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Your monthly compilation of upcoming events, resources, state highlights and more!





Health Insurance Marketplace




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*Welcome back to the Transitions in Coverage Assister Monthly Digest!*

States have resumed regular eligibility enrollment operations for Medicaid and the Children’s Health Insurance Program (CHIP), including renewals and coverage terminations.

Assister communities are vital in helping consumers who might have recently lost Medicaid or CHIP coverage navigate their health coverage options. This digest is intended to equip assisters with resources and tools to connect with consumers in need of assistance.

*"Have questions?"*" Certified Application Counselors (CACs) should contact the CAC mailbox at ""CACQuestions@cms.hhs.gov" <CACQuestions@cms.hhs>", Enrollment Assistance Personnel (EAPs) should contact ""EAPQuestions@cms.hhs.gov" <EAPQuestions@cms.hhs.gov>", and"" Navigators should reach out to their Project Officer."

 

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*Reminder:* Use communication and engagement methods tailored to the specific needs of your consumers, which include (but aren’t limited to) phone calls, emails, and texts. Additionally, ensure that consumers _enter your assister ID_ when they complete the Marketplace application, and make sure that consumers are aware of your role as a CAC by identifying you as a CAC on the application. Your assister ID, whether CAC, Navigator or EAP, is a 13-digit alphanumeric ID assigned to you by your organization leadership. Including your assister ID will help CMS better understand the support that the assister community provides and continue to improve the consumer experience.



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"Important transitions in coverage resources on REGTAP and CMS.gov are located at the ""bottom of this resource." [ #key ] "You can also view past editions of this digest ""here" [ https://regtap.cms.gov/reg_library.php?libfilter_keyword=transitions%20in%20coverage&libfilter_resource=11 ]"."

*"In Case You Missed It: "*"The Complex Case Web Form allows Navigators, CACs, EAPs, and Advocates (using the “Other” category) to submit a complex case for investigation by the Complex Case Help Center (CCHC) team. A complex case is an issue involving a single consumer or tax household where the assister has not been able to resolve a specific issue on the consumer or tax household’s application for Marketplace coverage. Complex cases are not policy questions or general questions about the Marketplace application. Assisters must first report the complex case issues to the Marketplace Call Center, unless they are reporting cases of unauthorized enrollments or unauthorized plan switches, which do not require contacting the Marketplace Call Center. "

"Click ""here" [ https://mats-cms-ccrms.my.salesforce-sites.com/complexcase ]" to access the Complex Case Web Form, and ""here" [ https://www.cms.gov/marketplace/technical-assistance-resources/training-materials/complex-case-user-guide.pdf ]" to access Complex Case Web Form navigation instructions."



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HHS Authorizes Five States to Provide Historic Health Care Coverage for People Transitioning Out of Incarceration 

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), approved the latest in a series of groundbreaking Medicaid and CHIP demonstrations that will allow Illinois, Kentucky, Oregon, Utah, and Vermont to provide coverage "before" release, creating a seamless transition and avoiding gaps in coverage. These states join California, Massachusetts, Montana, and Washington in pursuing an innovative option for expanding access to high-quality, affordable health care.

The Medicaid Reentry Section 1115 Demonstration Opportunity [ https://www.medicaid.gov/federal-policy-guidance/downloads/smd23003.pdf ] allows a state to cover certain services not otherwise coverable in Medicaid and CHIP up to 90 days before an eligible person’s expected release from incarceration. This includes coverage of substance-use disorder treatment before a Medicaid or CHIP beneficiary is released from jail, prison, or a youth correctional facility. Additionally, states will be able to help connect the person to community-based Medicaid and CHIP providers up to 90 days prior to their release to ensure they can continue their treatment after they return to the community. 

"For more information, click ""here" [ https://www.cms.gov/newsroom/press-releases/hhs-authorizes-five-states-provide-historic-health-care-coverage-people-transitioning-out ]"."

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State Highlight: North Carolina

North Carolina

Each month in this section, we review state updates pertaining to coverage transitions.

On July 1, 2024, North Carolina launched their Managed Care health plan product, Tailored Plans. A Tailored Plan is an NC Medicaid Managed Care health plan. It offers physical health, pharmacy (prescriptions), care management and behavioral health services. It serves members with a mental health disorder, substance use disorder, intellectual/developmental disability or traumatic brain injury. Tailored Plans offer the same basic benefits and services as Standard Plans. To learn more, go to medicaid.ncdhhs.gov/tailored-plans [ https://medicaid.ncdhhs.gov/tailored-plans ] or Tailored Plan services [ https://ncmedicaidplans.gov/en/tailored-plan-services ]. Or call toll free at 1-833-870-5500 (TTY: 711 or Rel­ayNC.com [ https://relaync.com/ ]) 

Assisters should be prepared to assist consumers with basic information regarding this change and help direct consumers to the right state assistance tools for more complex and detailed questions.

CMS shares this information to help assisters like you become aware of common pain points consumers may experience and recognize that some challenges are beyond your control.



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Marketplace Assister Webinars and More

The 2024 Marketplace Assister Webinar Series began in January and will continue through November 20, 2024. Sessions will be held, as scheduled, on Wednesdays from 2:00 p.m. – 3:00 p.m. E.T.  Any changes to the schedule and presentation topics will be announced​. Webinars provide a unique opportunity for you to learn about topics that can help you support consumers who wish to enroll in the Marketplace.

*Upcoming Marketplace Assister 2024 Webinar Series topics include**: *


* Assisting Consumers with Limited English Proficiency
* Assisting Members of the LGBTQI+ Community
* Complex Case Web Form Presentation for Assisters
* New Eligibility Rules for DACA Recipients
* Marketplace Appeals
* Medicaid and CHIP

*Register Here for Assister Webinars* [ https://regtap.cms.gov/reg_events_view.php?class=639 ]


For complete instructions for how to register for webinars, click here [ https://content.govdelivery.com/landing_pages/46044/315d75855de61a4dd08982899adf603b ]. Resources from past webinars can be found here [ https://www.cms.gov/marketplace/in-person-assisters/training-webinars/webinars ].

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CAC Designated Organization (CDO) Office Hours

The CMS CDO Program Office is hosting CDO Office Hours, which are monthly technical support calls for CDO leadership contacts (Organization Senior Official, CAC Project Director, and Secondary Contact) who may need assistance with technical aspects of the CDO Program.

These calls will give CDOs the opportunity to raise questions with CMS subject matter experts on issues they may be experiencing with the CDO Program such as, but not limited to:


* Using the Organization Maintenance Web Form (OMWF),
* Updating your CAC Roster,
* Renewing your CMS-CDO agreement or signing your agreement with DocuSign, or
* Annual assister certification training issues.

CMS hosts these CDO Office Hours calls the *second Thursday of the month from 2 p.m.-3 p.m. E.T.*

If your organization is interested in attending these office hours, CDO leadership should keep an eye out for reminder emails which will be sent the Monday before each call, and will include the Zoom link, meeting ID, and passcode. For questions, please send an email to cacquestions@cms.hhs.gov.

Additionally, please be on the lookout for new engagement opportunities that will give you an opportunity to discuss transitions in coverage topics in more detail with CMS and other assisters.

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Assister Success Story

Assisters like you are essential to keeping consumers enrolled in the coverage that they need.

In this section, we share examples of positive feedback from consumers you’ve assisted to showcase the impact of your reach. If you are aware of a success story from a consumer, please share them at the appropriate email addresses listed above [ #questions ].

This month, we heard from an assister organization who helped a patient whose cancer was in remission transition from Medicaid to Marketplace coverage. To read the full story and learn more about the incredible impact of assisters like you, click here [ https://content.govdelivery.com/landing_pages/46161/89f8f9dab5cc6db7e590da9b36fed314#Feb2024 ].  [ https://content.govdelivery.com/landing_pages/46161/89f8f9dab5cc6db7e590da9b36fed314#Feb2024 ]

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Common Misconceptions

Each month, we’ll feature a new misconception or question we’ve identified using your feedback to help you assist consumers securing coverage.

We’re focusing on the recent Final Rule that expands access to health care for Deferred Action for Childhood Arrivals (DACA) recipients, effective November 1, 2024. The Final Rule makes additional technical changes to the definition of "lawfully present" for Marketplaces. These changes result in certain groups of noncitizens being newly considered "lawfully present" for purposes of enrolling in Marketplace and BHP coverage. To view July’s common misconception and Marketplace eligibility for DACA recipients truth that addresses this issue, visit this page [ https://content.govdelivery.com/landing_pages/46163/6a084f265e23138f287d911a28d47b20 ].

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Key Resources

*"REGTAP Resources"*


* This webinar [ https://regtap.cms.gov/reg_library_openfile.php?id=5443&type=l ] and job aid [ https://regtap.cms.gov/reg_library_openfile.php?id=5442&type=l ] provide information and guidance regarding health coverage options for American Indians and Alaska Native consumers.
* This resource [ https://regtap.cms.gov/reg_library_openfile.php?id=5419&type=l ] provides detailed information regarding health coverage effectuation, grace periods, and terminations you can use to educate consumers as they access their coverage.
* This resource [ https://regtap.cms.gov/reg_library_openfile.php?id=5425&type=l ] explains information and guidance about advance payments of the premium tax credit and cost-sharing reductions.
* Review previous editions of this digest here [ https://regtap.cms.gov/reg_library.php?libfilter_topic=36&libfilter_resource=11 ] to access valuable resources and information that will support your ability to assist consumers transitioning coverage!

*"CMS.gov Resources"*


* Keep an eye on this page [ https://www.cms.gov/marketplace/in-person-assisters/training-webinars/training ] for updates regarding Assister Training for Plan Year 2025. The annual assister certification training for PY2024 was taken off line on 7/12/24 at 6 p.m. in preparation for our PY2025 annual certification training and is no longer available. The PY2025 annual assister certification training will go live later this summer.
* Check out these recently updated videos for a step-by-step walkthrough of how to help consumers fill out the latest version of the HealthCare.gov application.
* Households seeking financial assistance [ https://youtu.be/mVkBSP9HKO0?si=U0R6Y7V2m1zYeIZ- ]
* Households not seeking financial assistance [ https://youtu.be/Dvd36cQWUgM?si=L2n7D95avKfR2ZXR ]
* How to answer optional demographic questions [ https://www.youtube.com/watch?v=8BvEtcdXDY4&list=PLaV7m2-zFKpgUK9AqdbnOdW69-WwodvRj&index=27 ]

* This resource [ https://www.cms.gov/marketplace/technical-assistance-resources/c2c-roadmap.pdf ] is a roadmap with guidance for connecting consumers to the right coverage for them. With it, you can walk consumers through every step of the process for receiving care from identifying a need for care to what happens after their appointment.
* Use these resources [ https://www.cms.gov/marketplace/in-person-assisters/outreach-education/new ] to connect with and support consumers considering applying for Marketplace coverage.
* Use these resources [ https://www.cms.gov/marketplace/in-person-assisters/outreach-education/already-enrolled ] to continue to support consumers already enrolled in Marketplace coverage, who may encounter questions regarding accessing care, or understanding and maintaining their coverage.



















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