The March 20, 2015 assister webinar featured an updated presentation on “Tips for Submitting Supporting Documents to the Health Insurance Marketplace.” Consumers may need to submit documentation to the Marketplace to (1) Verify their identity for identity (ID) proofing purposes; or (2) Resolve application inconsistencies. ID proofing is one of the first steps for consumers to set up their online Marketplace account, and it must be completed for a consumer to submit an online application for coverage through the FFM. For an explanation of why ID proofing is necessary, please click here. ID proofing is only linked to the account-creation process; for example, a consumer may still be asked to submit documents for ID proofing even if he or she does not submit an application.

Data Matching Issues or inconsistencies occur when some of the information in a Marketplace application for coverage does not match information in trusted data sources when we check to verify a consumer’s eligibility. It is important to remember that, regardless of whether an applicant has a data matching issue or inconsistency, he or she can still continue on to enroll in coverage consistent with the eligibility provided by the Marketplace through his or her eligibility determination notice. Data matching and inconsistencies are only linked to a consumer’s application; for example, a consumer may still be asked to submit documents for data matching issues even if he or she applies through the Call Center and never creates an account.

Click here to view a list of “Marketplace tips and troubleshooting” that includes short explanations about ID proofing and data matching. See the March 24, 2015 assister newsletter for a longer summary of this presentation.

  • Presentation slides from the March 20, 2015 webinar can be accessed here; you can also view them along with other resources on application process assistance here.

On April 22, 2015, CMS released guidance on annual eligibility redeterminations and re-enrollments for Marketplace coverage for 2016. This guidance builds on the procedures that were provided in similar guidance for benefit year 2015, as well as the FFM’s experience in implementing that guidance. Like the guidance for benefit year 2015, the procedures described in this year’s guidance ensure that most enrollees do not have to take action to retain their coverage for 2016, which is important in promoting continuity of coverage while limiting administrative burden for enrollees, issuers, and Marketplaces.

Future newsletters and webinars will highlight details from this guidance that will help assisters work with consumers renewing their coverage in 2016. These details will include key changes from last year and additional information about what to expect for this upcoming redetermination and renewal cycle.

  • Click here to access, “Guidance on Annual Eligibility Redeterminations and Re-enrollments for Marketplace Coverage for 2016.”

A new IRS Tax Tip highlights the importance of planning ahead for next year’s tax filing process in a variety of ways, including taking action when life changes occur, staying informed, and keeping important records safe. Assisters may find some of these tips useful for talking with consumers about the importance of reporting life changes to the Marketplace. Consumers should report these changes as soon as possible to ensure that their health coverage eligibility and financial assistance stays up to date throughout the year. By taking action right away, consumers can help ensure that they don’t owe money at tax time for financial assistance they receive based on outdated information. Please click here to view this IRS Tax Tip online.

Another resource that assisters can use to help consumers understand the need to report life changes to the Marketplace is the summary of the April 2, 2015 “Helping Consumers Report a Life Event or Change in Circumstance” assister webinar presentation. This summary was included in last week’s newsletter, and we encourage assisters to use it as a resource for helping consumers understand how they can update their Marketplace applications. CMS will include a link to the slides from this presentation in a future newsletter, so please stay tuned!

KEY TAKEAWAY: The Office of Population Affairs (OPA) released a funding opportunity announcement (FOA) to fund existing Title X grantees to initiate or expand enrollment assistance activities and facilitate enrollment of eligible clients into affordable health insurance coverage through the Health Insurance Marketplace, Medicaid, the Children’s Health Insurance Program (CHIP), or other local programs. 

On March 17, 2015 the Office of Population Affairs (OPA) released a funding opportunity announcement (FOA) to fund existing Title X grantees (i.e. those grantees that directly receive funding from OPA) to initiate or expand enrollment assistance activities and facilitate enrollment of eligible clients into affordable health insurance coverage through the Health Insurance Marketplace, Medicaid, the Children’s Health Insurance Program (CHIP), or other local programs. Note: other funding for outreach and enrollment received by an applying organization may be taken into account when funding decisions are made. Non-binding letters of intent for this FOA were due by April 20th, but organizations can still apply and full applications are due May 18, 2015.

You can read the full funding opportunity for FOA PA-FPH-15-029 at

Individuals may qualify for SEPs outside of Open Enrollment if they experience certain events. We wanted to highlight a couple of the SEPs finalized in the recently published Final Notice of Benefit and Payment Parameters for 2016 (“Payment Notice”). Some information on these SEPs were also included in the April 14th Newsletter, and we wanted to summarize the information below.

New or amended SEPs that are available to consumers starting on April 28, 2015:

  • New SEP for gaining a dependent or becoming a dependent due to a child support or other court order. The coverage effective date will be the effective date of the court order.
  • Continuing the SEP for when consumers are enrolled in a non-calendar plan that ends outside of the Marketplace Open Enrollment Period. Consumers will receive a regular coverage effective date (following the 15th of the month rule).
  • A change in the SEP for consumers living in a non-Medicaid expansion state who were previously ineligible for Marketplace coverage with APTC due solely to household income and were ineligible for Medicaid during the same time, who have experienced a change in household income (to 100% FPL or above), making them newly eligible for APTC. Consumer no longer need to receive a Medicaid denial in order to qualify for this SEP. Consumers will receive regular coverage effective dates.

Additional coverage effective date options that Marketplaces may make available to consumers as of April 28, 2015:

  • Additional effective date options following birth, adoption, placement for adoption or placement in foster care of (1) the first day of month following birth, adoption, foster care placement and (2) regular coverage effective dates.
  • Additional effective date option following a child support or other court order of regular coverage effective dates.

New or amended SEPs that the Marketplaces may make available to consumers in the future after April 28, 2015:

  • New SEP for losing a dependent or dependent status due to divorce or legal separation.
  • New SEP for losing a dependent or dependent status due to death.
  • A consumer can report a permanent move up to 60 days in advance of the move to qualify for the SEP (this option must be available to consumers by 1.1.17).



KEY TAKEAWAY: CMS has resolved a system issue in which not all applicants who were eligible for APTC based on an income under 100% of the Federal Poverty Level (FPL) and ineligibility for Medicaid due to immigration status received APTC.  Consumers affected by this issue can now change their applications to receive an updated APTC determination. The consumers impacted by this system issue now can qualify for a prospective or retroactive special enrollment period (SEP). NEW: This SEP will be available until July 31st and consumers must report the event and enroll in coverage during that period. As a reminder, consumers enrolling through this SEP can request coverage to start on the next available coverage date. Or, if they prefer, they can request retroactive coverage beginning as early as January 1, 2015. If they request retroactive coverage, they will be responsible for premiums due back to the coverage start date and will be responsible for any deductibles, copays, and coinsurance for services received during those months. This update was featured in last week’s newsletter. New content is in bold.

BACKGROUND: The Marketplace application includes a question to help consumers who have been denied Medicaid and CHIP by the state because of their immigration status to be assessed for APTC and CSRs. The question asks:

“Was this person found not eligible [for Medicaid or CHIP] by their state because of their immigration status”? 

The question appears when: (1) an applicant attests to being denied eligibility for Medicaid or CHIP, and (2) the applicant attested earlier in the same application to having a QHP-eligible immigration status. Answering this question allows the Marketplace to properly evaluate individuals for APTC and CSRs when they have an income under 100% FPL and an immigration status that makes them ineligible for Medicaid or CHIP.

SYSTEM ISSUE: We have resolved a system issue that was affecting certain immigrants with incomes below 100% of FPL who applied for coverage with financial assistance between 11/15/14 and 3/13/15. Previously, when a household applied for Marketplace coverage and more than one applicant selected “yes” to the question below asking whether the applicant was denied Medicaid or CHIP eligibility based on his or her immigration status, the system issue was causing only the first person on the list of applicants to receive APTC. This issue has been resolved so that all applicants who select “yes” to the question described above can receive APTC, if otherwise eligible.

If a consumer meets the criteria above they may have been impacted by this system issue, and can confirm by looking at their Eligibility Determination Notice (EDN) which will display two distinct patterns listed below. Consumers can also contact the Marketplace Call Center to see if they were impacted by this system issue.

  1. The EDN will show that the first applicant was found eligible for APTC and CSRs, while the other applicants were not.
  2. Under the EDN section titled “Why Don’t I Qualify for Other Programs?” the applicants who are affected by this system issue and found not eligible for APTC or CSRs will have the message:  “Your household’s yearly income is too low for a tax credit. Generally, individuals and families whose household income for the year is between 100 percent and 400 percent of the federal poverty line for their family size may be eligible for the tax credit.”

NEW INFORMATION FOR IMPACTED CONSUMERS: Assisters can help consumers who were affected by this issue receive a Special Enrollment Period (SEP) that can be prospective or retroactive with a coverage effective date beginning as early as January 1, 2015. This SEP will be available until July 31st and consumers must report the event and enroll in coverage during that period.  For consumers that want to utilize the SEP, assisters should help them follow the instructions below:

Option 1: Visit to determine if consumer is eligible for an existing SEP (prospective coverage only). Visit, log into account, and select “Report a Life Change” to update application. Consumers who are already eligible for an SEP can choose a plan and enroll.  Consumers affected by the system issue described above should attest to the following question which grants an SEP:  “Did any of these people apply for coverage between November 15, 2014 – February 15, 2015? (Select their names if they applied through their state or the Marketplace).”  If a consumer is able to enroll through this SEP and does not want retroactive coverage, he or she can enroll prospectively with no further action needed.  If a consumer is able to enroll through the SEP and would like to enroll retroactively, he or she can do so by calling the Marketplace Call Center as outlined below.

Option 2: Contact Marketplace Call Center for a SEP (prospective and/or retroactive coverage). Consumers affected by the system issue described above can call the Marketplace Call Center at 1-800-318-2596 / TTY: 1-855-889-4325. Consumers should explain that they were affected by the “immigration block system issue” and that only some people in their household received APTC when they applied earlier. A Call Center Representative will help the consumer complete an application and grant a prospective SEP if one is not unlocked by answering the question described above.

Under this SEP, consumers can also request that the enrollment and APTC be made retroactive with a coverage effective date as early as January 1, 2015. Note: it is important to make sure that consumers understand that if they request retroactive coverage, they will be responsible for premiums due back to the coverage start date and will be responsible for any deductibles, co-pays, and co-insurance for services received during those months.



The Department of Health and Human Services (HHS) announced a funding opportunity for organizations and individuals to operate as Navigators in Federally-facilitated Marketplaces (FFMs), including State Partnership Marketplaces (SPMs).  As they did have done over the past two years, and as they are doing now, Navigators will continue to assist consumers in various ways, including providing information about available coverage options through the Marketplace during open enrollment.

Navigators have been an important resource for the millions of Americans who enrolled in coverage over the past two years. This funding announcement ensures this important work will continue over the next three years in states with a FFM, including during Marketplace open enrollment periods.

Key Changes

This year’s FOA creates a multi-year funding structure. The 2015 FOA expands the period of performance, or project period, from 12 months to 36 months. The multi-year grant award will have a funding period of one year and subsequent years will be funded incrementally based on funding availability. This change is designed to provide greater consistency for Navigator grantee organizations and their staff from year to year, reducing yearly start up time and providing for a more efficient use of grant funds.

In addition, the 2015 FOA places a greater emphasis on re-enrollment activities and consumers enrolled in coverage through the Marketplace. Applicants are encouraged to explain how they will assist persons seeking to re-enroll in coverage through Marketplaces and how they will assist consumers with applications for coverage available through the Marketplace and selection, including renewal of a QHP. The 2015 FOA also places a greater emphasis on working with underserved populations. This year applicants are encouraged to demonstrate a focus on rural, underserved, vulnerable, or special needs populations or communities, and a commitment to serve these populations or communities.

Application and Award Information

HHS will award up to $67,000,000 to recipients across all service areas of FFMs (including SPMs).

Key Dates for Pre-Application Calls:

First call: Wednesday, April 29, 2015 from 2:00 to 3:30 p.m. Eastern Time

Second call: Wednesday, May 6, 2015 from 4:00 to 5:30 p.m. Eastern Time

Third call: Wednesday, May 20, 2015 from 11:00am-12:30 p.m. Eastern Time

Fourth call: Wednesday, June 3, 2015 from 2:00-3:30 p.m. Eastern Time

Letter of Intent to Apply (required) Due: June 3, 2015

Applications Due: June 15, 2015, by 1:00pm ET

Anticipated Award Date: September 2, 2015

At least $600,000 in total cooperative agreement funds will be available for each FFM (including SPM) service area. Small entities and individuals proposing to serve smaller, hard-to-reach or underserved populations are encouraged to apply, particularly by partnering with other entities and/or individuals to form a consortium which serves a larger total portion of the population.

To see the FOA for the Cooperative Agreement to Support Navigators in Federally-facilitated and State Partnership Marketplaces go to and search for CFDA 93.332.

Under PAL 2015-03, HRSA established new expectations for governing board approval of specific policies and procedures. In addition, HRSA established a strict “one time only” policy to correct an incomplete deeming application. These, among other requirements, will apply to CY2016 deeming applications, due to HRSA on or before May 26, 2015. Grantees may submit their deeming application through the HRSA Electronic Handbook (EHB) as early as April 13, 2015. To learn more and access FTLF resources, click here.

  • Thursday, April 30, 2015 | 1:00 pm EDT – 2:00 pm EDT: To register, please click here (registration in advance is required to attend).
  • For more information, please contact Valerie Gallo at 415-437-8095 or

This webinar aims to build competency in addressing the clinical needs of transgender patients in a culturally appropriate manner and will feature promising practices of HRSA grantees in Region IX—some of which specialize in serving transgender patients, and others which have improved their practices to serve their diverse patient mix.

The target audience is other HRSA grantees, healthcare providers, public health officials, and advocates wanting to improve their competency in serving the needs of the transgender patients in their practices.

Last week, CMS introduced star ratings on Hospital Compare, the agency’s public information website, to make it easier for consumers to choose a hospital and understand the quality of care they deliver. This initiative builds on a larger effort across HHS to build a health care system that delivers better care, spends health care dollars more wisely, and results in healthier people. As assisters, we wanted to share this resource in hopes that you can encourage consumers to use this new tool to compare the quality of care at hospitals.

The Hospital Compare star ratings relate to patients’ experience of care at almost 3,500 Medicare-certified acute care hospitals. The ratings are based on data from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS), which has been in use since 2006 to measure patients’ perspectives of hospital care. HCAHPS includes topics like how well nurses and doctors communicated with patients, how responsive hospital staff were to patient needs, how clean and quiet hospital environments were, and how well patients were prepared for post-hospital settings. (For more information on HCAHPS, please click here.)