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.

~ JULY 28, 2017 ~


Friday, Sept. 1st 2017  
12:30-1:30 PM  
Call # 

After seven years of emphatic campaign promises, Senate Republicans demonstrated they didn't have the stomach to repeal "Obamacare" on Wednesday when it actually counted. The Senate voted 55-45 to reject legislation to throw out major portions of the ACA without replacing it. New York Times

They couldn't pass a repeal of "Obamacare," or find the votes for a White House-backed replacement. So now Senate Republicans are lowering their sights and trying to unite behind a so-called "skinny repeal" that would merely undo just a few of the most unpopular elements of Barack Obama's law. The "skinny bill" is an admittedly lowest-common-denominator approach, and it may not even have the votes to pass, either. But as Republicans search for how to keep their years-long effort to repeal and replace "Obamacare" alive, they're coming to believe that the "skinny bill" may be the only option left. New York Times

Even a bare-bones repeal of Obamacare is no sure thing in the Senate. A handful of key Republican senators who had spurned earlier overtures from GOP leadership endorsed the latest plan to gut Obamacare's individual and employer coverage mandates and its medical device tax. But several centrists said they're undecided on the so-called skinny repeal, leaving the GOP in limbo through at least the end of the week. Politico

Senate Majority Leader Mitch McConnell is promoting a so-called "skinny repeal"  to advance the proposed legislation to conference with the House. But a conference committee won't likely be any more open and inclusive than the Senate's secretive approach to date. And there are no rules that prevent Republican leaders from continuing their closed-door, partisan approach to rewriting our nation's health care laws. Here's why:
  • Congressional leaders can exclude conferees from the real negotiations.
  • The conference process doesn't require hearings or necessarily allow amendments.
  • Conference reports are final products and can't be amended.
  • A conference report retains reconciliation's special protections.


After a week sparring with his attorney general and steaming over the Russia investigation consuming his agenda, President Donald Trump was closing in on an important win. House Republicans were planning to pass a spending bill stacked with his campaign promises, including money to build his border wall with Mexico. But an internal House Republican fight over transgender troops was threatening to blow up the bill. Politico

President Trump's announcement that he wants to ban transgender people from serving in the military could mean a historic reversal in the Pentagon's long-term trend of lowering barriers to service. "The president's tweet this morning regarding transgender Americans in the military is yet another example of why major policy announcements should not be made via Twitter," said Senate Armed Services Committee Chairman John McCain, R-Ariz. NPR 
The 2017 Assister Certification Training that is hosted on the Marketplace Learning Management System (MLMS) was taken offline at 12:01 P.M. on Friday July 21, 2017. During this "go-dark" period, assisters will not be able to access the certification training. It is anticipated that the 2018 Assister Certification Training, which will contain program updates and an improved learning format, will be available to assisters in early August.  
Under the recently finalized Marketplace Stabilization Rule as of June 23, 2017, a health plan issuer may apply any payments a consumer makes for new coverage (a binder payment) with that issuer towards past-due premiums owed to that issuer. The issuer may also refuse to effectuate the new coverage if the consumer fails to pay past-due premiums owed from the 12-month period preceding the effective date of new coverage. This applies to the consumer who is contractually obligated to make payments (ie., not dependents) during the coverage period and i ncludes issuers in a controlled group.  
There remains a lot of confusion among both Enrollment Assisters and consumers about eligibility for a Coverage Gap SEP when an increase in household income makes consumers newly eligible for coverage. Refer to this CMS presentation slide deck for guidance. Following are some key points:
  • Prospective coverage available only to consumers in non-expansion states.
  • Household income was below 100% FPL but consumer did not qualify for Medicaid.
  • Must be requested from Call Center within 60 days of new eligibility.
  • No need for Medicaid denial letter or ECN.
When consumers apply for Marketplace coverage, they provide information that helps to determine whether they're eligible for coverage, and may provide information to determine whether they're eligible for financial help. In some cases, consumers need to submit documentation to verify information on their application. Beginning on June 23, 2017, new applicants who attest to information that may qualify them for certain types of Special Enrollment Periods (SEPs) will need to submit documents to confirm their SEP eligibility before they can start using their Marketplace coverage. This requirement is referred to as an SEP Verification Issue (SVI).  SVI Process

Centers for Medicare & Medicaid Services (CMS) issued guidance on annual eligibility redetermination and re-enrollment (ARR) outlining the policies the Federally Facilitated Marketplace (FFM) will put in place for the upcoming Open Enrollment Period starting 11/1/2017. These policies and procedures ensure that an enrollee may take no action and maintain coverage across benefit years.
2018 Marketplace Redeterminations


Who's on First?  Who's on Second?

The Centers for Medicare and Medicaid Services posted an update to the Health Insurance Exchanges
2018 Issuer County Map . This map is of projected issuer participation on the Health Insurance Exchanges, based on the known issuer public announcements through July 3. Participation is expected to fluctuate and does not represent actual Exchange application submissions. This map currently shows that nationwide issuer participation declines and 40 counties are projected to have no issuers, meaning that Americans in these counties could be without coverage on the Exchanges for 2018. It's also projected that as many as 1,300 counties - over 40 percent of counties nationwide - could have only one issuer in 2018. This could represent as many as 2.4 million Exchange participants that will only have one choice and may not be able to receive the coverage they need. Currently for 2018, at least 27,000 active Exchange participants live in the counties projected to be without coverage in 2018. "There's no question insurers are nervous about participating in the marketplaces next year, given uncertainty over payment of cost-sharing subsidies and enforcement of the individual mandate, let alone of the future of the Affordable Care Act in general," said Larry Levitt, executive vice president of the Kaiser Family Foundation.   USA Today
Insurers in the Affordable Care Act marketplaces earned an average of nearly $300 per member in the first quarter of 2017, more than double what they earned in a similar period in the marketplaces' previous three years, according to new analysis by the Kaiser Family Foundation.That figure puts insurers on track to make a profit in the marketplaces after years of losses, according to Cynthia Cox, a researcher at the Kaiser Family Foundation who worked on the analysis. Total profits in 2017 will probably be lower than the first-quarter numbers suggest. First-quarter earnings are typically higher than subsequent quarters, since many people are still paying off their deductibles. Additionally, the gross earnings measure does not include administrative costs, which further eat away at profit margins. Still, the bountiful first quarter suggests the marketplaces are becoming a more profitable environment for the private companies selling insurance plans on the public exchanges.  Washington Post 


On July 7th, Health and Human Services Secretary Tom Price, M.D., named Brenda Fitzgerald, M.D., as the 17th Director of the Centers for Disease Control and Prevention (CDC) and Administrator of the Agency for Toxic Substances and Disease Registry (ATSDR).

"Today, I am extremely proud and excited to announce Dr. Brenda Fitzgerald as the new Director of the CDC," said Secretary Price. "Having known Dr. Fitzgerald for many years, I know that she has a deep appreciation and understanding of medicine, public health, policy and leadership-all qualities that will prove vital as she leads the CDC in its work to protect America's health 24/7. We look forward to working with Dr. Fitzgerald to achieve President Trump's goal of strengthening public health surveillance and ensuring global health security at home and abroad. Congratulations to Dr. Fitzgerald and her family."

The Affordable Care Act introduced Modified Adjusted Gross Income or MAGI as a new way of calculating income eligibility for
Advance Premium Tax Credits and cost-sharing reductions in the marketplaces, as well as for eligibility for the Children's Health Insurance Program (CHIP) and many Medicaid categories. MAGI has two components that must be considered: (1) who is in the household and household size, and (2) what is the household income. MAGI applies one methodology to determine eligibility across multiple programs, replacing the myriad of income counting rules, disregards, asset tests, and household composition rules that previously existed for many Medicaid eligibility categories. MAGI eligibility is based upon household income as a percentage of the Federal Poverty Level (FPL) for that household's size. The calculation requires a little bit of basic Tax Code knowledge. Check this out!   Calculating MAGI

Excess Body Weight and Cancer Risk
Thursday, August 23rd, 2017
12:00 - 1:00 p.m., ET

The Florida Department of Health with the American Cancer Society 
present this webinar as part of the Cancer Free Florida Webinar Series.
Join us for a live webinar discussing the relationship between obesity and cancer. The presentation will also review guidelines on nutrition and physical activity for cancer prevention. Attendees can receive 1.0 CME/CE credit upon successful completion of the webinar and corresponding quiz. Intended Audience: Primary care physicians, nurses, allied health professionals, navigators, community health workers, administrators and interested stakeholders.
Learning Objectives
1. Describe the role of excess body weight in the cancer process
2. Identify the cancers where there is sufficient evidence that excess body weight increases risk
3. Increase knowledge about recommendations for weight control and cancer prevention

After registering, you will receive a confirmation email with information about joining the webinar.
  We want to be sure the
Enrollment Assister database is accurate.
So, whether you are a CAC or a NAV
and d
id this before, please do it again.

Go to,  or click on the link below to register or update your contact info.

A consumer stated that her new husband pays alimony ($500 monthly) and child support ($400 monthly). I know Alimony is considered a deduction that consumers can claim when doing a Marketplace application but I was not sure if child support if both Alimony and Child Support are deducted from the annual household income.
First of all, make sure that you have the husband's designation of his wife as a Medical Representative before you provide any direct assistance on this case. Then, point out that  neither alimony nor child support constitute a tax deduction. Alimony is an adjustment which reduces one ex-spouse's annual income and transfers the tax liability for the alimony to the other ex-spouse. Child support is the amount that any parent would pay to support their child(ren). It is neither a deduction or an adjustment to income. So, for example, John Doe earns $50K per year but pays Sandra Doe SS# 123-45-6789 $6K ($500/month) in alimony.  This reduces his tax liability by $6K as long as he enters her SS# next to the amount on Line 31 of IRS Form 1040. This results in his Adjusted Gross Income (NOT the same thing as MAGI which is used for Marketplace purposes) and the former spouse pays the taxes on the $6K she received as alimony. See above!

 It looks like I will be the one for our DOH to help consumers with enrollment during the open enrollment period. My CAC certificate expires on 8-30-17. Can you send me a "step by step" how to re-certify? Will you be doing a "in-person" seminar like we had last year?
CMS has announced that the MLMS training site for 2017 will go dark at the close of business on July 21st. It intends to begin offering the mandatory 2018 on-line training in early August but it has not announced a specific date at this time. As for a "step-by-step" orientation to renewing your CAC certificate, keep attending our Lunch & Learn conference calls and reading the Assister Bulletin. All you need to know, right now, is that after your CAC expiration date you cannot assist anyone until you have successfully completed the renewal. The modules will again be offered through the MLMS training site but have yet to be published. Finally, thank you for asking about our Regional Conferences for Enrollment Assisters. I'm so glad you found them useful!

A consumer was released from incarceration on 07/17/17. I know the person would normally qualify for an SEP because he no longer has subsidized healthcare. But, if that consumer gets a job on 08/01/17 earning $10 an hour working 40 hours per week, would they qualify for APTC and/or CSR?
You can verify if a person is eligible for an SEP by going through the questions on Eligibility for APTC and/or CSR is based on the household size and what the individual expects to earn during the enrollment year (ie., what he expects to report on his income tax return) NOT what he would have earned if he had worked all year.

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