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.

~ December 1, 2017 ~

Nov. 1 - Dec. 15, 2017   
But be sure to check out Hurricane SEPs!!!! 
Friday, Dec. 22nd 2017
due to Christmas & New Year  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  
Uncertainty gripped the Senate on Wednesday over efforts to pass a sweeping $1.5 trillion tax cut after a Wisconsin Republican became the first senator in his party to declare that he could not vote for the tax bill as written, and other senators expressed serious misgivings over the cost and effect on the middle class. The House is set on Thursday to pass its own version of the tax bill, which would cut taxes by more than $1.4 trillion over 10 years and broadly rewrite the business tax code. But as with the health care debate earlier this year, the Senate emerged as the inconstant ally in President Trump's pursuit of a major legislative accomplishment in his first year. New York Times 
The U.S. House of Representatives passed a bill to reauthorize a health insurance program for low-income children, sending the legislation to the Senate. The bill would reauthorize the Children's Health Insurance Program for five years, after which Congress will have to reconsider it. It passed the House by a vote of 242-174. The proposal will also extend funding for community health centers and several other health programs. It's funded by taking money from the Prevention and Public Health Fund, a program under the ACA. Bloomberg
President Trump, who has repeatedly assailed pharmaceutical companies for the high cost of prescription medications in the United States, nominated on Monday a former executive of one of the nation's largest drug companies to be secretary of health and human services, which has responsibility for regulating the pharmaceutical industry. Mr. Trump announced his choice of Alex M. Azar, a former president of the American division of Eli Lilly and a health official in the George W. Bush administration. New York Times 
U.S. authorities released a 10-year-old immigrant girl with cerebral palsy who had been detained by border agents after surgery because she is in the U.S. without legal permission. The American Civil Liberties Union and U.S. Rep. Joaquin Castro said that Rosa Maria Hernandez was returned to her family Friday. Her parents brought her into the U.S. from Mexico in 2007, when she was a toddler, and they live in the Texas border city of Laredo.   Associated Press 
Health-care issues are at the top of Congress's hefty December to-do list.Republicans spent much of the year on a failed bid to repeal and replace ObamaCare. That's left several programs and taxes hanging in the balance as the year draws to a close, in addition to the latest health-care drama thrust into the GOP tax-reform debate. Here are 5 of the biggest health-care issues Congress faces:
  • Will Republicans repeal the individual mandate?
  • Will Congress reauthorize critical health programs it let lapse?
  • Will Congress fund the opioid response?
  • What does Congress do on ObamaCare taxes?
  • Will Congress help Puerto Rico fund its Medicaid program?

The Hill 

Health Centers Face "Funding Cliff"
As Florida's community centers, we are the health care home for more than 1.2 million patients living in medically underserved communities. We are writing today with an urgent, collective request: that you work with your colleagues to immediately pass a multi-year extension of critical funding for Health Centers and related primary care programs. With over a month having elapsed since funding for these programs expired, our statewide network is increasing fragile, and access to care for patients with few or no other options is already being disrupted... And yet, despite the fact that funding for these programs expired October 1, the Senate has taken no action to move the kind of multi-year funding extension needed to bring stability for the patients we serve. Worse, we have read reports that Senate consideration of this funding extension may be put on hold until the end of the year. Delaying this extension until December would mean it would be considered alongside a host of other unrelated issues, many of which lack the consensus that exists around Health Center funding - potentially ensnaring this priority within larger, more contentious political debates. We urge you in the strongest possible terms not to wait until December to act.    FACHC CEO Letter 

In the first month of online voter registration in Florida, more than 8,000 people electronically joined the voter rolls in Florida. A lot more people would have registered online, says the League of Women Voters of Florida, but few people know the program exists because the state has done almost nothing to educate Floridians about it."This is a tree falling in the forest," said League president Pamela Goodman. "We're going to come up with our own campaign." It has only been one month, so it's hardly a definitive trend. But October saw 2,965 Democrats using their computers to become voters, compared to 2,267 Republicans. More people (2,606) registered to vote with no party affiliation than Republicans, with the rest signing up with a minor party.You can register to vote or update your existing registration at 

How Do You Solve a Problem Like Maria?

Last week, they arrived - two brothers, their wives and their four children - and plopped onto newly bought bunk beds. The family is one small part of a sudden exodus of tens of thousands of Puerto Ricans racing to Florida after Hurricane Maria, a migration so large it rivals those from New Orleans to Houston after Hurricane Katrina and from Cuba to Miami during the Mariel boatlift. The scale is larger than any previous movement of Puerto Ricans to the mainland, including the wave that arrived after World War II, said Jorge Duany, the director of the Cuban Research Institute at Florida International University and an expert on Puerto Rican migration. "It's a stampede." More than 168,000 people have flown or sailed out of Puerto Rico to Florida since the hurricane, landing at airports in Orlando, Miami and Tampa, and the port in Fort Lauderdale. Nearly half are arriving in Orlando, where they are tapping their networks of family and friends. An additional 100,000 are booked on flights to Orlando through Dec. 31, county officials said. Large numbers are also settling in the Tampa, Fort Lauderdale and West Palm Beach areas. New York Times
If uninsured evacuees from Puerto Rico need assistance in obtaining medications, click here.

If the pharmacy needs assistance in processing authorized meds, certain medical supplies, or vaccines for uninsured evacuees from Puerto Rico, click here.
Use the correct & complete CAC & NAV # on all applications!
***13 characters (FLCAC or FLNAV + A/B/C/D + 2 digit contract # + 5 digit CAC or NAV # ***
*** CAC or NAV # is issued by your employer***

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma discussed her vision for the future of Medicaid and unveiled new CMS policies that encourage states to propose innovative Medicaid reforms, reduce federal regulatory burdens, increase efficiency, and promote transparency and accountability during a plenary session at the National Association of Medicaid Directors (NAMD) Fall Conference in Arlington, Virginia. During her first major speech on the subject, Verma noted that when the federal government established Medicaid, it was intended to be a partnership with state governments to care for society's most vulnerable citizens. With the growth of the program over the last several years came increased federal and state spending, which naturally meant increased federal oversight and regulation, said Verma. "Our vision for the future of Medicaid is to reset the federal-state relationship and restore the partnership, while at the same time modernizing the program to deliver better outcomes for the people we serve," said Administrator Verma. "We need to ensure that we are building a Medicaid program that is sound and solvent to help all beneficiaries reach their highest potential."  CMS Press Release
The Trump administration's recent endorsement of work requirements in Medicaid and increased state flexibility is part of broader strategy to shrink the fast-growing program for the poor and advance conservative ideas that Republicans failed to get through Congress. Seema Verma, administrator of the Centers for Medicare & Medicaid Services, laid out her vision for the state-federal program in two appearances last week, saying her new course give states wide latitude over eligibility and benefits.  Kaiser Health News  
In the first few days of open enrollment under the Affordable Care Act, the numbers of participants has surged compared with the past, according to federal officials who spoke on the condition of anonymity because the administration has yet to release official numbers. More than 200,000 Americans chose a plan on Nov. 1, the day open enrollment began, according to one administration official. That's more than double the number of consumers who signed up on the first day of enrollment last year. More than 1 million people visited, the official federal website, the official said, which amounts to roughly a 33 percent increase in traffic compared with 2016. Platform Snapshot
Nov 5 - 11
Nov 1-11
Plan Selections
New Consumers
Consumers Renewing Coverage
Consumers on Applications Submitted
Call Center Volume
Calls with Spanish Speaking Representative
91,539 Users
5,788,238 Users
Window Shopping Users
Window Shopping Users
There will, once again, be a designated call center line for Assisters. This year the line features several enhancements designed to help better streamline the call process. Utilizing the Assister line will only allow Assisters to bypass the regular call center line if they need help with password resets or accessing certain call center-initiated SEPs. This enhancement is designed to help minimize the time they have to spend on the phone trying to resolve certain consumer issues. For all other issues, the wait time will be the same as the regular call center line.  
Assister Line for CACs:  1-855-879-2683
Assister Line for Navigators: 1-855-868-4678
A consumer may not be determined eligible for advance payments of premium tax credit (APTC) if the tax filer for the household did not comply with the requirement to file an income tax return for a year in which APTC was paid on his/her behalf and reconcile the associated APTC for that year. This situation is called "failure to file and reconcile" or "FTR."  Enrollees can avoid losing APTC in 2018 by filing their 2016 tax returns and reconciling their 2016 APTC immediately. Enrollees whose APTC is discontinued beginning January 1, 2018, due to FTR can restore their APTC. As long as the enrollee remains enrolled in their Marketplace plan, he or she may return to the Marketplace application, report a life change, attest to filing and reconciling, receive a new eligibility determination, select a plan, and receive APTC prospectively, following the 15th of the month coverage effective date rules.
CMS is extending the deadline through Sept 30, 2018, for equitable relief assistance to Medicare beneficiaries currently enrolled in Medicare Part A and the Marketplace. This assistance provides eligible individuals with an opportunity to enroll in Medicare Part B without penalty. Further, CMS is offering assistance to eligible individuals who were dually enrolled in Medicare Part A and the Marketplace and subsequently enrolled in Medicare Part B with a penalty. This assistance provides these individuals an opportunity to request a reduction in their Medicare Part B late enrollment penalty. Click here  to review the Fact Sheet. 
OE5 Resources from CBPP
Click here  for information on eligibility for APTC, federal poverty levels, repayment limits, etc.
Click here  for information on documents that can be used to verify immigration status. Remember, you may need to submit more than 1!

Is this of Interest? 
PAR-17-266: Pilot Studies to Test the Initiation of a Mental Health Family Navigator to Promote Early Access, Engagement and Coordination of Needed Mental Health Services for Children and Adolescents (R34)  Click here to learn more.
  So, even if you did this before , do it again ! 

When an employee becomes a CAC, what is kept in their personnel file?
Each year a CAC is required to complete federal on-line training to be eligible for certification. Employers are required to ensure this occurs. So, in addition to other pertinent documents, the CAC's employee file should contain a copy of the annual Certificate of Training Completion, specific to the coming Plan Year. There should also be a copy of the fully executed CDO-CAC Agreement, co-signed by both the employer and the employee and, a copy of the CAC Certificate signed by the CEO (or designee) of the employer organization.

Would "social security widow benefits" be qualifying income for the Marketplace?'
The expected annual household income is used to determine the consumer's eligibility to purchase health insurance on the Marketplace and the amount of tax credits.they will receive. All qualifying income is taxable. Therefore, the easiest thing to do is to refer to last year's income tax return to see if all/some/none of the widow benefits are reported as taxable income. Since the earliest age you can get "widow's benefits" is age 60, I would also ask if the consumer is eligible for Medicare.
What about tax credits?  Many clients are confused by what they hear on the news.  
The only thing that was eliminated by the President was the Cost Sharing Reductions payable to insurers [for households under 250% FPL]. Because the Florida Office of Insurance Regulation instructed insurers to publish their premiums without CSRs, they are already 30-40% higher than in the past. But,since the cost of the benchmark plan is now greater, consumers may receive even more PTCs than before! This makes it possible for some to purchase a Gold-level plan for what the Silver-level plan cost in the past. What's really confusing is that consumers will see the CSRs even when the administration has stopped making these payments to insurers!  Premium tax credits to individuals remain active. 
A client said they made more than what was reported on their 2016 application and wanted to know how much they would have to pay back when they file taxes. Is there a max that the Marketplace charges or do they pay back the whole amount of the tax credit received?
PTCs are reconciled by the IRS (not the Marketplace) on forms 1095-A and 8962. Repayment of tax credits appears as a reduction in the income tax return and depends on your annual income in relation to FPL. Changes to the eligibility for premium tax credits is the main reason for ensuring a consumer's Marketplace account is accurate all year long. Following is the 2017 table.    
Annual Income
< 200% FPL
>200% < 300% FPL
>300% < 400% FPL
> 400% FPL
Does a low-interest disaster loan from FEMA count as income?
All taxable income counts as income for Marketplace applications except for Supplemental Security Income (SSI). FYI - loan interest is deducted when consumers file their tax returns. For a list of income sources considered by the Marketplace, click here.

Would you be able to forward the template used for the Certified Application Counselor Certificate?
All pertinent documents and templates were sent via the Electronic Handbook (EHB) by CMS to your organization together with the Certified Designated Organization agreement and appendices back in 2013. Fortunately, a copy remains posted for now on-line on the Welcome Packet.
My patient is 45 yo female who married a 75 yo veteran this year. Their household income comprises $800 SSA and $2800 VA Disability. Does VA Disability income contribute to MAGI?
Your consumer's primary interest is in getting coverage.The Marketplace does not consider her spouse's VA Disability benefits as (See FL Medicaid does. That denial alone should make her eligible for Marketplace coverage. But she was denied because of their sizeable savings account. That amount should appear as "other income" in a Marketplace application.
A consumer requested assistance but she did her own on-line application. May I help her?
Absolutely!  Even though you did not complete the original application, you are required to provide enrollment assistance.
What should be the first step for a family of 4 (2 adults/2 children) with $43K annual household income and eligibility for job-based coverage?  
The rule is that individuals eligible for job-based coverage are not eligible for Marketplace plans unless the premiums make it "unaffordable" (see The same applies for KidCare which does not use income as the sole eligibility factor. Once you apply, the Marketplace eligibility determination will tell you the options. You mentioned the employer has not released the PY2018 insurance rates. The Marketplace application will force them to do so. Remember that applying is not the same as enrolling. So, if they want "wiggle room" for studying the costs of the options, I would recommend applying right away.   
When do SEPs end?
Technically, eligible consumers may request an SEP for Plan Year 2017 through Dec. 31st. But since coverage is paid for 1 month in advance, it may not be practical to request an 2017 SEP after Dec. 1st. SEPs for Plan Year 2018 are available from Dec. 16, 2017 through Dec. 31, 2018. But remember that eligible Florida consumers can request a Hurricane Irma SEP from the Call Center that extends Open Enrollment through Dec. 31, 2017. The same kind of SEP is available to Puerto Rico evacuees because of Hurricane Maria.    

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