The CMS Office of Minority Health (CMS OMH) has just released an updated Index of CMS Resources by Language, which provides English and non-English speakers access to information about the Health Insurance (Marketplace), Medicare, Medicaid, and Consumer Information & Insurance Oversight in nineteen (19) different languages. Each language includes key messages, public service announcements (PSAs), publications (brochures, issue briefs, multimedia, toolkit, fact sheets, etc.) and other materials. Use the link above to view the index, and click here to view the CMS OMH website, which was recently redesigned to provide easier access to important information and new resources for researchers, providers, and consumers.
A new HHS research brief explores outreach and enrollment strategies tailored to lesbian, gay, bisexual, and transgender (LGBT) individuals and families. Through discussions with consumer advocacy coalitions, education and law centers, not-for-profit organizations, grassroots human rights organizations, and a Federally Qualified Health Center, researchers identified a set of promising practices to help enroll LGBT consumers. These practices encompass five major themes: outreach, partnerships, engagement, staffing, and a focus on the transgender community. The report’s findings can guide and inform assister efforts to reach this underserved population and help LGBT consumers access affordable coverage through the Marketplace.
- The research brief can be found here, and you can learn more about LGBT health and well-being under the Affordable Care Act here on HHS.gov.
Key Takeaway: Consumers who receive tax credits through the Marketplace are required to file taxes to reconcile the financial assistance they received with their actual income. Some consumers have not yet filed taxes for 2014, and these consumers must file their 2014 taxes or they will lose the opportunity to continue to receive tax credits in 2016. Assisters should encourage these consumers to file their 2014 federal income taxes as soon as they can in order to have the opportunity to continue to receive tax credits in 2016. Additionally, assisters should remember that if you have received a consumer’s consent to follow up to provide application and enrollment assistance, then you CAN and ARE ENCOURAGED to follow up with consumers about re-enrollment, including the need to file their taxes to maintain eligibility for tax credits!
Most consumers who received tax credits to assist them with paying for Marketplace health coverage have already filed their taxes. However, some consumers have not yet filed because they requested an extension, or they were not able to file for some other reason and did not request an extension. Additionally, some consumers forgot to use the information provided on their Form 1095-A to reconcile their tax credits when they originally filed their federal income taxes for 2014.
It’s important for these consumers to understand that there is still time to file their 2014 taxes and that the Marketplace continues to process requests for corrected and reprinted Forms 1095-A as they are received, but consumers who received tax credits through the Marketplace and have not yet filed 2014 taxes need to act soon.
If these consumers do not file a tax return and reconcile the tax credits they received last year, they will lose the opportunity to continue to receive tax credits to help lower the cost of their health insurance when they renew their coverage for 2016.
Remember, assisters who have received consent from consumers to help them apply for and enroll in coverage CAN and ARE ENCOURAGED to follow up about re-enrollment! This is because if a consumer already provided his or her consent to an assister to follow up on applying for or enrolling in coverage, the assister is permitted (though not required) to contact this consumer and offer assistance with Marketplace eligibility redetermination and re-enrollment processes, including the need to file their taxes to maintain eligibility for tax credits. To clarify that consumers’ consent to follow up also applies to re-enrollment, CMS has included language on following up to assist with re-enrollment in updated drafts of the Navigator and CAC model authorization forms. You can read more about this here.
Consumers who have not yet filed their 2014 taxes, or who have filed their 2014 taxes but did not reconcile the premium tax credit they received, should first make sure that they have their Form 1095-A. If these consumers no longer have their Form 1095-A, which they should have received last spring, they can find it by logging into their HealthCare.gov account. Direct consumers to this page on HealthCare.gov for information on how to find their Form 1095-A and use it to reconcile the Marketplace tax credits they received.
The Marketplace Call Center (1-800-318-2596) is also a helpful resource, especially for consumers who cannot find their Form 1095-A online.
For more information about the ACA and 2014 tax filing, see the resources below:
- Click here to see the Treasury blog post, click here to see the IRS Commissioner letter to Congress, and click here to see the CMS blog post.
- Click here to view a page on HealthCare.gov that explains how consumers who have not yet filed their 2014 taxes should find and use their Form 1095-A.
The Thursday, May 21, 2015 assister webinar featured a deep dive presentation on updates to the streamlined application. The presentation provided an overview of the updated streamlined application process for consumers new to the marketplace. The online application begins with account creation (including verifying your identity/aka identity proofing) and ends with the applicant seeing their eligibility results. The applicant will then move on to compare plans and select a Qualified Health Plan (QHP), if eligible to enroll in a QHP through the Marketplace. The presentation includes an in-depth look into how the online application will look and work for new consumers, who have simple household situations and have not previously applied for Marketplace coverage. Slides from this webinar presentation are available online here.
KEY TAKEAWAY: Last week, the Administration took important steps to make sure women have access to recommended preventive services – including contraceptive services – at no additional cost, as required by the Affordable Care Act.
On Friday, July 10th, the Administration issued a final rule on coverage of certain recommended preventive services without cost-sharing. This rule maintains the existing accommodation for eligible religious nonprofits, but also finalizes an alternative pathway for those organizations to provide notice of their objection to covering contraceptive services and provides the same accommodations for certain types of for-profit entities. The rule also finalizes the preventive services interim final rules from 2010 with few changes, such as standards to ensure that when a recommendation or guideline for a preventive service is downgraded in the middle of a plan year, group health plans and insurers generally must continue to cover the preventive service without cost sharing through the end of the plan year, except in certain limited instances related to safety concerns.
KEY TAKEAWAY: HHS recently released data that show the number of plans selected by county for the 2014-15 Open Enrollment Period in states that use the HealthCare.gov platform. These data are now available online and in the form of new, subject-specific tables on the HealthData.gov website. Assisters who are interested can view these data and look up the number of plan selections that took place in the counties where they work, as well as information about plan selection by household income, race, metal level, and more.
Last week’s assister newsletter featured a link to a new dataset that provides the total number of Qualified Health Plan (QHP) selections by county for the 37 states that use the HealthCare.gov platform for the Marketplace Open Enrollment Period from November 15, 2014 through February 15, 2015, including the special enrollment period (SEP) through February 22, 2015. This week, this data became available on the HealthData.gov website. This means that those who are interested in accessing the data can now use the links below to view tables online that feature plan selection by county based on several different categories such as level of APTC, race, and age group. As mentioned last week, you can also click here to download these data in an Excel file.
- Advanced Premium Tax Credit (APTC): Qualified Health Plan Selections by APTC and county
- Cost-Sharing Reduction (CSR): Qualified Health Plan Selections by CSR and county
- Metal Level: Qualified Health Plan Selections by metal level and county
- Consumer Type: Qualified Health Plan Selections by type of consumer (i.e., new, auto re-enrollment, or active re-enrollment) and county
- Household Income: Qualified Health Plan selections by household income as a Percent of the Federal Poverty Level and county
- Race: Qualified Health Plan selections by race/ethnicity and county
- Age Group: Qualified Health Plan selections by age group and county
Key Takeaway: When a young adult turns 26 (or older, if state or issuer rules require or permit a higher maximum child age), and is covered by their parent’s Marketplace plan, she can stay on her parents’ policy until the plan year ends on December 31.
When a young adult turns 26 (or older, if state or issuer rules require or permit a higher maximum child age), and is covered by his or her parent’s Marketplace plan, he or she can stay on the parent’s policy until the plan year ends on December 31st. If the child is no longer the parent’s tax dependent when coverage ends on December 31, the child can enroll in a Marketplace plan him/herself for the next year during Open Enrollment.
Should a parent wish to remove a child from the family coverage for any reason, the parent should report a life change/Change in Circumstance to the FFM. This will trigger a Change in Circumstance termination ending the policy covering the parent and adult child, and a Change in Circumstance enrollment beginning coverage for the parent only. An adult child removed from coverage by a parent may be eligible for a Special Enrollment Period to regain coverage as an individual subscriber outside of an Open Enrollment Period.
Assisters should note that this policy only affects Marketplace individual plans. If a child turns 26 (or the maximum child age) and is covered by a parent’s job-based plan, the employee should check with the plan or the employer to find out exactly when the coverage ends. If the child loses coverage from the parent‘s job based plan, she would qualify for a Special Enrollment Period outside of the Open Enrollment Period and may qualify for premium tax credits and other savings based on her own income. Consumers who are enrolled in non-marketplace plans (including SHOP) typically terminate coverage for a young adult dependent at the end of the month in which he or she reaches age 26 (or the maximum child age).
Example of how assisters can help consumers with this policy: An assister is helping Andrew who is 25 and is on his parents’ Marketplace plan. He turns 26 on October 15, 2015 and will be able to remain on his parent’s plan until December 31, 2015. After his 26th birthday, if his parents still claim Andrew as a dependent on their taxes, they can apply together during Open Enrollment, though Andrew will be enrolled separately from his parents. Most issuers do not permit child dependents older than 25 years old on a policy with their parents; if an issuer does permit child dependents older than 25, then 26-and-older children can enroll in the same policy with their parents if they enroll with that specific issuer.
Click here to view more information on this policy on health coverage for children under 26.
Date: Tuesday, July 21, 2015 2:00-3:00pm ET
Faculty: Harvey J Makadon, MD, Director, Division of Education and Training, The Fenway Institute, Fenway Health
Sponsors: The National LGBT Health Education Center
LGBT people face multiple barriers to accessing inclusive and affirming care. Health centers and other health care organizations are well-positioned to provide environments that are welcoming to the LGBT people in their communities, and many are seeking guidance in how to do so. In this webinar, Dr. Harvey Makadon, Director of the Division of Education and Training at The Fenway Institute, will lead participants through ten key practices for creating LGBT-inclusive and affirming in health care organizations. Participants will learn approaches ranging from shaping policies and processes, to collecting data, to engaging the community.
All webinars include free CME/CEU credit from the American Academy of Family Physicians, and now are eligible to fulfill the on-going training requirement for the Human Rights Campaigns Healthcare Equality Index! For more information about these and all National LGBT Health Education Center webinars, click here.
July 30, 2015 marks the 50th anniversary of the Social Security Amendments that established Medicare & Medicaid. To honor Medicare and Medicaid’s contribution to the health and security of millions of Americans, CMS is sharing daily posts on Twitter (@cmsgov) and on Medicaid.gov. Click here to view examples of outreach and Medicaid success stories throughout this month that celebrate “Fifty Years of Medicaid.”
Additionally until July 30th, the Medicaid.gov page will feature highlights of the program’s achievement. Check out last week’s feature on how Medicaid programs benefit Tribal communities. These highlights feature:
- The unique authority of Indian health care programs to bill Medicare and Medicaid for services provided;
- Outreach and enrollment activities of American Indian and Alaska Native Connecting Kids to Coverage grantees; and
- A tribal leader’s perspective on how Medicaid expansion has increased Medicaid enrollment and benefited tribal health centers.
We know that assisters are doing great work post –Open Enrollment to help consumers use their health coverage and access health care. Below are several recently-updated resources to help you talk to consumers about important post-enrollment topics such as how to get in touch with their health insurance company’s customer service department, access help in a language other than English, and understand how to seek care from providers included in their plan’s provider network.