Transcript Virginia-CAC-Webinar - The Commonwealth Institute

Certified Application
Counselors: Enrolling
Virginia
Advocate/Stakeholder Webinar
September 5, 2013
Presenters:
Kathy May, Virginia Consumer Voices for Healthcare
Massey Whorley, The Commonwealth Institute
Tricia Brooks, Georgetown University Health Policy Institute
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In Brief
2
Beginning October 1, hundreds of thousands of
Virginians will have the opportunity to purchase
health insurance through the Marketplace. Many
consumers will need assistance, and one way you can
help is by becoming a Certified Application Counselor
(CAC).
Topics
3
What is happening with the Marketplace?
What changes are happening this fall?
4

Some of the ACA’s most significant changes are
taking effect this fall.
Aug
Sept
Navigators
announced
Training
available
Oct
Nov
Dec
Jan
Feb
Open enrollment
Marketplace opens
October 1, 2013
Coverage begins
January 1, 2014
March
Who can enroll in the marketplace?
5

Uninsured & under-insured Virginians with incomes
between 100% and 400% of poverty level are
eligible for tax credits.

Others can enroll, but they are not eligible for tax
credits.
Who will fall into the coverage gap?
6
What does this mean for consumers?
7

Many consumers will need help understanding new
terms and options.
Cost-Sharing Reductions
Advance Premium Tax Credits
Essential Health Benefits
Catastrophic Coverage
Qualified Health Plans
Metal Tiers
Marketplace
Actuarial Value
Modified Adjusted Gross Income
Topics
8
What are the opportunities for consumer
assistance?
What are the opportunities for
consumer assistance?
9



Navigators
Certified Application Counselors (CACs)
Champions for Coverage
Who are Virginia’s navigators?
10

Virginia Poverty Law Center (VPLC)
 1.3
navigators at VPLC, including project manager
 13 navigators at 8 legal aid programs around the state
 2 navigators with the Young Invincibles, focusing on
NOVA community colleges

Advanced Patient Advocacy, LLC
 Existing
and new staff will work with Bon Secours,
Sentara, and HCA
Who can be a CAC?
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Trusted, community-based
organizations that are interested in:
 Connecting families with health
coverage and other benefits
 Promoting the historic opportunity
to expand coverage
 Contributing to the success of
health reform
Who can be a Champion for
Coverage?
12



Organizations that want to help with outreach or
education can become a Champion for Coverage.
There are many ways to be a Champion for
Coverage, like sending a message to your network
about the Marketplace.
For more information, please visit:
http://marketplace.cms.gov/help-us/champion.html
Topics
13
What are the opportunities for consumer
assistance?
How can your organization become a CAC?
What are the duties of CACs?
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


Provide information about full
range of QHP options, Medicaid,
and CHIP
Assist individuals through a QHP in
the marketplace and the insurance
affordability programs
Help facilitate enrollment in a
QHP, Medicaid, or CHIP
What other requirements must CACs
meet?
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




Serve consumers’ best interests
Comply with privacy and security standards
Disclose all relationships with QHPs, and potential
conflicts of interest
Complete FFM approved training and pass all FFM
certification exams
Serve or refer people with disabilities to navigators
or other resources
How do Navigators and CACs differ?
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CACs perform similar but more limited functions:





CACs are not required (but may) do outreach
CACs are not subject to same stringent conflict of interest
standards but must disclose potential conflicts of interests
CACs do not have to meet cultural and linguistically
appropriate standards (CLAS) beyond other obligations they
already have
CACs may refer individuals with disabilities
CACs do not have to refer consumers to ombudsman or other
consumer assistance programs
How will the CAC program work in
Virginia’s Marketplace?
17

The Federally-Facilitated Marketplace (FFM):
 Must
have a CAC program in Virginia
 Will designate CAC entities that will be responsible for
certifying their staff and volunteers
 Maintain a registration process and method to track the
performance of CACs
 Develop procedures to withdraw CAC designation

All CACs will be listed on the Marketplace website
(along with Navigators)
What are the responsibilities of CAC
designated entities?
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Enter into a formal, written agreement with the FFM
assuring that it and its CACs will:





Comply with all standards, including privacy and applicable
authentication and data security standards
Establish procedures to inform applicants of CAC
responsibilities
Complete training with passing grade
Disclose potential conflicts of interest
Not impose any fees on consumers
What types of organizations can serve
as CACs?
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Final regulations do not specifically restrict the types
of organizations, but the FFM will designate
organizations that:



Have processes in place to screen staff and volunteers who are
certified to ensure they will protect personal information
Engage in services that position them to help connect people to
coverage
Have experience providing social services to the community
What are some examples of potential
CAC organizations?
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





Community Health
Centers (such as FQHCs)
Hospitals
Health Care Providers
Indian Health Services
and Providers
Ryan White HIV/AIDS
Providers
Behavioral or Mental
Health Providers

Agencies with
experience providing
social services such as
SNAP outreach,
energy assistance, or
tax assistance, which
are:
 State and local
government entities
 501(c)
organizations
How will CACs be funded?
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

The FFM has indicated that it
will NOT provide funding to
CAC entities.
However, the federal
regulations clearly state that
CAC entities may receive
funding from other sources to
support their CAC activities.
How does an organization become a
CAC?
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Apply on-line: http://marketplace.cms.gov/helpus/cac.html
What is involved in the application
process?
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What is involved in the application
process?
24
What is involved in the application
process?
25
What is involved in the application
process?
26
How long does the application process
take?
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



CMS is working through a backlog of CAC
applications
Delay does not reflect likelihood of approval
Organizations should continue to move forward with
recruiting and plans for training
Copies of the CAC training are now available
http://marketplace.cms.gov/training/gettraining.html
How do individuals become CACs?
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



Contact a CAC organization to work or volunteer
for them
Complete the organization’s screening process for
CACs
Complete the FFM CAC training
Pass the FFM CAC test
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Does Virginia’s Navigator law
impact CACs?


Defines Navigator as “an individual or entity
described in 42 U.S.C. § 1311(i)(2) that is selected
to perform the activities and duties identified in 42
U.S.C. § 18031(i) in the Commonwealth.”
Reference is specific to federal Navigator grant
program
Topics
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What are the opportunities for consumer
assistance?
How can your organization become a CAC?
What are the next steps?
What are the plans to strengthen the
Virginia CAC programs?
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




Coordinate consumer assistance activities to
minimize redundancy, maximize coverage
Connect individuals interested in volunteering with
CAC organizations
Provide supplemental training through our partners
Create networking opportunities to share best
practices
Promote the collection of feedback from the field
What are your next steps?
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


Consider whether your organization should apply to
become a CAC and dedicated staff or volunteers to
do CAC work
Plan to monitor on-the-ground experiences of
consumers and share feedback
Start education and outreach efforts now
What’s your level of interest?
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

Is your organization interested in receiving
additional information on becoming a CAC?
Or is your organization more interested in becoming
a Champion for Coverage?
Topics
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What are the opportunities for consumer
assistance?
How can your organization become a CAC?
What are the next steps?
Q&A
Q&A
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Contact us
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
Massey Whorley, The Commonwealth Institute
[email protected]
 804-396-2051


Tricia Brooks, Georgetown University Health Policy
Institute
[email protected]
 202-365-9148


Kathy May, Virginia Consumer Voices for Healthcare
[email protected]
 804-592-6438

Thank you for attending!
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