Last week, the Health Resources and Services Administration (HRSA) announced approximately $58 million in awards made available through the Community Health Center Fund in the Affordable Care Act (ACA). These awards will support 1,157 health centers across the nation currently working to enroll uninsured Americans in new health insurance coverage options made available by the ACA.  With these funds, health centers will be able to expand their enrollment assistance efforts as more Americans enroll into affordable health insurance coverage. More specifically, this will help health centers to meet immediate needs, including expanding the hours of their existing Outreach and Enrollment assistance workers, and hiring new or temporary Outreach and Enrollment assistance workers.

Eligible applicants were Health Center Program grantees who received outreach and enrollment funding from HRSA in FY 2013.

Press Release: Health Centers to Help Uninsured Americans Gain Affordable Health Insurance Coverage 

List of health centers receiving this funding: Outreach & Enrollment Assistance Awards to Health Centers 

Q:  It looks like some people who have received their eligibility results can't reset their application and start over, but other people can.  Why is this happening?

A:  You are right, currently the option to remove an application is not enabled for individuals who have already enrolled in a QHP, and also is not enabled for individuals who have already received affirmative eligibility determinations for Medicaid and CHIP.  This is because the information about applicants who have already enrolled has been sent to the insurance company, and information about applicants who are Medicaid or CHIP eligible has already been queued for sending to the state Medicaid and CHIP agencies.  If the Medicaid or CHIP agency finds that the individual is not eligible, the state agency will transfer the account back to the Marketplace and the applicant will have an opportunity to get APTC at that time. 

This is something we are still working on, because we know some consumers are questioning their eligibility determinations.  We are working on some strategies to help people who think they may have received an incorrect determination for Medicaid and CHIP, especially if their application was submitted early in the open enrollment period.  We will be in touch to let you know if the option to reset the application becomes available for more consumers.  In the meantime, the fact that these types of consumers can't remove their applications from the website is not a defect. 

Q:  If an applicant who has not been assessed eligible for Medicaid asks to have a full determination for Medicaid (e.g., they check the box next to their name on the results page and press the "Send to Medicaid" button), does the rest of the application process stop and wait for an answer from the Medicaid agency?

A:  No.  An applicant who has been determined eligible to enroll in a QHP and/or to get a premium tax credit, may continue to plan selection and enrollment even if they choose to send their information to the state for the state Medicaid agency to do their own check on the individual's eligibility.  If the applicant ends up being Medicaid-eligible, the Medicaid agency will let the Marketplace know, so the Marketplace can terminate the premium tax credit if necessary.  Applicants who choose to get a full determination by the Medicaid agency, or whose information is sent to the Medicaid agency because the individual has a disability, can still enroll in a plan through the Marketplace to be sure they have coverage on January 1st.

Q:  How should consumers respond to the question about tobacco use that is part of the Plan Compare feature?

A:  If a consumer is a regular tobacco user, insurance companies may be allowed to charge that person a higher premium.  The question about tobacco use is very specific. The question asked on the application is this:  Within the past 6 months, have you used tobacco regularly?  Regular tobacco use is defined next to the question as "using tobacco 4 or more times per week on average, excluding religious or ceremonial uses."  This question will be asked for each member of the household who is over the age of 18 and seeking health coverage. 

When you are assisting consumers, you should tell them to answer this question truthfully.  So, if during the past 6 months, they have used tobacco 4 or more times per week, on average, they should answer yes to the question on whether they use tobacco regularly.  The only exception to this is if they are using tobacco for religious or ceremonial purposes.  Religious or ceremonial use of tobacco does not count as "tobacco use" when determining whether an individual uses tobacco regularly.   

If a person answers "yes" to the question about regular tobacco use, they will also be asked on the application to provide the date when they last used tobacco regularly.  This question should be answered truthfully for each household member who answered yes to the question about regular tobacco use. 

Q:  What is acceptable documentation for income?

A:  The list of acceptable documentation for self-employed income is as follows:

• Wages and tax statement (W-2)
• Pay stub
• Letter from employer
• Self-employment ledger
• Cost of living adjustment letter and other benefit verification notices
• Lease agreement
• Copy of a check paid to the household member
• Bank or investment fund statement
• Document or letter from Social Security Administration (SSA)
• Form SSA 1099 Social Security benefits statement
• Letter from government agency for unemployment benefits

These documents don't necessarily need to be dated for 2014.  For example, consumers can provide recent pay stubs if they don't expect their income to change in 2014.  If consumers expect their income to go up or down in 2014, they can provide other documents, like documents that state when contract work will end.  If any of their income comes from freelance work, they can fill out self-employment ledgers that include their expected income. For more information on income:  What income and household information do I provide when I apply for Marketplace coverage? and Answers to Questions About Income.

Remember:  On the application, when in doubt, always enter an income source.  As an assister, you should inform consumers about all types of income that should be included on the application. If a consumer informs you that they have income that should be included on their application that they are not including, it is an assister's responsibility to inform the consumer that all income sources should be included. 

Q:  Can assisters retain a consumer's application ID number in order to assist the consumer with follow up with the Marketplace?

A:  Yes, as retaining the application ID number is a form of contact information that a consumer can chose to provide to the assister for the purposes of follow up.  An assister may retain a consumer's application ID number with a consumer's consent so long as they protect that information consistent with all other PII as discussed in the next section. 

An assister can help a consumer follow up with the FFM using the consumer's application ID number if the consumer asks the assister to do so.  However, an assister may not follow up on a consumer's application without the consumer being physically present with the assister, or on the telephone.