The Assister Bulletin is a technical assistance resource supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under cooperative agreement number U58CS06812, State and Regional Primary Care Associations for the total amount of $1,109,444.  This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsement be inferred by HRSA, HHS or the U.S. Government.

~ August 31, 2018 ~


NOV. 1 - DEC. 15, 2018 !

Friday, September 28th 2018
12:30-1:30 PM
From your computer, tablet or smartphone:   
Or, you can dial +1 (872) 240-3311 

Access Code: 307-260-925  

President Donald Trump says insurers are "going wild" about his new health care options and "millions and millions" of people will be signing up. But insurance companies say it will take time to design new plans and get approval from state regulators, and two major industry groups have actually expressed concern about potential downsides for consumers.
Short-term plans "may not be the right choice for everybody," Azar said at an afternoon news briefing. But, "we believe strongly in giving people options here." Azar predicted that short-term, limited-duration plans will appeal mainly to middle-class people who do not qualify for government subsidies for ACA health plans - especially people who are young or healthy. With the law still in place despite Trump's and congressional Republicans' hostility toward it, "we are looking to do everything we can to take incremental steps that will make insurance coverage more affordable," said Jim Parker, director of HHS's Office of Health Reform.  Washington Post  
The resolution of disapproval will be introduced by Sen. Tammy Baldwin (D-Wis.). During a call with reporters Thursday, Senate Minority Leader Charles Schumer (D-N.Y.) said he thinks there will be unanimous support among Democrats once the resolution is introduced. The measure will only require 51 votes to pass, which would mean that in Sen. John McCain's (R-Ariz.) absence the backers need to recruit one Republican to their cause. "All it takes is one or two Republicans who claim to support preexisting condition protections," Schumer said. The Hill 
The Department of Health and Human Services says 96 organizations will get funding under the federal family planning program this year. Twelve will be new. They include community health centers, state agencies and Planned Parenthood affiliates. In Florida, only DOH and Community Health Centers of Pinellas received a portion of the $286M available. Associated Press 
A July tweet from President Donald Trump sent panic through the C-suites of some of the world's biggest drug companies, prompting Pfizer and nine other companies to roll back or freeze prices. But there's less to those announcements than meets the eye. The gestures turned out to be largely symbolic - efforts to beat Trump at his own game by giving him headlines he wants without making substantive changes in how they do business. The token concessions are "a calculated risk," said one drug lobbyist. "Take these nothing-burger steps and give the administration things they can take credit for."   Politico 
The Trump administration said on Tuesday it would give Medicare Advantage health plans for the elderly new tools to negotiate for lower prescription drug prices. The Centers for Medicare and Medicaid Services (CMS) said Medicare Advantage plans will be allowed to require that patients first try certain lower-cost drugs before moving to a more expensive alternative if the first treatment is not effective.  Reuters 
Brett Kavanaugh offered glimpses of his position on abortion that strongly suggest he would vote to support restrictions if confirmed to the Supreme Court. One was in a dissent in the case of a 17-year-old migrant seeking to terminate her pregnancy. The other was a speech before a conservative group in which he spoke admiringly of Justice William Rehnquist's dissent in the 1973 Roe v. Wade case that established a woman's right to abortion.  Associated Press   
Supreme Court nominee Brett Kavanaugh's Senate confirmation hearings will start on Sept. 4 and last between three and four days, Judiciary Chairman Chuck Grassley (R-Iowa) announced on Friday. That scheduling tees up the GOP to meet its goal of getting President Donald Trump's pick seated on the high court by the time its term begins in early October, barring unforeseen obstacles or a breakthrough by Democrats who are pushing to derail Kavanaugh's confirmation. Politico 
Senate Republicans say they would like Arizona Gov. Doug Ducey (R) to appoint a successor to late Sen. John McCain (R-Ariz.) who, unlike McCain, would support GOP legislation to repeal ObamaCare. GOP lawmakers say they won't have time to hold another vote to repeal the law in 2018 but vow to try again next year if they manage to keep their Senate and House majorities. 
With input from WH Advisor, Stephen Miller, the federal government is at the verge of imposing some serious changes to current immigration rules. We have previously reported on the proposed broadening of the definition of "public charge" to include both cash and non-cash public benefits (eg., EITC, APTC, Medicaid, HUD, SNAP, TANF, etc.). We have also previously reported on the impact of the proposed rule change on lawfully present immigrants and their household members, including the withdrawal of whole families from healthcare programs to which they are legally entitled. This will have a very negative financial impact on FQHCs which are required to serve the uninsured and underinsured. The Migration Policy Institute estimates a decreased non-citizen enrollment of 20%-60%. FQHCs are encouraged to estimate the financial impact of this rule change and to share it when it comes time for public comment. To prepare your center's Estimated Financial Impact:
  1. Determine the number of non-citizen patients at your FQHC.
  2. Determine the annual revenue collected per patient at your FQHC.
  3. Multiply #1 against #2  to arrive at the annual revenue collected from non-citizen patients.
  4. Multiply #1 and #2 and decrease by 20% to arrive at Scenario 1.
  5. Multiply #1 and #2 and decrease by 60% to arrive at Scenario 2.
A federal judge said the Trump administration is responsible for finding hundreds of immigrant parents deported or released into the U.S. without their children in the wake of the government's policy of separating families at the Mexican border. U.S. District Judge Dana Sabraw said not finding those parents, as many as 400 who may have been deported primarily to Central America, could leave hundreds of children permanently orphaned. "That is 100% the responsibility of the administration," Judge Sabraw said during a hearing Friday in San Diego.  Wall Street Journal
The Trump administration and the American Civil Liberties Union revealed widely divergent plans on how to reunite hundreds of immigrant children with parents who have been deported since the families were separated at the U.S.-Mexico border. President Donald Trump's administration puts the onus on the ACLU, asking that the organization use its "considerable resources" to find parents in their home countries, predominantly Guatemala, El Salvador and Honduras. The U.S. Justice Department said in a court filing that the State Department has begun talks with foreign governments on how the administration may be able to aid the effort.  Associated Press 
The Trump administration is advancing a plan to punish legal immigrants for accepting food stamps, public housing and other government benefits they are entitled to - a strategy that appeals to conservatives and could help to galvanize Republican voters before the midterm elections. The proposed rule first surfaced last year. Last month, the White House Office of Management and Budget published a notice that it was under consideration. A Trump administration official said Tuesday that details of the proposal were still weeks away from being finalized and made public. New York Times 
A new study finds that immigrants have lower health-care costs than people born in the United States, meaning they are likely helping support public health insurance programs like Medicare. The report from researchers at Harvard Medical School and Tufts University examined all peer-reviewed studies since 2000 on immigrants' health-care costs in the United States. It found that immigrants' health-care expenditures were one-half to two-thirds those of people born in the U.S.  

It's been almost a year since Hurricane Maria slammed into Puerto Rico, battering the U.S. territory with heavy rain, flash floods and winds that blew up to 155 mph. Officially, the death toll stands at 64. But a new report estimates that 1,139 people lost their lives as a result of the Category 4 storm. The figure is based on mortality data that was not previously available. LA Times 
The government of Puerto Rico on Tuesday embraced the GWU estimate as the official death toll, ranking Maria among the deadliest natural disasters in U.S. history. For much of the past year, the government had formally acknowledged just 64 deaths from the hurricane, which ravaged much of the territory and destroyed critical infrastructure. The spike in mortality came as the territory dealt with widespread and lengthy power outages, a lack of access to adequate health care, water insecurity and diseases related to the crisis.  Washington Post 
Use complete CAC# on all applications!
***13 characters (FLCDO + A/B/C/D + 2 digit contract # +  
5 digit CAC#  for Plan Year 2019 ***
  *** CAC# is issued by your employer***
[OH-OH!  Only 275,822 "assists" reported in the 2017 Uniform Data System.]
for General Election
is October 9 
T he  2019 Assister Certification Training is live for Certified Application Counselors and other non-Navigator assisters ! (Navigator training will be made available following the Navigator Grant Awards in Sept.) The training is hosted by the Marketplace Learning Management System (MLMS); the online web-based training platform for assisters providing application and enrollment assistance to consumers in Federally-Facilitated Marketplaces (FFMs), including State Partnership Marketplaces (SPMs), and certain State-based Marketplaces using the Federal platform (SBM-FPs). If you have a new CAC#, the training can be accessed through the CMS Enterprise Portal by logging in or registering as a new user or existing user 14 days after your employer has been issued a new CDO#.
On 8/1/18, the departments of Health and Human Services, Labor and the Treasury, issued a final rule which allows for the sale and renewal of short-term, limited-duration plans that cover longer periods than the previous maximum period of less than three months. Such coverage can now cover an initial period of less than 12 months, and a maximum duration of no longer than 36 months in total. This action will help increase choices for Americans faced with escalating premiums and dwindling options in the individual insurance market.Short-term, limited-duration insurance, which is not required to comply with federal market requirements governing individual health insurance coverage, can provide coverage for people transitioning between different coverage options, such as an individual who is between jobs, or a student taking time off from school, as well as for middle-class families without access to subsidized ACA plans. Access to these plans has become increasingly important as premiums have escalated for individual market plans, and affordable choices for individuals and families have dwindled.  HHS Press Release  
"Equitable relief" for Marketplace enrollees who need Medicare expires September 30! Qualified Medicare beneficiaries have until September 30, 2018 to request equitable relief assistance to help them avoid or reduce the late enrollment penalty for Medicare Part B. Equitable relief is available to Medicare beneficiaries currently enrolled in Medicare Part A and a Marketplace plan and, it allows them to enroll in Medicare Part B without penalty. Equitable relief is also available to Medicare beneficiaries who were dually enrolled in a Marketplace plan and subsequently enrolled in Medicare Part B with a penalty.  Learn more here.

CMS has released guidance clarifying Federally-facilitated Marketplace (FFM) Special Enrollment Period (SEP) policy for consumers impacted by an emergency or major disaster that is recognized with a formal declaration from the Federal Emergency Management Agency (FEMA). Example:  Hurricane Irma. This guidance clarifies that an individual is eligible for an Exceptional Circumstances SEP when that individual and any dependents were eligible for another enrollment period, such as a SEP or Open Enrollment Period (OEP), but were unable to enroll due to being affected by a FEMA-declared emergency or major disaster.  This guidance was effective on August 9, 2018.  Click here for details.

In order to align with the statutory changes to Section 330 Public Health Service Act, we are excited to announce that the HRSA Health Center Program Compliance Manual update is now available. This document continues to serve as a streamlined and consolidated resource to assist health centers in understanding and demonstrating compliance with the Health Center Program and Federal Tort Claims Act deeming requirements.


The CDO Application Refresh process has confounded many FQHCs. It is a process whereby the original 2013 CMS agreement for consumer enrollment assistance services is renewed.  
The CDO Application Refresh process involves 2 steps:  submission of the application and submission of the signed agreement. For each step, you should receive an e-mail from confirming receipt of the document and informing you of the next steps to take. You may contact them directly for a status report on your CDO Application. 
The process is complete when your organization receives a congratulatory e-mail with a new CDO# and a Welcome Packet. The new CDO# becomes the basis for you to issue new CAC#s to all your trained staff. When training is complete, the organization can issue the CAC a signed certificate which bears their name, the new CAC# and the expiration date of 12/31/2019. Training for Plan Year 2019 cannot begin until 14 days after the date of the new CDO#.
Existing CACs may continue to provide consumer assistance for Plan Year 2018. However, failure to complete the entire CDO Application Refresh process by Sept.14 will result in your FQHC and your staff to be disallowed to provide enrollment assistance for Plan Year 2019.   
Part I: Premium Tax Credits 
Thursday, September 13 | 2:00 pm ET (11:00 am PT)
Part I will provide a detailed discussion of eligibility for premium tax credits-including how offers of employer-sponsored insurance can affect eligibility-as well as how premium tax credits are calculated.  
Click here to register  
Part II: Determining Households and Income for PTC and Medicaid
Tuesday, September 18 | 2:00 pm ET (11:00 am PT)
Part II will detail the rules used to determine household size and will explain what counts as income when determining eligibility for premium tax credits and Medicaid.
Part III: Plan Design
Thursday, September 20 | 2:00 pm ET (11:00 am PT)
Part III will provide an overview of health plan design-including cost-sharing charges in marketplace plans, eligibility for cost-sharing reductions, and how plan design affects costs for consumers. It will also include information on the expansion of skimpy plans.
Part IV: Plan Selection Strategies
Tuesday, September 25 | 2:00 pm ET (11:00 am PT)
In a special presentation by Dave Chandrasekaran, a training consultant working with CBPP, Part IV will provide an in-depth lesson on effectives strategies to support consumers with understanding how commercial insurance works, evaluating and comparing Marketplace plans, and selecting the plan that best meets their families' needs.
Auto-Renewal Process for 2019 in
Thursday, September 27 | 2:00 pm ET (11:00 am PT)
This webinar will provide an explanation of the auto-renewal process for 2019 coverage and will cover both the process for plan enrollment and redetermination of eligibility for premium tax credits.
CBPP will have additional in-depth webinars on immigrant eligibility for coverage programs, preventing and resolving data-matching issues, and assisting people with disabilities enroll in coverage in October, and will let you know as soon as registration for those webinars is available.
For more information, go to: 

You are cordially invited to the 2018 Florida Community Health Worker Coalition 8 th Annual FL  CHW Summit at the Holiday Inn Orlando-International Airport located at 5750 T.G. Lee Blvd in Orlando, Florida 32822, September 14-15, 2018.  Register here
Many of you became Certified Community Health Workers at my encouragement. However, in 2016, centers only reported 20.70 CHW FTEs in the whole state!  In 2017, that number was even less! I know, that there are many CCHWs in our centers. But the Uniform Data System does not reflect that. The same goes for Medical Interpreters.  Please help me figure this out by completing this 2018 CHW-CMI Staffing Survey.  Only 7 people have responded to date! 

My pregnant consumer is here on a 6-month tourist visa. Is she entitled to purchase health insurance from the Marketplace?
Although your consumer is currently here lawfully with a visa that does not expire for 6 months, she is NOT eligible for healthcare from the Marketplace. Remember, that in order to receive healthcare from the Marketplace, the consumer attests to being in the US for a minimum of 5 years and to having income that she will report on an income tax return with a valid SS#. For further information on Marketplace eligible immigrant visas, click here.  However, if your consumer delivers her child while she is here and she is uninsured, she can apply for emergency Medicaid which can cover her hospital expenses and 6 weeks post-partum care. [Thank you Maria Hdz-Rojas!] 

How long are we supposed to keep Authorizations for Assistance?
Per HIPAA, personally identifiable information must be kept securely for 6 years. That doesn't mean that you need to keep mountains of paper documents for all that time. Once the consumer gives consent and signs the form, you can upload it to a special "Authorization for CAC Assistance" section on your FQHC server. Involve your Administration and IT Department on this!  Once uploaded, you must shred the document.

If the Marketplace cancels a consumer APTC for non-payment, but the grace period extends  for 90 days will the consumer have to pay the full premiums for the grace period ?
The Marketplace can only cancel APTC once the insurer has cancelled coverage after the 90-day grace period is over. But always check on the Marketplace account to confirm this happened because the consumer doesn't want to repay all of that money at tax-time! If coverage is terminated due to non-payment, that person in unable to re-enroll until the following Open Enrollment period and no SEP for loss of coverage applies. Also, before new coverage is effectuated, insurers can insist on repayment of past due premiums thru the termination date if
services have been provided. 
I met with a couple. The husband works PT and is on Medicare. The wife has a Marketplace plan. Recently, the husband was asked to work FT. He has decided to keep Medicare and forego job-based coverage. The wife is concerned that this will affect her APTC.
It is illegal to have a taxpayer subsidized plan when you are eligible for a job-based plan. But, in this case, the husband prepaid for Medicare with years of payroll deductions. So, he can continue Medicare and forego the job-based plan. The wife's APTC will not be affected because her eligibility depends on her husband's enrollment in the job-based plan. However, the wife's APTC will change due to the increase in household income from the husband going to FT employment.
We are beginning to experience immigrant withdrawal from Medicaid because of the proposed public charge rule change. Did it happen yet? What do we tell consumers?
See above for more information about immigration. Altho' already practiced by embassies and consuls abroad, the rule change in the definition of "public charge" has not yet gone into effect. But we are expecting it to be published in the Federal Registrar at any moment. A period of public comment will follow its publication and will be considered before the rule is finalized. So, it will be at least a few months before the rule is finalized. The Migration Policy Institute estimates between 20%-60% lawfully present immigrants will withdraw from public programs as a result of this proposed rule change. Please report to me how many consumers are taking this action. Remember, no identifiable information!
We are experiencing some confusion about when we begin using the new FLCDO#. Is it for enrollment this year or next? 
Once your organization receives its new CDO#, you should be given a new CAC# which begins with FLCDO... Fourteen days later, you will need that number to register for Plan Year 2019 training. When your Plan Year 2019 training is completed, you present your certificate of training completion to your employer. At that point, your employer issues you a signed CAC Certificate with your new CAC#. They should also give you a CDO-CAC Agreement to sign. A copy of your CAC Certificate and your CDO-CAC Agreement should be kept in your personnel file. You begin using the FLCDO# as soon as you receive the new CAC# from your employer. BTW - Your CAC Certificate should state it is valid through Dec. 31, 2019, which is the end of the new Plan Year.
What do we tell consumers about the new short-term plans?
The first thing we tell consumers is that the short-term plans are not new. They are an extended version of plans that have always been around. Short-term plans are an insurance option for students or consumers who will not meet the criteria for APTC. Short-term plans do not comply with the ACA, have very high deductibles and are not available for enrollment by CACs through the Health Insurance Marketplace. It is important for CACs to know they exist and know they have been expanded to cover 12 months with possible renewals up to 36 months. You should refer interested consumers to insurance agents/brokers.    

Does the Call Center give you a headache?
Got a question and need a reliable answer FAST?
Click here to contact me!
 Like us on Facebook