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.

~ SEPTEMBER 29, 2017 ~

Nov. 1 - Dec. 15, 2017  
Friday, Oct. 27th 2017   
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 government says about 500,000 fewer Americans had no health insurance the first 3 months of this year, but that slight dip was not statistically significant from the same period in 2016. Progress reducing the number of uninsured appears to have stalled in the last couple of years, and a separate survey through the first half of 2017 even registered an uptick. Associated Press 
Last year, 8.6 percent of Americans lacked health insurance. Three years earlier, that figure was 14.5 percent, meaning that the rate dropped by 5.9 percentage points over the period that the Affordable Care Act went into effect, a 40 percent decline from the 2013 figure. In real terms, that's about 19 million fewer people lacking health insurance, per estimates released Tuesday by the Census Bureau. Washington Post 
Legal groups filed a class-action lawsuit last month against the health insurer Aetna, alleging the company violated the privacy of its customers by sending many of them letters through which the phrase "filling prescriptions for HIV" was visible through envelope windows. The federal suit alleges the breach affected as many as 12,000 Aetna customers living in 23 states. STAT News 
Here's the fundamental barrier to shoring up Obamacare's marketplaces for next year: Virtually nobody sees it in their political interest. Democrats desperately needed the Affordable Care Act to thrive while they still controlled the White House. But with President Barack Obama gone, and GOP majorities in the House and Senate, they're pretty much off the hook - at least, according to polls showing 60 percent of Americans find Republicans responsible for the ACA. As for Republicans, they're still deeply bitter they weren't able to repeal one iota of Obamacare despite their high-drama effort over the spring and summer. Many members have spent too many years characterizing the extra Obamacare subsidies now at stake as improper insurer "bailouts" to get excited about funding them, even though providing them could somewhat improve otherwise skyrocketing rates next year.  Health 202  
Sens. Lindsey Graham, Bill Cassidy, Dean Heller and Ron Johnson on Wednesday released an Obamacare repeal bill, framing it as the last, best hope to fulfill the GOP's promise to undo the health law. The bill faces long odds: Even some of its GOP backers say it would be almost impossible to get a massive rewrite of the health care system through the Senate within 17 days, or before the expiration of fast-track procedural powers Republicans hope to use to bypass the threat of a Democratic filibuster. Politico
So, what did the CBO say yesterday about Cassidy-Graham? It would cause "millions" of Americans to lose insurance by 2026 while lessening the federal deficit by at least $133 billion,
The Post's Amy Goldstein reports. According to the partial analysis, the precise increase in people without health coverage "could vary widely," because the legislation would give each state great latitude to design its own health-care policies.  Health 202 
Sen. Bernie Sanders (I-Vt.) rolled out his "Medicare for all" health-care bill to much fanfare. While the bill has no chance of passing in the current GOP-led Congress, it is a marker of where the Democratic Party is heading. The Hill  

After an estimated 215 people died in hospitals and nursing homes in Louisiana following Hurricane Katrina in 2005, policy makers realized that the nation's health care institutions were ill-prepared for disasters. One of the rules they created after years of discussion looked especially prescient in light of the tragic deaths on Wednesday of eight nursing home residents in Florida's post-hurricane heat. But the rule, regarding power supplies and temperature control, will not be enforced until November, and even then, some patient advocates are concerned that it does not go far enough. New York Times 
The news that eight Florida nursing home residents died in the aftermath of Hurricane Irma has prompted a criminal investigation and spurred widespread outrage. But it also poses unsettling, difficult questions for people selecting a nursing home for themselves or a loved one. This emotionally fraught choice often must be made at a chaotic moment when a relative is sick, his or her time in the hospital is running short and the options seem confusingNew York Times   
The emergency room workers at Memorial Regional Hospital rushed the first patient to Room 9, which was devoted to the hope and practice of arresting death. They threaded fluid lines into her veins and readied a breathing tube. Even through gloves, they could feel the heat corseting the 84-year-old woman's body. As they prepared to insert a catheter, they saw what looked like steam rising from her legsNew York Times 
Jodi Ray, Director of Florida Covering Kids & Families, ( FL-CKF) a community and consumer-focused nonprofit initiative of The Chiles Center, based in the College of Public Health at the University of South Florida, announced today that her organization has received a $4.9M award from the US Health and Human Service Centers for Medicare & Medicaid Services
for Affordable Care Act enrollment and outreach programs for the current project year beginning September 13, 2017. Ray acknowledged that her program has received a 15% reduction in its expected award, requiring the organization to adjust the statewide program budget for the coming year's activities. Research shows that consumers are twice as likely to successfully enroll having in-person assistance as those who have attempted online without help. In addition, historically underserved communities rely more on in-person assistance. Read the CMS Announcement here
Health insurers selling Affordable Care Act plans in Florida will raise monthly premiums nearly 45% on average next year, the state's Office of Insurance Regulation said Tuesday. Florida regulators said most of the average rate hike - 31 percentage points - came from standard plans sold on the ACA exchange at  Insurers raised rates for those plans due to the political uncertainty that has plagued the healthcare debate, specifically whether the Trump administration will stop paying subsidies that lower out-of-pocket costs for low-income Americans. Miami Herald 
The Trump administration plans to shut down the federal health insurance exchange for 12 hours during all but one Sunday in the upcoming open enrollment season. The shutdown will occur from 12 a.m. to 12 p.m. ET on every Sunday except Dec. 10. The Department of Health and Human Services will also shut down the federal exchange - - overnight on the first day of open enrollment, Nov. 1. More than three dozen states use that exchange for their marketplaces.  
re-printed from Assister Bulletin 9/1/2017
  1. Open Enrollment 2018 is from November 1, 2017 through December 15, 2017.
  2. The annual training modules for enrollment assisters is currently available at the MLMS training site through the CMS Enterprise Portal. Completion is mandatory for Navigators, CAC and non-navigator personnel.
  3. The training includes mandatory and optional modules, as well as, non-certification modules. Be sure to enroll in the correct series!
  4. Access the  CMS Enterprise Portal, accept the Terms & Conditions and log-in. Returning assisters use the same log-in information as before. Returning assisters may also be asked to create a new password. New assisters will need to set up an Enterprise account.
  5. New assisters will need to request access to FFM Training - Agents/Brokers/Assisters.
  6. A yellow MLMS button & pull down will appear on the left of the page.
  7. If necessary, update your contact information before clicking Next.
  8. Select the appropriate modules and complete testing, as indicated. For problems with the training modules contact the MLMS Help Desk. [Do not phone. Responses often take 72 hours.]
  9. There is no need to repeat training modules if the system does not register them. Simply take a screen shot showing the results of each test and send your request for a Certificate of Completion to MLMS Help Desk.
  10. If you are a Certified Application Counselor, submit the Certificate of Completion to your organization Human Resources Dept. They will issue a signed Certified Application Counselor Certificate (valid for one year) and a CDO-CAC Agreement describing your program duties as a CAC. All documents are available in the CDO-CAC Welcome Packet.
  11. A copy of your Certificate of Training Completion, Certified Application Counselor Certificate and CDO-CAC Agreement should be kept in your personnel file.
CACs are certified by their employer and that certificate must be visible to consumers at all times. This is NOT the same as a Certificate of Training Completion.
Review   MLMS FAQ for questions about the annual training modules. Further information may be found at CMS Technical Assistance Resources . 
Be sure to post your contact information on the 2018 Florida Enrollment Assister Database.  

The Health Resources and Services Administration (HRSA) awarded more than $200 million to 1,178 health centers and 13 rural health organizations in every U.S. state, the District of Columbia, Puerto Rico, the Virgin Islands, and the Pacific Basin to increase access to substance abuse and mental health services."No corner of our country, from rural areas to urban centers, has escaped the scourge of the opioid crisis," said HHS Secretary Tom Price, M.D. "The Trump Administration is taking strong, decisive action to respond to the crisis caused by the opioid epidemic. These grants from HRSA go directly to local organizations, which are best situated to address substance abuse and mental health issues in their own communities." Approximately $200 million will support 1,178 health centers to support expansion and integration of mental health services and substance abuse services. These services focus on the treatment, prevention, and awareness of opioid abuse in the primary care setting by increasing personnel, leveraging health information technology, and providing training. HRSA 
It's an administrative task for the ages. Medicare is getting ready to issue all 60 million of its beneficiaries new cards with new ID numbers as way to combat identity theft and fraud. The rollout begins next April, but the agency is already beginning its outreach campaign.  NPR
The 2017 UDS Manual describes the annual reporting requirements for all health centers that receive federal award funds (grantees) as well as for look-alikes under the Health Center Program. This comprehensive guide helps health centers understand the framework of reporting requirements, including data submissions on patients, operations, and clinical performance. The manual provides. Find the 2017 UDS Manual at UDS Resources

IRS Decreases the ACA Affordability Percentages

For plan years beginning in 2018, employer-sponsored coverage will be considered affordable if the employee's required contribution for self-only coverage does not exceed:
  • "Affordability" is "9.56 percent (in 2017, it was 9.69%) of the employee's tax household annual income for the year, for purposes of both the pay or play rules and premium tax credit eligibility; and"
  • "Exemptions" are possible if the cost of health insurance is 8.05 percent (in 2017, it was 8.16%) of the employee's tax household annual income for the year, for purposes of an individual mandate exemption.
Volunteers for Free Tax Preparation

The IRS is looking for community volunteers to provide free tax preparation and help to their neighbors and other area residents in 2018. The IRS sponsors the Volunteer Income Tax Assistance (VITA) and the Tax Counseling for the Elderly (TCE) programs. These two programs offer free tax help across the country for people with low-to-moderate incomes, senior citizens, persons with disabilities, those with limited English proficiency and Native Americans. This year, VITA and TCE volunteers prepared more than 3.5 million federal tax returns for all types of taxpayers at no cost. To become a VITA or TCE tax volunteer, visit and type "tax volunteer" in the search box.

Marketplace updates and two webinar presentations
Friday, September 29 at 2:00 PM ET
The first presentation will provide an overview of Advanced Premium Tax Credit (APTC) and Cost Sharing Reductions (CSRs), which are subsidies that some consumers may qualify for when purchasing coverage through the Marketplace. This presentation will provide essential background information assisters can use when helping consumers determine whether they qualify for, and how to use, APTC/CSRs. Next, there will be a refresher on Assister Dos and Don'ts in the Federally Facilitated Marketplace, including application and enrollment assistance; outreach and education; and providing nondiscriminatory, culturally and linguistically appropriate services and services accessible for consumers with disabilities. This presentation will help assisters gear up for the fifth Open Enrollment Period (OE5) and beyond.  Register here 
To prepare for the upcoming open enrollment period, Health Reform: Beyond the Basics is presenting a reprisal of their four-part webinar series on key topics that assisters need to know.
Wed., 10/4/2017  2:00-3:00PM 
Immigrant Eligibility for Coverage Programs 

Click here to register  
Wed., 10/18/2017
Preventing & Resolving Data Matching Issues  

All webinars will be recorded and available for viewing at

EQUIFAX Security Breach  
As reported widely in the media, Equifax identified a cybersecurity incident potentially impacting approximately 143 million U.S. consumers. Equifax does not maintain consumer data related to verification requests. According to Equifax, the breach did not impact the Current Sources of Income Service, available through the Hub nor the database CMS uses. Equifax has established a dedicated website,, to help consumers determine if their information has been potentially impacted and to sign up for credit file monitoring and identity theft protection, which they are offering complimentary for one year to all U.S. consumers.

There are many changes to Enrollment Assister staffing.
We want to be sure our database is correct.
So, even if you did this before
, please register now !

Can you please tell me which Federal Poverty Level guidelines I'm supposed to use for Marketplace enrollment?
As an Enrollment Assister you are required to do insurance and Medicaid/CHIP enrollments. Currently, the 2016 Federal Poverty Level guidelines are used to establish eligibility for Plan Year 2017 insurance enrollment. Effective 11/1/2017, the FFM will begin using the 2017 Federal Poverty Level guidelines for Plan Year 2018. However, Medicaid/CHIP programs have used the 2017 Federal Poverty level guidelines as soon as they were published in Spring 2017.

How affordable will 2018 plans be if Cost Sharing Reductions (CSRs) are rescinded?
We know that insurers in Florida have a history of requesting rather significant price increases in their monthly premiums from year to year. The Florida Dept. of Insurance Regulation didn't even provide oversight on this until recently. Like you, we are hearing a lot of buzz around the elimination of the CSRs and the resulting premium increases of  20% or more. 

I just remembered that marketplace enrollment is November 1st. Will there be a training that needs to be completed as the years before? I have 2 new registration counselors that need to get certified.
Yes. Marketplace enrollment for Plan Year 2018 is from Nov.1-Dec. 15, 2017 and the mandatory annual on-line training requirement has not changed for enrollment assistance personnel. See article above.
What happens if an SVI is not resolved within the 30 days of plan selection? Would the consumer have to pay the full premium until the SVI is resolved (as the application currently warns)? Or will the consumer plan selection be cancelled and if eligible they can apply again?
If a consumer does not resolve the SVI within 30 days of plan selection then the SVI will expire and the pended plan selection will be canceled. The consumer in this case would not have an effectuated plan and therefore wouldn't owe a premium. If a consumer in this situation still has time in the 60 day SEP window, he or she can return to their application, re-attest to the SEP qualifying event, and pick a new plan. This will generate a new SVI and SVI clock, and the consumer can submit documents based on the new deadline. Note: Consumers who do not resolve his or her SVI in time and receive an expiration notice will see language in this notice that notes that they may still be able to enroll if he or she can submit documents that successfully confirm their eligibility for the SEP.
I believe I have registered for the incorrect course.  I am a CAC and need the 40-hour course.
When requesting access to the MLMS training modules, you are correct to select "FFM Training". Once granted, you need to take the PY2018 CAC Required Curriculum. There are 6 mandatory modules. The "abbreviated" training is only for re-certifying NAVs and is not for CACs. There are 10 CAC "optional" modules for which you may not register until you have completed the 6 mandatory modules. You can choose to enhance your CAC training with these optional modules but they are not required for certification.

My consumer is currently a Medicaid Share of Cost beneficiary who has applied for SSI. Should he terminate his Marketplace plan?
No. Consumers with Medicaid Share of Cost do not have Minimum Essential Coverage (MEC) and are therefore eligible for tax credits to purchase affordable health insurance on the Marketplace. Consumers may not be beneficiaries of 2 federally subsidized plans simultaneously. Therefore, it may be prudent for your consumer to retain his Marketplace plan and decline the Medicaid Share of Cost until his SSI is approved. Once that happens, he should also become a regular Medicaid and/or Medicare beneficiary and he can safely terminate his Marketplace plan.


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