The Assister Bulletin is a technical assistance resource funded under a grant from the  Health Resources Services Administration (HRSA), 
Bureau of Primary Health Care
for Florida Assisters  on the Health Insurance Marketplace.

~ OCTOBER 27, 2017 ~

Nov. 1 - Dec. 15, 2017   
But be sure to check out Hurricane Irma SEPs!!!! 
Friday, Dec. 1st 2017
due to Thanksgiving holiday    
12:30-1:30 PM
From your computer, tablet or smartphone:   
Or, you can dial +1 (872) 240-3311 

Access Code: 307-260-925  
The epic disaster that left Puerto Rico devastated has few, if any, parallels in modern times. Hurricane Maria flattened the island, leaving its 3.4 million American residents without the essential resources of daily life: water, food, electricity, communications, transportation, fuel - you name it, they don't have it.  Miami Herald  
Tom Price, President Trump's embattled health and human services secretary, resigned Friday amid sharp criticism of his extensive use of taxpayer-funded charter flights, the White House said. The announcement came shortly after Trump told reporters he considered Price a "fine man" but that he "didn't like the optics" and planned to make a decision by the end of the day. By that point, the president had already received Price's resignation letter. In a statement shortly afterward, the White House said Trump would designate Don J. Wright as acting secretary. Wright has been the acting assistant secretary for health and director of the Office of Disease Prevention and Health Promotion.  Washington Post  
A gunman in a high-rise hotel overlooking the Las Vegas Strip opened fire on a country music festival late Sunday, killing at least 50 people and injuring hundreds of others in the deadliest mass shooting in modern American history. The gunman, identified by police as Stephen Paddock, was later found dead by officers on the 32nd floor of the Mandalay Bay Resort and Casino, Sheriff Joseph Lombardo said during a news briefing.The shooting marked the nation's latest outbreak of gunfire and bloodshed to erupt in a public place, again transforming a seemingly routine night into one of terror.  Las Vegas Video 
Congress just allowed the Children's Health Insurance Program, which provides health insurance to 9 million children, to technically expire, although states still have enough funding to carry them through a few more months. The Senate had allowed the CHIP deadline to pass without action as it focused on passing a bill repealing the ACA; two committees (Senate Finance and House Ways and Means) are finally scheduled to mark up CHIP legislation this week. "The program was primarily funded by the federal government, with states paying a good deal less," The Post's Valerie Strauss reports. "States still have some CHIP money available, but if Congress does not act quickly to restore the program, they will start to run out. Several states and the District of Columbia are expected to drain CHIP funding by the end of this year and many more by March 2018, according to this government report."  MACPAC Report
In a one-two punch elating religious conservatives, President Donald Trump's administration is allowing more employers to opt out of no-cost birth control for workers and issuing sweeping religious-freedom directions that could override many anti-discrimination protections for LGBT people and others. At a time when Trump finds himself embattled on many fronts, the two directives - issued almost simultaneously on Friday - demonstrated the president's eagerness to retain the loyalty of social conservatives who make up a key part of his base. Leaders of that constituency were exultant.  Miami Herald 

Executive Orders
President Trump's health care executive order is designed to increase competition and choice. But it would also deal a major blow to the health of Obamacare.The president says his action would give millions of Americans more access to affordable coverage. Supporters, such as Republican Senator Rand Paul of Kentucky, say the order will make it easier for people to obtain large group coverage, which is generally considered the best insurance to have. But critics argue it could lure younger, healthier consumers away from Obamacare with cheaper, but skimpier policies, while leaving sicker folks to pay higher premiums on the exchanges. Many industry and consumer groups, including the American Cancer Society and the American Hospital Association, voiced concerns about Trump's move. Money
President Donald Trump will "immediately" halt payments to insurers under the Obama-era health care law he has been trying to unravel for months. Before sunrise Friday morning, Trump went on Twitter to urge Democrats to make a deal: "The Democrats ObamaCare is imploding," he wrote. "Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!" The Department of Health and Human Services had made the announcement in a statement late Thursday. "We will discontinue these payments immediately," said acting HHS Secretary Eric Hargan and Medicare administrator Seema Verma. Sign-up season for subsidized private insurance starts Nov. 1, in less than three weeks, with about 9 million people currently covered...Halting the payments would trigger a spike in premiums for next year, unless Trump reverses course or Congress authorizes the money. The next payments are due around Oct. 20. Miami Herald

After nearly two months of negotiations, key senators said Tuesday they have reached a bipartisan deal on a proposal intended to stabilize the Affordable Care Act's insurance market, which has been rocked by recent actions by President Donald Trump. Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), respectively the chairman and the top Democrat of the Senate Health, Education, Labor and Pensions Committee, negotiated the emerging deal. The milestone agreement, they said, would guarantee payment of "cost-sharing reduction" subsidies that help some policyholders with low incomes afford their deductibles and other out-of-pocket costs for two years, 2018 and 2019.  Kaiser Health News

Pay Up or Lose Coverage
Florida families whose children receive state subsidized health insurance under the KidCare program were told by state officials this week that they have until Oct. 31 to pay up or lose their coverage - because the state has chosen not to seek a waiver to provide them with more financial relief. "Florida KidCare understands that Hurricane Irma may have impacted families and their ability to make their payment for October coverage, so we are extending the payment deadline until October 31, 2017," writes Florida KidCare on its website. But, it also notes, that kids whose families fail to pay up by then "will not have Florida KidCare coverage in October." The decision by the Agency for Health Care Administration, the Florida Department of the Health, and Florida KidCare to extend the payment deadline from Oct. 1 to Oct. 31 is being criticized by children's advocates as unfair and shortsighted. But after the Herald/Times published this report online Thursday, the agency said it would consider "further extending the deadline should the need arise" and "will work with every family to ensure there is NO lapse in coverage due to Hurricane Irma."  Miami Herald  
With more than 4,000 families facing the loss of their state-subidized KidCare health insurance in the wake of Hurricane Irma, Florida regulators have reversed course and now say they are prepared to seek federal help. Florida Healthy Kids, the agency that operates the KidCare insurance program, told the Herald/Times Friday that it will call a special board meeting next week to explore asking the federal government for a waiver to help families still financially stressed from the hurricane. The proposal would allow taxpayers to cover the premiums for low-income families who have lost jobs and homes or are facing other financial hardships because of Hurricane Irma. The cost to Florida: an estimated $240,000. The cost to the federal government: about $6.2 million. The state of Texas successfully sought a similar waiver after Hurricane Harvey. "We will not allow ANY family to lose their insurance coverage due to Hurricane Irma,'' wrote Mallory McManus, a spokesperson for the state Agency for Healthcare Administration, which oversees the program, in a statement late Friday. Miami Herald
Use the correct & complete CAC & NAV # on all applications!
***13 characters (FLCAC + A/B/C/D + 2 digit contract # + 5 digit CAC or NAV # ***
*** CAC or NAV # is issued by your employer***

During a public health emergency (PHE), health centers play an important role in delivering critical services and assisting with the local community response. As the recovery efforts from Hurricanes Harvey and Irma continue and the anticipated adverse impacts of Hurricane Maria unfold, BPHC continues to provide guidance that may support your response and recovery. BPHC has published a bulletin with updated guidance & resources on hurricane recovery efforts, including information on FTCA volunteer coverage. See the  Hurricane Updates and Resources webpage.
Hurricane SEPs
As a result of Hurricanes Harvey, Irma and Maria, the Centers for Medicare & Medicaid Services (CMS) will make available special enrollment periods (SEPs) for certain Marketplace consumers.  
Marketplace consumers affected ( see FEMA Hurricane Irma map) by one of the above hurricanes who need to enroll in a 2017 plan or make changes to their existing 2017 plan can do so if they experienced a qualifying event between 60 days prior to the start of the incident period and December 31, 2017, but were unable to complete the application, plan selection and enrollment process due to the hurricanes. These consumers can select a new 2017 Marketplace plan or make changes to their existing plan at any time through December 31, 2017 and should call the Marketplace at 1-800-318-2596 to request the SEP. Marketplace consumers who reside in or move from areas affected by a hurricane in 2017 will be eligible for an SEP that extends the 2018 Annual Open Enrollment Period through December 31, 2017. These individuals should call the Marketplace at 1-800-318-2596 to request this SEP after December 15, 2017.  
Unwanted Health Plans
Millions of Americans with insurance through the Affordable Care Act could find themselves locked into health plans they do not want for the coming year become of the Trump administration's schedule for the enrollment seasons that starts in less than two weeks. The complication arises when people who already have health plans under the law are automatically re-enrolled in the same plan. In the past, a few millions consumer each year have been auto-enrolled and then were sent notices encouraging them to check whether they could find better or more affordable coverage. This time, the automatic enrollment will take place after it is too late to make any changes.  

How Do You Solve a Problem Like Maria?

No one could foresee a catastrophe as devastating as Hurricane Maria. Some Caribbean islands were literally wiped out and nearly a month later, there still is no electricity and adequate water supply. Many evacuees from Puerto Rico and US Virgin Islands are coming to Florida where they have family and friends. However, the State of Florida faces some particularly difficult challenges in providing them with needed services. Here are some resources and suggestions:
  • A Public Health Emergency (PHE) was declared on 9/19/17 for US citizens in PR & USVI.
  • An 1135 Waiver was executed to streamline the enrollment of eligible evacuees to FL Medicaid. [No waiting period.]
  • In addition to meeting all other eligibility requirements, evacuees must declare Florida as their new permanent address.
  • Once a FL address is declared as permanent residence, a beneficiary goes to the "end of the line" if he/she decides to return to PR.[They operate a capitated model.]
  •  Evacuees who declare a temporary FL address will NOT BE ELIGIBLE for benefits.
  • The mission of federally qualified health centers (FQHCs) is to provide healthcare to the un/underinsured. Therefore, uninsured evacuees may become patients at an FQHC.
    • Sliding Fee Scale - Board policy
    • "Homeless"


On Monday, Oct 23rd, CBPP partnered with Dave Chandrasekaran (consultant), USF and FACHC to present, The Right Fit: Helping Consumers in Florida Navigate the Selection Plan Process. Over 90 persons participated in the webinar. To hear a recording of the presentation click here. For a copy of the slide deck, click here.

The Center on Budget and Policy Priorities will host a special invitation-only webinar for staff that are in program manager roles on Monday, Oct. 30, from 1:00 - 2:00 pm ET (10:00 - 11:00 am PT). This will be a limited-space webinar and include time for live questions and discussion. This new webinar will provide an in-depth analysis of ways in which assister programs can improve their performance in plan comparison and selection. The presentation will also include time for Q&A as well as peer-to-peer sharing of best practices among the participants. To apply, click here.
Get America Covered helps people get covered and stay covered. We're here to help people looking to enroll in health coverage and those who are helping other people sign-up. Open Enrollment will be half as long this year and there will be less public education about enrollment information and key deadlines than during previous open enrollments. This will make it that much harder for people to find the facts and information they need in order to sign up for health coverage this year. Take action. Click here.

  So, even if you did this before , do it again ! 

Where do CACs report their work accomplishments now?
The last Quarterly Progress Report was in December 2016. This year, the only thing that CACs are required to report to the feds is the number of "assists". That is done on Appendix E of the annual Uniform Data System (UDS) captured by your organization in the Electronic Handbook (EHB). That does not mean that your individual organization can not choose to require other reporting protocols internally in addition to this baseline federal requirement !!!

In the Enrollment Assister training modules, is the Assister Feedback module required for certification?
No. It's there but not a mandatory component of training completion . Remember that you receive your certification document as a CAC from your organization after you submitted your certificate of training completion from MLMS to your supervisor.

I recently spoke to a consumer that has issues with her "premiums" and the Marketplace. She was approved for a $0 premium but her BCBS has been in a "grace period" all year. She has contacted the Marketplace and BCBS several times but has been unsuccessful in getting it straightened out. As a CAC, am I able to help her?
Absolutely!  As a CAC, your job is not only to help consumers during Open Enrollment but also with Special Enrollment Periods, Appeals, Exemptions, etc. That means your tasks are year-round and your agency has an executed agreement with CMS to support that. That said, every organization has their own way of complying with the requirement. So please check with your supervisor. I'm surprised with this case because u sually "grace periods" are terminated quickly by the insurer. You found out that this consumer was enrolled by the Call Center in an incorrect plan for her county and you were advised to file an appeal.
Can PR Medicaid beneficiaries still use their Medicaid benefits here in FL via a "waiver". How do they get this waiver or is it automatic?
The 1135 Waiver applies only to PR Medicaid beneficiaries who choose to permanently relocate to FL. It streamlines the FL Medicaid process so there is no waiting period. However, these patients must meet all other eligibility requirements. There has been no official statement about how to finance the healthcare of those who temporarily relocate to FL or those who were already here and got stuck here. The "homeless" category is possible. What is your Board's policy regarding the use of the Sliding Fee Scale?

We have 2 new employees we want to get certified only for open enrollment.
No one is certified only for Open Enrollment. Certification is for the entire Plan Year. However, certification does not require your agency to have the new employees work year-round as CACs. You need to start them off by letting them know their CAC#. They will use that set up their profile and open an account at the CMS Enterprise Portal. Then they request access to FFM Training - Agents/Brokers/Assisters. [Trouble? Contact XOSC Help Desk or 1-855-267-1515]. Once granted, the candidates will need to complete the PY2018 Certified Application Counselor (CAC) curriculum modules. Be careful because there are some non-certified modules too! [Trouble? Contact MLMS Help Desk. I recommend taking a screen shot of each passed test. Candidates are to present their certificate of training completion to you and you give them a Certified Application Counselor certificate which is to be visible to consumers at all times. It's a maze!

I am new to my supervisory role. Please clarify the period of validity of the certificates.
Welcome to your new role!  It is often very confusing but I will try to make sense. First of all, there are 2 certificates:  the Certificate of Training Completion (from CMS/MLMS Training) and the Certified Application Counselor certificate (signed by your employer). The Certificate of Training Completion is valid thru the entire Plan Year. But the Certified Application Counselor certificate is valid only 12 months from the date it was issued by your employer. So, if you completed PY2018 training on Sept. 15, 2017 the Certificate of Training Completion will show that date. But, if your  CAC Certificate wasn't issued until Nov. 1, 2017, it will be valid until Oct. 31, 2018.

If someone applies for Marketplace coverage and estimates enough income to qualify for tax credits but then makes under 100% FPL when they file their taxes, would they need to repay back PTC's?
No. There is a special rule that exempts them from repaying the tax credits since Florida chose not to expand Medicaid. For additional information, please see CBPP Guidance.

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