written a blog post to help explain the IRS guidelines. This resource is also helpful for anyone working with a consumer that had a retroactive Medicaid eligibility determination.

Plain Language Working Group – In the Loop
Plain language materials can be very helpful while assisting consumers. A group of In the Loop enrollment assisters has come up with “plain language” explanations of health insurance terms and concepts to better help consumers understand complex health insurance terms. This resource from the plain language working group aims to increase consumers’ understanding and confidence as they make decisions about their health insurance.

NEW MARKETPLACE RESOURCES

Premium Tax Credits Tips and Tricks 
Health Reform: Beyond the Basics

Tax Filing Preparation: FAQs in the Navigator Resource Guide 
CHIR Blog

GREAT WORK GEORGIA ENROLLMENT ASSISTANCE COMMUNITY!

Congratulations to All!

OE-3 ended with a tremendous success with 12.7 million consumers enrolled nationally and 587,845 enrolled in Georgia.We would love to hear some success stories from the GEAR network! If you have a success story that you would like to share, email Pranay!

Helping Consumers Use Their Coverage

Now that Open Enrollment is over, you can focus on helping the newly insured understand how to use their coverage and navigate any issues they may have. GHF has created a variety of resources to do just this! Some of these resources are highlighted below, and you can find more on our website.

So You’re Covered, Now What?

How to Find a Primary Care Provider

Preventive Services

Appeals and Complains

Health Insurance and Taxes

SEP Screening Gets Tighter!

On February 24th CMS announced The New Special Enrollment Confirmation Process. Consumers in 38 states using healthcare.gov, including Georgia, will now be required to provide sufficient proof to the marketplace to determine their SEP eligibility. This will certainly add more work at the consumers’ end and may limit SEP enrollments. As SEP screening get tighter, consumers will need to be more proactive in acquiring SEP eligibility documents.

ACA and Tax Filing

Join Us for a Webinar on the ACA and Taxes

In the next two months, consumers may come to you looking for assistance with reconciling their 2015 Marketplace coverage on their tax return. To learn more about the Marketplace and tax filing requirements, please join us and Elise Blasingame from Georgia Watch on our GEAR webinar series titled The ACA and Taxes for Enrollment Assisters on March 1^ST at 2:00 PM.

Tax Filing Forms

Anyone with minimum essential coverage (MEC) in 2015 needs to report their health coverage on their 2015 tax return. Everyone that had coverage in 2015 will receive one of the following forms, depending on where they got their coverage:

1095-A — Marketplace (Healthcare.gov) coverage

1095-B — Medicaid, Medicare, Peachcare, individual plans outside the marketplace, other coverage through DHHS designated as minimum essential coverage

1095-C — Employer-based coverage

You can learn more about the forms here. You can also find more information in our Health Insurance and Taxes resource.

National Resource Highlight

Special Enrollment Period Announcement – CMS

In February, CMS announced a special enrollment period for those consumers who do not currently have marketplace coverage due to failure to file and reconcile 2015 taxes. This special enrollment period runs from February 1 to March 31, 2016.

New Marketplace Resources

Special Enrollment Periods Webinar

Beyond the Basics

Reporting Health Coverage on IRS Tax Forms
In the Loop

2016 Federal Poverty Guidelines 
Families USA

If you have any resources that you would like to highlight in GEAR, please send them to Pranay.