*Success stories/Barriers

Please complete the following two questions as it related to your health center:

1.)    Major outreach and enrollment issues/barriers encountered for your health center in this reporting period 7/1/2013 - 9/30/2013?

2.)    Key strategies and lessons learned that have contributed to the success of your health center outreach and enrollment efforts in this reporting period?

HHS recently posted stories about individuals who enrolled in the Marketplace at the HHS storyboard. It's encouraging to read through some of these stories, and be reminded about the importance of the work we are doing together to enroll people in coverage. Take a look at this video profiling Daniel, a young man in Florida, or another video about Deborah from New Hampshire, who had a pre-existing condition and is excited about her coverage that starts in January 2014.

Consumers can always share their stories using the hastag #GetCovered on Facebook, Twitter, and Pinterest. (share this with consumers)

Marketplace Tech Update

In the past week, the Marketplace has made great strides to improve the online system and encourage you to utilize the online system as your first option for enrollment. The Marketplace continues to improve the overall user experience each week on HealthCare.gov, so that by the end of November the site will be functioning smoothly for the vast majority of users. CMS is working through the list of items to improve the HealthCare.gov marketplace functionality.  The tech team has put into place fixes to address performance and functionality and will continue to make progress each week.  They have added a blog entry  that will be updated with information about the latest fixes and current plans to improve the website.  It contains links to the following:   

• HealthCare.gov: Improving the Account Registration Process 
• Clearing Up the Facts  
• More on the Tech Surge 
• Continued Improvements to HealthCare.gov

Tips for Assisting Consumers

To make sure that consumers appropriately fill out the application, the Marketplace have a few tips below about attesting that someone will file taxes in 2014 and that the person will not be enrolled in comprehensive Medicaid in 2014.

• Filing Taxes: If you are helping someone file an application and they want to be considered for financial assistance, including advance premium tax credits ("APTC") or cost sharing reductions (CSRs), they must file taxes. Filing taxes is a requirement to get APTC. If someone wants to be considered for APTC / CSR, they need to express that they will file taxes in 2014, even if they have not filed taxes in the past. If the consumer does not indicate that they will file taxes in 2014, the consumer will be determined ineligible for APTC because the consumer will have attested on their application to being a non-filer (not filing taxes in 2014).  This information is important for all assisters to become familiar with.  When you help someone fill out the application, please make sure that the consumer expresses that they will file taxes by checking "Yes" on p. 2 of the family paper application. Question 6 on page 2 asks, "Do you plan to file a federal income tax return NEXT YEAR?" If the consumer wants to be considered for APTC/CSR, they should check "yes" here.

• Medicaid that will end before January 1, 2014: If you are helping someone who has Medicaid now but it will end before January 1, 2014, that person can apply to buy private insurance through the Health Insurance Marketplace. Depending on his or her household income and size, he or she may qualify for  lower costs on premiums or out-of-pocket costs.
•  Note: When filling out an application, consumers should not check the box saying the person has Medicaid, because the coverage will be ending. Check "No" or "None of the above" instead.  For example, look at p. 6 on the family paper application, step 4, question 1.    In addition, please refer to our FAQ on HealthCare.gov at What if I have Medicaid coverage, but I got a notice saying my Medicaid will end? 

• Medicaid that provides limited benefits: If you are helping someone whose Medicaid coverage pays only for family planning, emergency Medicaid, tuberculosis services, or outpatient hospital services, the consumer can apply for coverage through the Health Insurance Marketplace . He or she could get this coverage in addition to his or her Medicaid coverage. Depending on the household size and income, the person may qualify for lower costs on their monthly premiums  and out-of-pocket costs.
•  Note: When you fill out a Marketplace application and are asked whether the person has coverage now, don't check the box saying you have Medicaid. Check "No" or "None of the above" instead.  For example, look at p. 6 on the family paper application, step 4, question 1.  What if I have Medicaid now, but I only have limited benefits? 

• Enrolling in a plan by March 31: CMS posted an FAQ clarifying that consumers who sign up for Marketplace coverage at any time during the initial open enrollment period will not be subject to the shared responsibility payment (the mandate penalty).   The  policy FAQ can be found on the CCIIO website.  Consumer-friendly language can be found on HealthCare.gov at under "Enroll by March 31, 2014 and You Won't Have to Pay the Individual Responsibility Payment."

Issue of the Week: What Works at Outreach and Enrollment Events

We are thrilled to hear about some amazing events that are happening across the country where assisters are reaching out to people and encouraging them to enroll in coverage.   Using the early experience, we've put together some tips on "what works" at these outreach and enrollment events.

• Timeliness of staff: Make sure your team is responsive, on time and willing to work side-by-side with other groups supporting enrollment, from set up to break down.
• Equipment: Make sure you have a plan for coordinating the equipment, for providing laptop computers, a tablet and continuous internet access on site.
• Separation of booth space: Have a dedicated area (table and chairs) for enrollment assistance, in addition to an area for outreach. It helps with the flow of attendees to have separate places for people to sit at the booth. Be sure to allow for privacy in the area where you will be helping with enrollment assistance.
• Branding: Consider ways to promote a unified "brand." Materials and T-shirts that make the whole group look as one cohesive unit can be effective.
• Language capability: Know your population and try to coordinate so that you can provide assistance in the language people feel comfortable with. It's a good idea to have a balance of English-speaking assisters and assisters who speak other languages for some events.
• Definition of roles: Develop a "run-of-show document" or do a quick meeting prior to starting the event with all of the event staff to understand what each member of the group is responsible for during the event.
• Visitors counter equipment: Have a way to keep an accurate count, consider what additional equipment, like a "booth counter," or whether you have a dedicated staff member to perform that function. After the event, it will be important to have a running tally of booth visitors.
• Additional means of capturing attention from event attendees: Think of creative ways to garner attention for the booth!   You can attract greater traffic to a booth through innovative mechanisms, such as a Zumba class or by using the PA system to ask on-lookers to stop by if they need additional information on the Health Insurance Marketplace. These are great ways to successfully drive greater traffic to your booth.
• Later consultations: Have mechanisms to collect information from booth attendees that need additional information to schedule follow-up consultations. It can be an extremely helpful way to manage traffic, make the most out of brief interactions, and continue the conversation after the fact. Make sure you get the attendee's permission to collect their personally identifiable information!

Helpful Tools and Information

Starting 2014, most individual plans must offer new benefits and protections. Some plans will be changed or replaced with upgraded plans with these protections. If this happens, a consumer can choose to buy a plan in the Health Insurance marketplace instead. All Marketplace plans include the new benefits and protections. If the person switches to a Marketplace plan, he or she may qualify for lower costs based on his or her income.

 Given the changes required in 2014, insurance companies offering individual plans have two choices:

• They can make upgrades to the person's plan to provide these benefits. If they do, the person will see these changes to his or her plan by the time he or she renews during 2014. For example, if the person's renewal date is in July 2014, he or she would see the changes no later than July.
• The insurance company may cancel the plan and decide to offer the person other individual plans.

Under the Health Insurance Portability and Accountability Act (HIPAA), a law in place before the Affordable Care Act was passed, individual policies are generally "guaranteed renewable" at the end of the 12-month contract. The insurance company can increase premiums, increase cost-sharing, and/or reduce the scope of benefits covered.

The insurer may stop offering the plan entirely if it meets all of the following requirements. It must:

• Provide the consumer with at least 90 days' notice in writing
• Offer the consumer the choice to buy any other individual plan it offers in that market
• Treat all covered individuals the same, regardless of health status
• Follow any additional state requirements

The only time an insurer can cancel an individual plan without offering the consumer the chance to buy a new plan is if the insurer chooses to end all health insurance in a state's individual market. If an insurer ends all coverage, it can't offer coverage in that state's individual market again for 5 years. It also must notify the state and all plan holders in writing at least 180 days before stopping coverage.

In addition, insurance companies can't market plans in a way that discourages people with significant health needs from enrolling.

If there is concern that an insurance company isn't following these rules, contact the State Department of Insurance.

If the consumer's plan is being cancelled or replaced with one that costs more, he or she can use the Health Insurance Marketplace to find a new health plan.

The Marketplace recently posted a helpful fact sheet that you can review.

You can see consumer-friendly language about plans that are changing or not being renewed in 2014 on HealthCare.gov.