NACHC Statement on Release of FY2016 Omnibus Appropriations Legislation

On Wednesday, House leaders released the text of the final negotiated appropriations legislation for Fiscal Year (FY) 2016, which includes funding for the Health Center Program and other key health priorities. A copy of the bill can be viewed here. The Health Center provision begins on page 889 line 6 and ends on page 890 line 5.

The bill contains a discretionary funding level of $1.491 billion for the Health Center Program, which, when combined with the $3.6 billion in mandatory funding provided earlier this year through H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), represents a total funding level of $5.1 billion for the Health Center Program in FY16. Of that total, the legislation specifies that no less than $150 million be spent on construction and capital improvements and no less than $200 million be spent on expansions of health center capacity, including new delivery sites and additional services like oral and behavioral health. Each of these funding levels is consistent with NACHC’s requests.

NACHC Senior Vice President for Public Policy and Research Dan Hawkins issued the following statement:

On behalf of America’s more than 1,300 Community Health Center organizations and the more than 24 million patients they serve, I am pleased to share NACHC’s support for this legislation. Combined with overwhelming bipartisan support shown earlier this year for health center funding included in H.R. 2, the funds in this bill will ensure access to high-quality, affordable primary and preventive care for millions of Americans.

We are extremely grateful to the bipartisan leaders in Congress who championed health centers in this legislation, first and foremost to Labor-HHS Appropriations Subcommittee Chairmen Senator Roy Blunt (R-MO) and Representative Tom Cole (R-OK) and Ranking Members Senator Patty Murray (D-WA) and Representative Rosa DeLauro (D-CT). Further, we wish to thank the bipartisan leads on Senate and House support letters sent to the Appropriations Committee earlier this year: Senators Roger Wicker (R-MS) and Debbie Stabenow (D-MI) and Representatives Gus Bilirakis (R-FL) and Gene Green (D-TX).

It is only because of the longstanding support of these and other Members of Congress that health centers today are able to provide not just needed care, but to deliver value, access and quality to our patients and serve as an asset to the broader health care system every day. We urge members to support this bill and look forward to working with all Members to ensure stability in funding for health centers long-term.

Deadline for insurance sign-up for Jan. 1, 2016 extended to Dec. 17

The deadline to sign-up for January 1 coverage has been extended until 11:59pm PST December 17. There has been an unprecedented demand and volume of consumers contacting call centers or visiting HealthCare.gov leading up to the December 15 deadline. The goal is to provide access to affordable coverage, and the additional 48 hours will give consumers who were in line an opportunity to come back and complete their enrollment for January 1 coverage.

Summary and Slides for Overview of Immigrant Eligibility Policies and Application Processes for Health Insurance Affordability Programs

The Friday, November 20, 2015 assister webinar included a presentation on assisting consumers who are immigrants to the United States, or whose families include immigrants, with their Marketplace applications. The deep dive presentation focused on immigrant eligibility policies in the Marketplace and was presented in partnership with the National Immigration Law Center (NILC), the Center on Budget and Policy Priorities (CBPP), and the Georgetown University Center for Children and Families. It included information about immigration enforcement, privacy and confidentiality, discrimination, language services, identity proofing and navigating the FFM website.

The presentation also included some important tips for talking to consumers about immigration status. Assisters may remind consumers that immigration information obtained will only be used for the purpose of eligibility determination and enrollment in the Marketplace. In addition, assisters can help consumers understand they need to submit all relevant immigration numbers to verify eligibility and reduce the occurrence of data matching issues or inconsistencies. Examples of immigration document types as well as applicable numbers are included in the slides. Finally, the presentation provided helpful tips to navigate identity verification requirements.

  • Presentation slides from the November 20, 2015 webinar can be accessed here, along with other resources on assisting special populations on the Marketplace.CMS.gov website. The presentation is linked along with a short summary and recording of the webinar on the CBPP website. You can view a blog post and additional slides on the Georgetown Center for Children and Families website here.

Additional Resources for Eligibility and Application Help for Immigrant Families:

Slides from the December 4th Application Spotlight on Income Presentation

The December 4th assister webinar included a presentation on the household income section of the Marketplace application. The income section of the application comes after the family and household section, which we covered in a separate presentation. In the family and household section, the system identifies who is in the tax household for the people applying for coverage, as well as other relevant people who live with them. The application will then ask for their income information to determine eligibility for advanced payments of the premium tax credit, cost sharing reductions, and Medicaid and CHIP.

  •  Click here to view the slides from this presentation, and click here to view them along with other resources related to the Marketplace application process.

For additional information about how consumers can provide accurate information about income when applying for Marketplace coverage, see the HealthCare.gov pages, “How to estimate your expected 2016 income” and “What to include as income.” For more information on how the Marketplace uses annual household income to decide whether consumers qualify for help paying for health coverage through the Marketplace, and how to prevent income data matching issues, see the recently released Consumer Guide for Annual Household Income Data Matching Issues.

NEW CMS RESOURCE: 5 FACTS FOR CONSUMERS ABOUT THE FEE FOR NOT HAVING HEALTH COVERAGE

As you help consumers understand their coverage options, some may have questions about the fee that may apply to consumers without coverage. Click here to view “5 Facts for Consumers about the Fee for Not Having Health Coverage” and learn more about how to discuss this issue with consumers.

New Functionality to Help Immigrant Consumers with Incomes Under 100% of the Federal Poverty Level (FPL) and Resources for Assisters

Key Takeaway: Immigrant consumers who have an annual household income under 100% of the Federal Poverty Level (FPL) may be eligible to receive advanced premium tax credits (APTCs) and Cost Sharing Reductions (CSRs) if they are eligible for Marketplace coverage and are not eligible for Medicaid due to their immigration status. In most cases, the Marketplace electronically verifies these consumers’ immigration status in real time through the U.S. Department of Homeland Security (DHS) and awards APTC and CSRs (when eligible). However, when the Marketplace cannot electronically verify these consumers’ immigration status, the Marketplace sets an immigration status data matching issue (DMI) and consumers are not eligible to receive APTC or CSRs until they resolve the DMI. The Marketplace has recently released new functionality to make it easier for immigrant consumers who have an annual household income below 100% FPL, have an immigration status DMI, are eligible for a qualified health plan (QHP), and are ineligible for Medicaid based on immigration status, to be determined eligible for APTC and CSRs.  You can learn more about this new functionality during the December 18th Assister Webinar and the presentation is posted here.

Assisters can help consumers understand the notices they receive from the Marketplace, determine the correct documentation to submit to resolve their data matching issue, and enroll in Marketplace coverage with or without APTC/CSRs. Assisters are strongly encouraged to help consumers submit their documents to resolve their immigration DMI as soon as possible.

  • Background

Generally, in order to be found eligible for advanced payments of the premium tax credit (APTC) and cost-sharing reductions (CSRs) a consumer’s income must be between 100% and 400% of the Federal Poverty Level (FPL), However, there is an exception.: a consumer who is lawfully present but has an immigration status that makes him or her ineligible for Medicaid may be eligible for APTC and CSRs even with an annual household income under 100% FPL.

In order to be determined eligible for APTCs and CSRs the Marketplace must verify the consumer’s immigration status. For most consumers, the Marketplace is able to verify immigration status electronically through the Department of Homeland Security (DHS) during the application process. If the consumer is verified as lawfully present with an immigration status that makes him/her ineligible for Medicaid, the consumer may be determined eligible for APTCs and CSRs in real time during the application process. If the Marketplace is unable to electronically verify the consumer’s immigration status, the Marketplace sets an immigration data matching issue (DMI) and the consumer is asked to provide additional information to verify his/her immigration status to be determined eligible for enrollment in a qualified health plan (QHP) with APTC and CSRs.

In the past, immigrant consumers under 100% FPL had to take several steps after resolving their immigration status DMI to receive APTC and CSRs. These steps included calling the Marketplace call center and/or attesting to relevant questions in the online application. Now the Marketplace can more quickly and seamlessly determine whether these consumers are eligible for APTC and CSRs with fewer steps required by the consumer.

  • What is the new functionality?

The Marketplace automatically identifies consumers with income below 100% FPL who appear eligible for a QHP and have who have an immigration status DMI (i.e. immigration status could not be verified electronically). These consumers receive an eligibility notice with new language explaining they have an immigration status DMI and may be eligible for APTC if they send in documents to resolve it. These consumers will not receive APTCs or CSRs with an unresolved immigration DMI. The notice will be mailed or emailed based on the communication preference indicted by the consumer.

Consumers should respond by providing documents to verify their immigration status and resolve their immigration status DMI within 95 days. The list of acceptable documents for resolving each type of DMI can be found here along with more information on how to submit documents. Assisters are strongly encouraged to help consumers submit their documents to resolve their immigration status DMI as soon as possible.

The Marketplace uses documentation to verify the consumer’s immigration status and notifies the consumer of their eligibility outcome through an eligibility notice. If the Marketplace verifies the consumer as being lawfully present, the consumer will receive one of the following outcomes.

Outcome A: Consumer is not eligible for Medicaid based on their immigration status —  eligible for a QHP with APTC/CSRs and a Special Enrollment Period (SEP).

The consumer will receive a notice that includes information regarding eligibility for the SEP and next steps for accessing the SEP.

The consumer will be able to proceed directly to plan compare in their HealthCare.gov account to select a plan or can complete next steps through the Marketplace Call Center.

Outcome B:Consumer eligible for Medicaid based on immigration status —  eligible for a QHP but without APTC/CSRs

  • How do I find out more about this new functionality?

Assisters can learn more about the new functionality to help immigrant consumers with incomes under 100% of the FPL through a presentation posted here, which will be presented during the December 18, 2015 assister webinar.

  • Role for Assisters

Assisters can help consumers understand the notices they receive from the Marketplace, determine the correct documentation to submit to resolve their DMI, and enroll in Marketplace coverage with or without APTC/CSRs.

 

 

Members sought for state health care professional boards

The State Board of Health is seeking members to serve on several health care Boards. Professional boards are responsible for granting license privileges to health care providers. Terms are five years long and run through November 30, 2020, and then members would be eligible for reappointment to a five-year term. The following boards have vacancies:

Board of Advance Practice Registered Nurses: Clinical Nurse Specialist
Board of Alcohol and Drug Counseling: Alcohol & Drug Counselor Only, Public
Board of Audiology & Speech-Language Pathology: Public
Board of Cosmetology, Electrology, Esthetics, Nail Technology, and Body Art: Tanning Salon Owner, Public
Board of Funeral Directing and Embalming: Public
Board of Medical Nutrition Therapy: Public
Board of Mental Health Practice: Licensed Mental Health Practitioner
Board of Occupational Therapy: Public
Perfusion Committee: Perfusionist
Board of Psychology: Public (partial term)
Board of Registered Environmental Health Specialists: Public (partial term)

People interested in serving on a board can get an application by contacting the Nebraska Department of Health and Human Services, Division of Public Health, Licensure Unit/RPQI, P.O. Box 95026, Lincoln, NE 68509-5026; by email at monica.gissler@nebraska.gov; or by phone at (402) 471-6515. Public member applicants must be at least 19 years old, be a Nebraska resident for at least one year, must not hold an active credential in a profession subject to the Uniform Credentialing Act, must not be or have been employed by a facility subject to the Health Care Facility Act, and must not be the parent, child, spouse or household member of a person currently regulated by the board to which the appointment is being made.

Application deadline is Jan. 11. Interviews will be conducted in Lincoln on Jan. 25.

Reminder: Next Week’s HHS LGBT Week of Action

The November 18, 2015 assister newsletter included information and resources on an OE3 Lesbian, Gay, Bisexual, and Transgender (LGBT) Week of Action that the Department of Health and Human Services will celebrate, starting December 7, 2015. This week, we’d like to remind you of this opportunity to promote Open Enrollment while doing targeted outreach to LGBT communities. In honor of LGBT Week of Action and to help you get ideas for  reaching and assisting these communities, please see the following resources dedicated to outreach, education, and enrollment assistance for LGBT communities (for a longer list of resources, please see the November 18 newsletter).

Assister Webinar on Reaching and Assisting Lesbian, Gay, Bisexual, and Transgender Communities (in collaboration with Out2Enroll):

On HealthCare.gov: Married Same-Sex Couples and the Marketplace

NEW CMS RESOURCE: FAST FACTS ON ASSISTING CONSUMERS WHO ARE IMMIGRANTS NOW AVAILABLE IN 16 LANGUAGES

Many immigrants are eligible for health coverage through the Health Insurance Marketplace (Marketplace) or through Medicaid or the Children’s Health Insurance Program (CHIP). Assisters helping immigrant applicants enroll in new health coverage must:

  • be aware of Federal and state rules that affect these consumers’ eligibility for coverage options;
  • understand the application and enrollment process; and
  • be able to provide assistance that is culturally and linguistically appropriate.

This “Immigration Fast Facts” sheet will help assisters to learn about and meet these requirements, and it is now available in 16 languages.

The English version was available in June, and it can be found here. Click here to view the page on Marketplace.CMS.gov where these fact sheets now available in Arabic, Chinese, French, German, Gujarati, Haitian-Creole, Hindi, Korean, Polish, Portuguese, Russian, Spanish, Tagalog, Urdu, and Vietnamese, along with other resources on assisting diverse communities.

Answers to Assister Questions from Overview of Periodic Data Matching (PDM) and Helping Newly Medicaid-eligible Consumers end coverage through the Marketplace with APTC and CSRs

The October 2, 2015 CMS webinar included an overview of Periodic Data Matching (PDM), which is a process the Marketplace uses to identify consumers in Federally-facilitated Marketplace states who are enrolled in Marketplace coverage with Advance Payments of the Premium Tax Credits (APTCs) or Cost Sharing Reductions (CSRs) and Minimum Essential Coverage (MEC) Medicaid or CHIP.

In September 2015, the Marketplace mailed paper notices to the household contacts of consumers who may be enrolled in a Marketplace plan with APTC or CSRs and Medicaid or CHIP that qualifies as MEC, with instructions on what to do next. If these “dually-enrolled” consumers do not end their Marketplace coverage with APTC or CSRs, the tax filer(s) will likely have to pay back all or some of the advance payments of the premium tax credit received for a Marketplace plan during the months the consumers were eligible for MEC Medicaid or CHIP. The October 2 webinar also included an update to a presentation originally made during December 2014, on how assisters can help consumers end their Marketplace coverage with APTC and CSRs.

Below are answers to questions that assisters asked during this presentation via the webinar chat feature. For more information, please see the September 30 and October 7, 2015 assister newsletter, and the following additional resources:

  • Click here to view the slide deck on Periodic Data Matching;click hereto view the slide deck on Helping Consumers End Coverage in a QHP through the Marketplace with APTC and CSRs; and click here to view both decks along with other resources on Marketplace eligibility and enrollment on Marketplace.CMS.gov.
  • Click here to view a sample PDM notice (also available in Spanish), and click here to view this notice along with other model notices on Marketplace.CMS.gov.

Q1: If a consumer who has Marketplace coverage with APTC/CSRs is determined eligible for minimum essential coverage Medicaid (with a retroactive Medicaid coverage start date that could be up to 3 months prior to the Medicaid application date), will the tax filer(s) be liable to pay back the premium tax credits received for the consumer’s Marketplace coverage during the time that the consumer was dually-enrolled in Marketplace coverage with APTC/CSRs and Medicaid?

A1: While tax liability is determined exclusively by IRS, according to IRS rules, the tax filer(s) may be liable to pay back APTC for months the consumer is enrolled in a Marketplace plan with APTC/CSRs and eligible for minimum essential coverage (MEC)* Medicaid or CHIP, beginning on the first day of the month following the Medicaid or CHIP eligibility determination. Thus, in the case of retroactive Medicaid coverage—back to the date of the application or up to three months prior, tax filer(s) are not liable to repay APTC received for the consumer’s Marketplace plan during the retroactive period; liability starts the first of the month following the Medicaid eligibility determination.

For example, if a consumer applied for coverage on May 20th and received a final determination of Medicaid eligibility on July 2nd, with a Medicaid coverage effective date back to April 20th, the tax filer’s liability to pay back APTC received for a Marketplace plan for that consumer would start August 1st. For consumer instructions on ending Marketplace coverage with APTC/CSRs when a consumer gets or has Medicaid or CHIP, click here. In addition, here is a presentation on the Process for Ending Coverage in a QHP through the Marketplace with APTC and CSRs. Note: These instructions include distinctions having to do with whether the consumer(s) are in an assessment or a determination state.

If interested, consumers determined eligible for MEC Medicaid or CHIP may maintain Marketplace coverage without financial assistance. After ending their Marketplace coverage with APTC/CSRs, they will need to submit a new application for Marketplace coverage without financial assistance, and enroll, if they are otherwise eligible.

*Most Medicaid or CHIP is considered MEC; some forms of Medicaid or CHIP coverage (e.g. emergency or coverage for pregnancy-related services only) are not considered MEC.

Q2: If a consumer is enrolled in Marketplace coverage with APTC/CSRs and is eligible for the Medicaid medically-needy program with a spend down (also known as share of cost Medicaid), does he or she need to end his or her Marketplace coverage with APTC/CSRs?

A2: Consumers who are enrolled in Marketplace coverage with APTC/CSRs and non-MEC Medicaid  do not need to end their Marketplace coverage with APTC/CSRs. Medicaid medically-needy coverage provided to consumers who must meet a spend down to be eligible (also known as share of cost Medicaid) is not recognized as MEC. Therefore, these consumers do not need to end their Marketplace coverage with APTC/CSRs, and tax filer(s) will not face a tax liability for dual-enrollment. Consumers who are enrolled in Marketplace coverage with APTC/CSRs and Medicaid medically-needy coverage with a spend down and who (for whatever reason) end their Marketplace coverage with APTC/CSRs could qualify for a hardship exemption from the MEC requirement if, in the discretion of the Marketplace, they have experienced a hardship with respect to the capability to obtain coverage.

Q3: Can a consumer stay enrolled in coverage through the Marketplace with APTC/CSRs if they are also eligible for MEC Medicaid/CHIP? What if the Medicaid/CHIP program is not considered MEC?

A3: Consumers determined eligible for MEC Medicaid or CHIP are not eligible for a Marketplace plan with APTC or CSRs. It is unlikely that a consumer who is enrolled in MEC Medicaid or CHIP will wish to maintain Marketplace coverage, but without financial assistance; however, if interested, these consumers may do so. In order to maintain Marketplace coverage without financial assistance, after ending their Marketplace coverage with APTC/CSRs, these consumers will need to submit a new application for Marketplace coverage without financial assistance, and enroll, if they are otherwise eligible.

Most Medicaid or CHIP is considered MEC; some forms of Medicaid or CHIP coverage (e.g., emergency Medicaid or coverage for pregnancy-related services only) are not considered MEC. If a consumer is enrolled in Medicaid or CHIP coverage that is not considered MEC, he or she may remain enrolled in Marketplace coverage with APTC/CSRs, if otherwise eligible; in such a case, the tax filer(s) will not face a tax liability at tax time to pay back APTC received for the Marketplace plan while the consumer was also enrolled in non-MEC Medicaid or CHIP.

Q4: Will consumers who may be dually-enrolled in Marketplace coverage with APTC/CSRs and Medicaid or CHIP who did not receive a notice (because they live in a state that had technical issues) still be liable to repay APTC for any months they were dually-enrolled?

A4: If dually-enrolled consumers do not end their Marketplace coverage with APTC/CSRs, the tax filer(s) will likely have to pay back all or some of the APTC received during the months* the consumers are also eligible for Medicaid or CHIP. Paper notices were sent to the household contact for consumers who were identified (through Periodic Data Matching) as enrolled in both a Marketplace plan with APTC or CSRs and Medicaid or CHIP; however, the Marketplace cannot identify all consumers in all Federally-facilitated Marketplace states who were dually-enrolled because not all states were able to fully participate in periodic data matching. Consumers in the following states will not receive notices in this round of PDM: AK, DE, GA, ME, MI, NJ, OR, SC, TN, and WY. Also, among participating states, sometimes states aren’t able to conduct the matching process for any consumers who were enrolled in a Marketplace plan with APTC, so some consumers who are dually-enrolled may not receive a notice. However, tax filer(s) will still be liable to repay all or some of the APTC received during the months* the affected consumers are also eligible for Medicaid or CHIP. To help address issues related to dual-enrollment in a Marketplace plan with APTC/CSRs and Medicaid or CHIP and the potential for increased tax liability, CMS has already published content in a number of venues, including on HealthCare.gov, other consumer notices, and within the online application.

*Note: liability starts the first of the month following the Medicaid or CHIP eligibility determination.

Q5: Will a dually-enrolled consumer who is ending his or her Marketplace coverage with APTC/CSRs at the Marketplace also need to contact his or her insurance company to end his or her Marketplace coverage?

A5: No. Consumers who are ending their Marketplace coverage with APTC or CSRs should take action to do so through the Marketplace (either at HealthCare.gov or through the Call Center). The process for ending Marketplace coverage with APTC/CSRs is outlined here. Instructions for consumers on cancelling a Marketplace plan when they get Medicaid or CHIP are available here. Important: For consumers ending Marketplace coverage with APTC/CSRs for some but not all people on their Marketplace application, they must continue through their “Enroll To-Do List” including selecting and confirming a plan for people staying in Marketplace coverage in order to complete the process and for coverage to be ended for those people being removed from Marketplace coverage (e.g. people who are ending Marketplace coverage with APTC/CSRs because they’re enrolled in Medicaid or CHIP).

Q6: Can consumers get back the premiums they paid to their insurance company for coverage through the Marketplace if they are enrolled in Medicaid/CHIP with a retroactive effective date, and they end their Marketplace coverage with APTC/CSRs?

A6: No. Consumers in this scenario generally will not be retroactively terminated from their Marketplace coverage with APTC/CSRs; therefore, issuers generally will not be required to refund premiums paid by consumers for the time in which the consumer(s) were enrolled in Marketplace coverage and were also enrolled in Medicaid/CHIP. This is true even if consumers did not use their Marketplace coverage while they were also enrolled in Medicaid or CHIP. For this reason, and also to help avoid potential tax liability, it’s important that consumers end their Marketplace coverage with APTC/CSRs when they are determined eligible for Medicaid or CHIP.

Q7: Can a consumer who is dually-enrolled in Marketplace coverage with APTC/CSRs and Medicaid/CHIP coverage retroactively end their Marketplace coverage when they realize they are enrolled in Medicaid/CHIP?

A7: No, generally, consumers can only end their Marketplace coverage prospectively. Retroactive termination of Marketplace coverage may be available only in limited cases, such as technical error of the Marketplace or an appeal decision holding that the eligibility determination was incorrect when made; in the event that prospective termination from Marketplace coverage was not possible due to technical error, retroactive termination must be requested through the Marketplace Call Center.

Q8: If some, but not all consumers on an application had a period of dual-enrollment in Marketplace coverage with APTC or CSRs and Medicaid or CHIP, will the tax filer(s) owe back APTC received for all consumers on the Marketplace application during reconciliation at tax time?

A8: No. Tax filer(s) for dually-enrolled consumers will likely have to pay back all or some of the APTC received for just the dually-enrolled consumers on the application, during the months those consumers were enrolled in a Marketplace plan with APTC/CSRs and eligible for Medicaid or CHIP (note: liability starts the first of the month following the Medicaid or CHIP eligibility determination).