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September Edition: Transitions in Coverage Assister Monthly Digest

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 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! Plan Year 2025 Assister Certification Training Modules are Now Available!

In preparation for the Marketplace PY 2025 Open Enrollment Period, which begins November 1, 2024, CMS has updated the Assister Certification Training curriculum. This training is hosted on the Marketplace Learning Management System (MLMS); the online web-based training platform for assisters providing application and enrollment assistance to consumers in Federally-Facilitated Marketplaces (FFMs) and State-based Marketplaces using the Federal platform.

The MLMS can be accessed through the CMS Enterprise Portal. You can find training presentations and additional resources, such as Frequently Asked Questions (FAQs) and MLMS Quick Reference Guides at the following link: Assister Training Materials [ https://www.cms.gov/marketplace/in-person-assisters/training-webinars/training ].


* *New users* register here: New User Registration [ https://portal.cms.gov/ ]
* *Existing users* can login at: Existing User Registration [ https://portal.cms.gov/ ]

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Consumers May Still be Eligible for a Special Enrollment Period!

The Unwinding Special Enrollment Period (SEP) extends through November 30, 2024. This SEP is in place to help consumers maintain coverage as they transition from Medicaid or Children’s Health Insurance Program (CHIP) coverage into a Marketplace plan. Assisters like you are key to helping these consumers transition smoothly. 

*The Unwinding SEP may be available to consumers who:*


* Live in states with Marketplaces served by the HealthCare.gov platform.
* Submit a new application or update an existing HealthCare.gov application between March 31, 2023, and November 30, 2024, and attest that they have lost Medicaid or CHIP coverage between the same time period.

Consumers who are eligible for the Unwinding SEP will have 60 days after they submit their application to select a plan with coverage that will start on the first day of the month after they select a plan. Click here [ https://www.medicaid.gov/resources-for-states/downloads/extn-sep-cnsmrs-lsg-chip-cvrg-adndm-faq.pdf ] for more information on the Unwinding SEP. This document is an addendum to the original FAQ, which is available for reference here [ https://www.cms.gov/technical-assistance-resources/temp-sep-unwinding-faq.pdf ].

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State Highlight: Arizona

Arizona Outline

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

AZ recently passed a bill allocating "$2.5 million to rural community health centers for on-call maternity care services in rural communities which often have little to no maternity care available." Assisters supporting consumers in rural communities should be familiar with these options for care available to their pregnant consumers, especially any consumers who may have been impacted by Medicaid redeterminations or who are transitioning coverage types. For more information regarding how consumers can access this care, check out the information available here [ https://www.azahcccs.gov/shared/News/GeneralNews/AHCCCSAllocates2point5MilliontoExpandMaternityCareinRuralCommunities.html ].

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
* Complex Case Web Form Presentation for Assisters

*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 that helped a patient enroll in Marketplace coverage and learn to navigate her new 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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Truth and Myth: Marketplace Financial Assistance Eligibility

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 the process the Marketplace uses to notify consumers they cannot receive APTC or CSRs if they are eligible for or enrolled in Medicaid/CHIP coverage. To view September’s fact and myth regarding Marketplace APTC/CSR eligibility, visit this page [ https://content.govdelivery.com/landing_pages/46163/6a084f265e23138f287d911a28d47b20 ]

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Key Resources

*"REGTAP Resources"*


* This job aid [ https://regtap.cms.gov/reg_library_openfile.php?id=5520&type=l ] provides information regarding health coverage options for uninsured consumers.
* This presentation [ https://regtap.cms.gov/reg_library_openfile.php?id=5556&type=l ] provides information regarding immigrant eligibility for Marketplace and Medicaid and CHIP coverage.

*"CMS.gov Resources"*


* This resource [ https://www.cms.gov/files/document/underserved-communities-teaching-guide-0192024.pdf ] provides in-depth insight and guidance for assisting underserved communities. This guide explores cultural competency and barriers to care, along with tips and trick to understanding low health literacy and health disparities.
* 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"*


* Distribute this resource [ https://www.medicaid.gov/resources-for-states/downloads/medicaid-phe-unwinding-conference-full-page.pdf ] to healthcare providers to encourage them to inform patients about key Medicaid reminders.
* Check out this resource [ https://www.medicaid.gov/resources-for-states/downloads/reachg-chid-famils-schol-based-erly-edctin-care.pdf ] to learn more about reaching children and families in school-based and early education and care settings. Assisters can insert their contact information in this flyer [ https://www.medicaid.gov/resources-for-states/downloads/12184-does-your-child-have-medicaid-or-chip-statefillable-508.pdf ] to promote Medicaid renewal awareness to parents.
* 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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