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





Health Insurance Marketplace




Assister digest email header




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

Following the end of the continuous enrollment condition on March 31, 2023, states have resumed regular eligibility enrollment operations for Medicaid and the Children’s Health Insurance Program (CHIP), including renewals and coverage terminations. This process is often referred to as “restarting/resuming Medicaid renewals/redeterminations.”

Assister communities are vital in helping consumers who might have recently lost Medicaid or CHIP coverage navigate their health coverage options. As Medicaid and CHIP renewals occur annually, your year-round assistance supports key access to coverage. 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. 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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CMS Announces $500 Million Funding Opportunity to Increase ACA Outreach and Enrollment Efforts

CMS announced the availability of $500 million in grants over the next five years to increase the number of organizations that help people enroll in health coverage through the Federally-facilitated Marketplace (FFM) on HealthCare.gov. This is the largest funding allocation CMS has made available for Navigator grants to date. With the additional funding, CMS encourages eligible entities and individuals to apply, especially those that focus on education, outreach, and enrollment efforts to underserved and diverse communities.

CMS will hold *a* *technical assistance session on July 2* for potential applicants. This session will provide applicants with an overview of this project, relay budget guidance, and review the instructions for applying outlined in the 2024 Navigator funding opportunity. Applicants are encouraged to submit questions in advance of the session to: Navigatorgrants@cms.hhs.gov.

*Technical Assistance Session *


* *Date:* Tuesday, July 2, 2024
* *Time:* 2:00-3:00pm ET
* *Join via Zoom:* 2024 Navigator NOFO Technical Assistance Session #2 [ https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclick.icptrack.com%2Ficp%2Frelay.php%3Fr%3D65887666%26msgid%3D578957%26act%3DZ2A0%26c%3D1185304%26pid%3D2116330%26destination%3Dhttps%253A%252F%252Fcms.zoomgov.com%252Fj%252F1618155550%253Fpwd%253Da21uR0hBVEg3OTRabVBRTVRheFpRUT09%2523success%26cf%3D6316%26v%3D0cb216ecb7202fcf56a7201289a981790dd17c4d3b903deea2c4f655369f3370&data=05%7C02%7Cjulia.heath%40dutyfirst.com%7Cfca969fc5c94446053ef08dc895a1d21%7Cf877ecce79b941d1a30a1a1816bf9403%7C1%7C0%7C638536268480716160%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=1yyHc6dOFBjoLxAQC6Jt%2FraVBo2m06FdPRZfR%2FHKxxo%3D&reserved=0 ], Meeting ID: 161 815 5550, Password: 829693

Applications must be submitted by *July 8, 2024 at 11:59pm ET*. You must submit your application through Grants.gov [ https://www.grants.gov/ ]. Grants.gov [ https://www.grants.gov/ ] creates a date and time record when it receives the application. If you submit the same application more than once, we will accept the last on-time submission. For instructions on how to submit in Grants.gov [ https://www.grants.gov/ ], see the Quick Start Guide for Applicants [ https://www.grants.gov/quick-start-guide/applicants ].

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State Highlight: South Dakota

South Dakota Outline

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

This month, we focus on South Dakota, which expanded Medicaid eligibility last July to include consumers with incomes up to 138% of the Federal Poverty Level (FPL). At the time, South Dakota estimated this expansion would allow 52,000 new individuals to qualify for Medicaid. According to a May 2024 analysis by CMS [ https://www.medicaid.gov/resources-for-states/downloads/sst-cmpltng-unwndng-rnwls-prlmnry-anlys-05312024.pdf ], South Dakota has returned to regular eligibility reviews, and assisters should continue to be aware of routine renewals and transitions in coverage consumers may experience and need support through. People currently enrolled in Medicaid will continue to go through the renewal process when appropriate, and assisters can help to raise awareness of transitions between Medicaid and the Marketplace.

For additional resources regarding Medicaid eligibility in South Dakota and the Medicaid Expansion, review information here [ https://dss.sd.gov/docs/economicassistance/expansion/Expansion_Overview.pdf ].

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**: *


* From Marketplace to Medicare
* Sexual Orientation and Gender Identity Questions on the Marketplace Application
* Consumer Options for Terminating Plans and Reporting Changes
* 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

*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 ]. 

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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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 will host these CDO Office Hours calls the *second Thursday of the month beginning on Thursday June 13th from 2pm-3pm ET.*

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 whose Medicaid Redeterminations education campaign allowed them to connect with a family in need of support. This connection allowed a CAC to identify the best coverage for the family and enroll them in 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 ].

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Biden-Harris Administration Launches New Option to Report Potential Violations of Federal Law and Continue to Promote Patient Access to Stabilizing Emergency Care

*NEW! *CMS launched a new option on CMS.gov to allow individuals to more easily file an Emergency Medical Treatment and Labor Act (EMTALA) complaint. This new web resource is part of the Biden-Harris Administration’s comprehensive plan to educate the public and promote patient access to the emergency medical care to which they are entitled under federal law.

"Click "here [ https://www.cms.gov/newsroom/press-releases/biden-harris-administration-launches-new-option-report-potential-violations-federal-law-and-continue ]" to learn more about this new option on CMS.gov."

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Strategies to Connect with CMS & Your State

* Follow along with your state’s Medicaid agency news releases and subscribe to their email lists to gather important updates related to your state’s return to regular Medicaid enrollment operations. Locate your state’s Medicaid enrollment websites here [ https://www.medicaid.gov/resources-for-states/coronavirus-disease-2019-covid-19/unwinding-and-returning-regular-operations-after-covid-19/renew-your-medicaid-or-chip-coverage/index.html ] for additional information.
* Look over the Medicaid, CHIP, and Marketplace Enrollment Trends Update [ https://www.medicaid.gov/sites/default/files/2023-12/medicaid-unwinding-enroll-trends-snapshot-sep2023.pdf ] to view state-specific trends for Medicaid and CHIP enrollment, including total Medicaid and CHIP enrollment by state and varying outcomes for Medicaid/CHIP renewals and auto renewal rates.

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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. CMS estimates that this rule could lead to 100,000 previously uninsured DACA recipients enrolling in health coverage through Marketplaces or a Basic Health Program (BHP). To view June’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 resource [ https://regtap.cms.gov/reg_library_openfile.php?id=5314&type=l ] provides information and guidance that you need to know in order to interpret the Summary of Benefits and Coverage (SBC) for health plans and assist consumers using the SBC to compare health plan benefits.
* This webinar [ https://regtap.cms.gov/reg_library_openfile.php?id=5305&type=l ] provides an overview of health disparities, health equity initiatives, and what you can do to help reduce health disparities.
* This webinar [ https://regtap.cms.gov/reg_library_openfile.php?id=5288&type=l ] explains the Coverage to Care program, which aims to help individuals understand their health coverage and connect to primary care and preventive services that are right for them, so they can live a long and healthy life. Through this webinar, you can access a variety of Coverage to Care resources, including this Roadmap to Better Care and a Healthier You [ https://www.cms.gov/files/document/c2c-roadmap-better-care.pdf ].
* 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"*


* 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 ]

* 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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