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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!*

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. 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, CMS.gov, and Medicaid.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, Certified Application Counselors (CACs), Enrollment Assistance Personnel (EAPs), and Advocates (using the “Other” category) to submit a complex case for investigation by the Complex Case Health Center (CCHC) team. A complex case is an issue involving a single consumer or tax household where the assister has 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 cased 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 Statement on Agent and Broker Marketplace Activity

*NEW! *CMS is committed to protecting consumers in the Marketplace. CMS has received reports of consumers in HealthCare.gov states whose coverage was switched by agents and brokers without their knowledge. In response, CMS is taking swift actions to protect consumers from unauthorized activity by agents and brokers, and to root out bad actors who are violating CMS rules.

*Click here for more information on CMS’ response to plan switching* [ https://www.cms.gov/newsroom/press-releases/cms-statement-agent-and-broker-marketplace-activity ]






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HHS Issues New Rule to Strengthen Nondiscrimination Protections and Advance Civil Rights in Health Care

*NEW! *The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) and the Centers for Medicare & Medicaid Services (CMS) issued a final rule under Section 1557 of the Affordable Care Act (ACA) advancing protections against discrimination in health care. By taking bold action to strengthen protections against discrimination on the basis of race, color, national origin, sex, age, and disability, this rule reduces language access barriers, expands physical and digital accessibility, tackles bias in health technology, and much more.

*Click here to learn more about this final rule* [ https://www.hhs.gov/civil-rights/for-individuals/section-1557/index.html ]






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HHS Issues Final Rule Clarifying the Eligibility of Deferred Action for Childhood Arrivals (DACA) Recipients and Certain Other Noncitizens

*NEW!* HHS published a final rule to modify the definition of “lawfully present” applicable to eligibility for enrollment in a Qualified Health Plan (QHP) through the Health Insurance Marketplace and a Basic Health Program (BHP). With this modification, DACA recipients will no longer be excluded from that definition, thereby making it possible, effective November 1, 2024, for DACA recipients who meet all other eligibility requirements to enroll in a QHP through the Marketplace with financial assistance like advance payments of the premium tax credit (APTC) and cost-sharing reductions (CSRs), or a BHP. 

*Click here to learn more about this final rule* [ https://www.cms.gov/newsroom/fact-sheets/hhs-final-rule-clarifying-eligibility-deferred-action-childhood-arrivals-daca-recipients-and-certain ]






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State Highlight: Texas & Florida

Texas & Florida

Each month in this section, we review state updates pertaining to coverage transitions and/or the unwinding period.

This month, we focus on the two states with the largest Marketplace enrollments, Florida and Texas, and the specific populations in each state that have been impacted by Medicaid redeterminations. Both* Texas and Florida *have seen reductions in children’s Medicaid and CHIP enrollment since resuming Medicaid redeterminations. With school years ending, this can be a great time to work with parents and guardians to evaluate their notices from the state and understand what coverage options are right for them and their dependent children. Some children were likely disenrolled for procedural reasons such as the state being unable to contact them, meaning many may still be eligible for Medicaid or CHIP, while others may now be eligible for Marketplace coverage.   

For additional resources to assist consumers in Florida, review information here [ https://www.myflfamilies.com/medicaid ]. To learn more about Medicaid redeterminations in Texas, review the resources available here [ https://www.hhs.texas.gov/services/health/medicaid-chip/end-continuous-medicaid-coverage ].

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**: *


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Assisting Immigrant Populations


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Advance Payments of the Premium Tax Credit (APTC) and Cost Sharing Reductions (CSRs)


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From Marketplace to Medicare


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Sexual Orientation and Gender Identity Questions on the Marketplace Application


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Consumer Options for Terminating Plans and Reporting Changes

*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 listening sessions 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 who was able to support a 19-year-old’s transition from CHIP to Medicaid coverage, and helped him understand his coverage and continue to received needed care. 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 ].  [ https://content.govdelivery.com/landing_pages/46161/89f8f9dab5cc6db7e590da9b36fed314#Feb2024 ]






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Common Misconceptions

CMS has identified answers to common misconceptions regarding transitions between Medicaid/CHIP and Marketplace coverage. Each month, we’ll feature a new misconception or question we’ve identified using your feedback to help you assist consumers transitioning coverage.

As transitions in coverage continue, we’re focusing consumers’ Medicaid Fair Hearing, or appeal, rights. For more information, review this factsheet [ https://www.medicaid.gov/resources-for-states/downloads/mdcid-fair-hrings-prtnr-rsurce.pdf ] from CMS. To view May’s common misconception and fair hearing 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 assisters like 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"*


* Have your consumers experienced a qualified life event, such as being denied Medicaid/CHIP coverage, and may qualify for a Special Enrollment Period (SEP) to enroll in or change plans? Learn more [ https://www.cms.gov/marketplace/technical-assistance-resources/sep-overview-complex-case-scenarios.pdf ] about SEPs, SEP Verification, qualifying life events and case scenarios, to better understand how to assist consumers who are eligible for SEPs.
* 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.

*"Medicaid.gov Resources"*


* This page [ https://www.medicaid.gov/resources-for-states/coronavirus-disease-2019-covid-19/unwinding-and-returning-regular-operations-after-covid-19/index.html ] is your go-to stop for all information on Medicaid and Marketplace transitions in coverage. Navigate to the “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 ]” section to download resources such as fact sheets and fillable postcards to educate your consumers about Medicaid or CHIP renewals and other health care options.
* This CMCS Informational Bulletin [ https://www.medicaid.gov/media/173651 ] provides reminders to states regarding the correct processes for renewals, to ensure consumers are accurately redetermined as states return to regular operations. Assisters can use this information, along with this presentation [ https://www.medicaid.gov/media/173656 ], to understand how consumers are renewed.
* Consult this presentation [ https://www.medicaid.gov/media/158931 ] for information about how you can best assist consumers with Medicaid/CHIP coverage in your community using the resources provided. Additionally, learn more about Medicaid/CHIP renewals, what actions consumers need to take if they’ve received a renewal form from the state and any next steps if they’ve lost Medicaid or CHIP coverage.



















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