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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 transitions for those no longer eligible.

Assister communities are vital in helping consumers who might recently have found out they’re no longer eligible for 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. [ #Resources ] "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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New! Sexual Orientation and Gender Identity (SOGI) Webinar

This webinar [ https://regtap.cms.gov/reg_library_openfile.php?id=4790&type=l ] provides detailed guidance for assisting consumers in the Marketplace and provides policy updates regarding SOGI-related questions on the Marketplace application. This webinar is part of the Marketplace Assister Webinar Series. For future webinars, check out the information below [ #Webinars ].

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State Highlight: Mississippi

Mississippi Outline

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

Mississippi recently passed a bill authorizing the Mississippi Division of Medicaid to offer presumptive eligibility for pregnant women (PEPW). The PEPW provision permits qualified providers to immediately deem presumptively eligible pregnant individuals to be temporarily eligible for limited Medicaid benefits.

Assisters supporting pregnant individuals waiting for a final Medicaid eligibility determination should check their state Medicaid agency website to see if their state has a similar provision which could allow that consumer to receive limited Medicaid benefits. Many states with similar programs have resources online to help consumers find participating providers. Assisters working with consumers in Mississippi can read more here [ https://medicaid.ms.gov/presumptive-eligibility-for-pregnant-women/#:~:text=House%20Bill%20539%2C%20approved%20by,coverage%20for%20ambulatory%20prenatal%20care. ].

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**: *


* Marketplace Appeals
* Medicaid and CHIP
* Limited English Proficiency
* Ready to Enroll
* Assister’s Do’s and Don’ts
* Coverage Appeals
* Outreach and Education
* Complex Case webform

*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 who was able to access affordable health coverage with the assistance of an assister. 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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Truth and Myth: Marketplace Appeal Rights and Processes

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

This month, we’re focusing on consumers’ rights and processes related to Marketplace appeals. Your ability to advise consumers regarding their appeal rights is vital to ensuring consumers’ access to care and coverage. To view August’s fact and myth regarding Marketplace appeals, 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=5425&type=l ] explains information and guidance about advance payments of the premium tax credit and cost-sharing reductions.

*"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.
* 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 ]

* Check out the updated Transitions in Coverage Guide for Marketplace Assisters [ https://www.cms.gov/files/document/transitions-coverage-guide-marketplace-assisters.pdf ] to review important Unwinding SEP guidance, best practices for assisting consumers transitioning coverage, talking points for answer common consumer questions, and more!
* 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.

*"Medicaid.gov Resources"*


* CMS recently updated numerous resources on the Medicaid and CHIP Renewals Outreach and Educational Resources [ https://www.medicaid.gov/resources-for-states/coronavirus-disease-2019-covid-19/unwinding-and-returning-regular-operations-after-covid-19/medicaid-and-chip-renewals-outreach-and-educational-resources/index.html ] webpage, to include evergreen language that partners can use to share information about regular Medicaid and CHIP renewals. These general and audience-specific resources will help assisters like you to connect with and guide consumers through transitions in coverage. CMS will continually update this page with important information and resources.
* Use this consumer-facing resource [ https://www.medicaid.gov/resources-for-states/downloads/medicaid-basic-for-partners.pdf ] to educate consumers regarding Medicaid basics.



















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