Transcript Thanks for joining us! The webinar will start at 2:33pm While you wait, submit your name, organization, and city in the comments box www.uhcanohio.org www.ohioconsumersforhealth.org.

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While you wait, submit your name,
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www.ohioconsumersforhealth.org
Technical Details
What Ohio Advocates Need to Know About Open Enrollment
10/8/13
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General Housekeeping
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What Ohio Advocates Need to Know About Open Enrollment
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Presenters
Nita Carter
Health Equity Director, UHCAN Ohio
Kathleen Gmeiner
Project Director , Ohio Consumers for Health Coverage
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What is UHCAN Ohio?
Statewide, non-partisan, non-profit organization working to achieve
quality, affordable health care for all Ohioans.
What is the purpose of our Health Equity project?
www.uhcanohio.org
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What Is Ohio Consumers for Health
Coverage?
Ohio Consumers for Health Coverage is a broad based coalition
working to achieve quality, affordable health care for all Ohioans.
www.ohioconsumersforhealth.org
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Overview
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Basics of the ACA
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Medicaid Expansion
Health Insurance Marketplace
Navigators
Mandate
What You Can Do to Help Your Members/Clients
Now
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The Affordable Care Act Expands
Access to Coverage
Medicaid Expansion
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All adults up to 138% of the Federal Poverty Level
($15,856 per year for household of one) are eligible if Ohio
accepts the expansion of Medicaid
Private insurance through the Marketplace
(Exchange)
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Offers choices of private insurance plans
(Qualified Health Plans – QHPs) with
financial help available to those who qualify.
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Why Medicaid Expansion Is So
Important
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Health Insurance Marketplace in
2014
Creates one-stop shop
for easy comparison of
coverage options
Interesting Fact
about the
Marketplace:
Gives consumers more
choice and control
Congress will get its coverage
through the same Marketplaces.
Subsidies for individuals
and tax credits for small
businesses are available
to make it more affordable
Offers coverage options
through a website and
helpline
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What A Household of One Can Expect
to Pay with a Tax Subsidy
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Navigators – How to Get Help with the
Marketplace
The Marketplace is required to create a navigator program
to:
• Inform people about their new insurance options
• Help people enroll in their plan of choice
• Help people keep their coverage (stay enrolled)
Insurance brokers and agents can also help.
The Navigator does not choose a plan or
advise which plan to choose.
Navigators may not be compensated by insurers to enroll people in
the Marketplace, and Ohio’s HB 3 is disqualifying providers
reimbursed by insurers for medical services provided.
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Poll:
My biggest concern about Open Enrollment is:
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The web site will not become fast enough to support all
enrollment that is desired
• I will not know where the face to face assistance is to tell my
clients/constituents/members about
• There will not be adequate materials in multiple languages
• The people we talk to will have unrealistic expectations about
the amount they will need to pay.
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Navigators Serving Ohio
• Ohio Association of Foodbanks (Serving
most parts of Ohio)
• Call 614 221-4336
• Anticipated grant amount: $1,958,961
• Helping Hands Community Outreach Center
(Dayton)
• Call 937-268-6066
• Anticipated grant amount: $230,920
• Neighborhood Health Association (Toledo)
• Call 419- 720-7883
• Anticipated grant amount: $684,630
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Navigator Collaborative of the Ohio
Association of Food Banks
• Ohio Association of Foodbanks, All 88 Counties
• Access Health Mahoning Valley (AHMV), Mahoning and
Trumbull Counties
• Asian Services in Action, Inc. (ASIA), Cuyahoga, Franklin,
Hamilton, Lucas, Montgomery, and Summit Counties
• Carmella Rose Health Foundation (CRHF), Cuyahoga
County
• Cuyahoga Health Access Partnership (CHAP), Cuyahoga
County
• Community Action Committee of Pike County (CACPC),
Jackson, Pike, and Scioto Counties
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Navigator Collaborative of the Ohio
Association of Food Banks
• Disability Rights Ohio (DRO), All 88 Counties
• Freestore Foodbank, Southwest Ohio
• Toledo/Lucas County CareNet Allen, Ashland, Auglaize,
Crawford, Defiance, Erie, Fulton, Hancock, Hardin,
Henry, Huron, Lucas, Mercer, Ottawa, Paulding, Putnam,
Richland, Sandusky, Seneca, VanWert, Williams, Woods,
and Wyandot Counties
• Ohio Association of Free Clinics (OAFC), 40 Counties
Across Ohio
• Ohio Department of Health (ODH), All 88 Counties
• The Community Action Program Corporation of
Washington Morgan Counties (WMCAP), Morgan and
Washington Counties
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How to Help Your Members/Clients
• Become a Certified Application Counselor
Organization
• Get the word out about Enrollment
• Encourage them to visit healthcare.gov and sign up for
email updates
• Include articles in your newsletter
• Print materials/handouts
• Invite Enroll America to your meetings
• Schedule a presentation with UHCAN Ohio
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Become a Certified Application
Counselor (CAC)
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CACs are trained by the federal government to help
people understand their choices under the Affordable
Care Act. The training is free.
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CACs are usually people working in agencies or
organizations that help people secure health care or
other benefits.
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CACs are not paid by the federal government to do
their work, but some private money may be
available.
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How to Become A CAC
1. Find out what is required of a CAC.
http://marketplace.cms.gov/help-us/cac.html
2.Fill out an application on-line found at
http://marketplace.cms.gov/help-us/cac-apply.html
(Application takes about 15 minutes to fill out)
3. Someone from Center on Consumer Information
and Insurance Oversight (CCIIO) will contact those
organizations who appear to have the qualifications
to get more detail.
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How to Become a CAC (continued)
An organization that wants to be a CAC should:
1. Already be helping people to secure
assistance of some kind.
2. Have a system for protecting confidential
client data
3. Screen employees and volunteers who help
clients and handle sensitive information
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Becoming a CAC (continued)
4. Be aware of any relationships with insurance
companies or others that could pose a conflict
of interest and be prepared to discuss with
CCIIO.
5. Be prepared to enter into a written
agreement with CCIIO.
6. Identify who in your organization will be
trained to be a CAC.
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What are the benefits to becoming
a designated CAC organization?
A: CAC designated organizations will benefit by
receiving the Marketplace’s training and being able to
represent themselves to consumers as being certified
by their state’s Marketplace to provide application and
enrollment assistance.
In addition, becoming a CAC will build the capacity of
the organization’s staff and volunteers which will build
their own marketability.
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Training To Be a CAC
How will training work?
A: Because the CAC training is web-based, it can be completed at any
time. Individual CACs must complete the training before being certified
by their designated CAC organization.
How many hours will the CAC training be?
A: Approximately 5 hours.
Do all of our employees/volunteers need to take the
training or just those it wants to certify to be CACs?
A: Only those who will be certified to be CACs are required to take and
pass the CAC training.
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Screening to Be a CAC
What does it mean to screen staff and volunteers
who would become individual CACs?
A: Screening could involve background checks, calling past employers
for references, checking government-issued identification, or other tools
that will tell whether the organization can trust its staff and volunteers to
handle any private consumer information responsibly and securely, to
adhere to all CAC program requirements and standards, and to act in
the best interest of the consumers they assist.
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Screening to be a CAC
What level of health care knowledge should an
individual already have to become a CAC?
A: There is no minimum level of knowledge required for an individual to
be certified as a CAC, other than completing the required CAC
training. The training will teach each individual CAC everything he or
she needs to know to help consumers apply for and enroll in coverage.
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Role of CAC
Can a CAC actually help an individual compare health
plans and assist the individual in choosing a health
plan?
A: Yes, those are required duties of a CAC. But remember that a CAC
cannot actually choose a plan or enroll someone in a plan. A CAC may
only assist with plan selection and enrollment, and must provide this
assistance in the consumer’s best interest.
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Role of CAC
Are there quotas for how many consumers each CAC
or designated CAC organization must assist?
A: No. There are no requirements regarding the minimum number of
consumers a designated CAC organization or each CAC must assist.
About how long on average will it take a CAC to walk a
consumer through enrollment?
A: It will vary depending on the consumer’s needs. We estimate that it
will take about one hour to walk a typical client through the entire
process.
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Difference Between and CAC and a
Navigator?
Navigators:
CACs:
• Funded through grants
through the Marketplace
• Not funded through
Marketplace but may
obtain finding from other
sources
• Strict conflict of interest
requirements
• Required to conduct
outreach and education
• Conflict of interest
disclosure requirements
but won't prevent from
becoming a CAC
• Not required to conduct
outreach and education
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Difference Between CAC and
Broker?
A: Unlike agents and brokers, CACs cannot charge
consumers for their assistance and are not paid by health
insurers to sell insurance. Agents and brokers are licensed
by their state to sell insurance. CACs do not sell insurance,
nor will they be enrolling individuals in health coverage,
including QHPs offered through the Marketplace.
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How to Become a CAC (continued)
Think through how you plan to help people.
• Will you establish an appointment system?
• Will you set up certain days of the week that you have
“first come, first serve” clinics?
• Will you partner with others who are knowledgeable (eg
brokers, tax preparers) Conflict of interest rules apply
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Poll:
After learning more about becoming a CAC,
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•
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I think my organization might want to become a CAC
I need more information about the responsibilities of
a CAC
I think it would be too hard for my organization to be
a CAC
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Get The Word Out About Enrollment
Put an article in your newsletter
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•
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In your next newsletter you can drop in this article from
the www.healthcare.gov web site.
Excerpt: No doubt you’ve been starting to hear about
the new Health Insurance Marketplace, a key part of
the health care law that will be open for business on
October 1st. But you probably still have questions …
Find the full version at:
http://marketplace.cms.gov/getofficialresources/publicati
ons-and-articles/relaunch-drop-in-article.pdf
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Download and Customize Materials
from Healthcare.gov
• Go to
marketplace.cms.
gov
• Click on “Get
Official
Resources”
• Click on
“Publications and
Articles”
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About the Health Insurance
Marketplace – Pg 1
Click here for
this publication
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About the Health Insurance
Marketplace – Pg 2
Click here for
this publication
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The Value of Health Insurance – Pg 1
Click here for
this publication
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The Value of Insurance – Pg 2
Click here for
this publication
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Things to Think About When Choosing
a Health Plan
Click here
for
this
publication
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Key Questions and Answers
Q: If I am eligible for a subsidy, how will I receive it?
A. You have several choices.
(1) You can ask for your subsidy as an advance tax
credit. Your subsidy will be paid each month by the IRS
to your insurance company.
(2) You can pay the whole premium and collect the tax
credit at the end of the year as part of your tax refund.
Ex: John’s premium is 400 per month, and based on his
income he is responsible for $100 per month. The federal
government will pay $300/month to the insurance company,
and John must pay $100.
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Key Questions and Answers
Q : I have been turned down from insurance in the
past because of a pre-existing medical condition. Can
the insurance companies still do that?
A: No, insurance companies cannot do that. They can
charge different premiums based only on these factors:
• Size of household
• Age
• Geography
• Tobacco Use
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Key Questions and Answers
Q: If I am working, but can’t afford the cost of buying
my employer’s insurance, can I go to the Marketplace
where I might be eligible for a subsidy?
A: You can only get buy insurance in the Marketplace with
a subsidy if certain conditions are met.
If you cannot afford your employer’s insurance, seek help
from a broker or navigator to determine if you might meet
those conditions.
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Key Question and Answers
Q: My spouse gets coverage from her job, but it doesn’t
cover me. Can I go to the Marketplace and get a subsidy?
A: It depends. The spouse can go the Marketplace and get a
subsidy
• If the employer does not offer* coverage for the spouse, OR
• If the cost of the employee’s share of premium is greater
than 9.5% of the HOUSEHOLD income.
• The insurance does not meet minimum value as required by
the ACA.
*The employer may offer coverage for the spouse, without
financially
contributing to the cost of the insurance.
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What Individuals Should Do Now
• Sign up for emails to get the most up to date
information about enrollment at www.healthcare.gov
• If you get your health insurance at work, find out if
your employer offers coverage for your spouse, even
if employer does not contribute to it.
• Find out your estimated expected contribution to
your monthly premium at www.kff.org and click
calculator.
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What Individuals Should Do Now
• Estimate what your income will be in 2014.
• Create a budget that includes your share of
premium. If your likely share of premium doesn’t fit
into your budget, you should still seek help from a
navigator or a broker after Open Enrollment starts
October 1.
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For More Information
Healthcare.gov Helpline
By phone -- available 24/7
• 1-800-318-2596
• TTY: 1-855-889-4325
On-line
www.healthcare.gov
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Get Involved!
•
Reach out to UHCAN Ohio to help you as you pursue
your work as a Certified Application Counselor.
•
Invite UHCAN Ohio to send a speaker to your
organization/faith congregation .
•
Volunteer with Enroll America to canvass neighborhoods
and table
•
Stay informed by following us on Facebook and Twitter
•
Join our newsletter by signing up on our website
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Questions?
Submit questions using the
GoToWebinar comment
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ask your question live
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You can also submit a question at www.uhcanohio.org.
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For More Information
Visit These Websites:
Need Help?
Call our helpline at
614-456-0060 x233
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Poll:
Would you like to join our email list?
•
•
Yes
No
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Thanks for Participating!
Nita Carter
UHCAN Ohio
[email protected]
614-456-0060 x224
www.uhcanohio.org
Kathleen Gmeiner
Ohio Consumers for Health Coverage
[email protected]
614-456-0060 x223
www.ohioconsumersforhealth.org
UHCAN Ohio
Ohio Consumers for Health
@UHCANOhio
@KathleenOCHC
A copy of this powerpoint will be sent to you in a follow—up email
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10/8/13
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