Certified Application Counselors: Enrolling Virginia

Advocate/Stakeholder WebinarSeptember 5, 2013Presenters:Kathy May, Virginia Consumer Voices for HealthcareMassey Whorley, The Commonwealth InstituteTricia Brooks, Georgetown University Health Policy Institute

11In BriefBeginning October 1, hundreds of thousands of Virginians will have the opportunity to purchase health insurance through the Marketplace. Many consumers will need assistance, and one way you can help is by becoming a Certified Application Counselor (CAC).22TopicsWhat is happening with the Marketplace?What are the opportunities for consumer assistance?How can your organization become a CAC?What are the next steps?Q&A33What changes are happening this fall?Some of the ACAs most significant changes are taking effect this fall.

4AugSeptOctNovDecJanFebMarchNavigators announcedOpen enrollmentCoverage beginsJanuary 1, 2014Training availableMarketplace opensOctober 1, 20134Who can enroll in the marketplace?Uninsured & under-insured Virginians with incomes between 100% and 400% of poverty level are eligible for tax credits.

Others can enroll, but they are not eligible for tax credits.5

5Who will fall into the coverage gap?6

6What does this mean for consumers?Many consumers will need help understanding new terms and options.7MarketplaceQualified Health Plans

Essential Health Benefits

Actuarial Value

Metal Tiers

Catastrophic Coverage

Modified Adjusted Gross Income

Advance Premium Tax Credits

Cost-Sharing Reductions

7TopicsWhat is happening?What are the opportunities for consumer assistance?How can your organization become a CAC?What are the next steps?Q&A88What are the opportunities for consumer assistance?NavigatorsCertified Application Counselors (CACs)Champions for Coverage

99Who are Virginias navigators?Virginia Poverty Law Center (VPLC)1.3 navigators at VPLC, including project manager13 navigators at 8 legal aid programs around the state2 navigators with the Young Invincibles, focusing on NOVA community collegesAdvanced Patient Advocacy, LLCExisting and new staff will work with Bon Secours, Sentara, and HCA1010Who can be a CAC?Trusted, community-based organizations that are interested in:Connecting families with health coverage and other benefitsPromoting the historic opportunity to expand coverage Contributing to the success of health reform11

11Who can be a Champion for Coverage?Organizations that want to help with outreach or education can become a Champion for Coverage.There are many ways to be a Champion for Coverage, like sending a message to your network about the Marketplace.For more information, please visit: http://marketplace.cms.gov/help-us/champion.html

1212TopicsWhat is happening?What are the opportunities for consumer assistance?How can your organization become a CAC?What are the next steps?Q&A1313What are the duties of CACs?Provide information about full range of QHP options, Medicaid, and CHIPAssist individuals through a QHP in the marketplace and the insurance affordability programsHelp facilitate enrollment in a QHP, Medicaid, or CHIP14

14What other requirements must CACs meet?Serve consumers best interestsComply with privacy and security standardsDisclose all relationships with QHPs, and potential conflicts of interestComplete FFM approved training and pass all FFM certification examsServe or refer people with disabilities to navigators or other resources1515How do Navigators and CACs differ?CACs perform similar but more limited functions:CACs are not required (but may) do outreachCACs are not subject to same stringent conflict of interest standards but must disclose potential conflicts of interestsCACs do not have to meet cultural and linguistically appropriate standards (CLAS) beyond other obligations they already haveCACs may refer individuals with disabilitiesCACs do not have to refer consumers to ombudsman or other consumer assistance programs1616How will the CAC program work in Virginias Marketplace?The Federally-Facilitated Marketplace (FFM):Must have a CAC program in VirginiaWill designate CAC entities that will be responsible for certifying their staff and volunteersMaintain a registration process and method to track the performance of CACsDevelop procedures to withdraw CAC designationAll CACs will be listed on the Marketplace website (along with Navigators)1717What are the responsibilities of CAC designated entities?Enter into a formal, written agreement with the FFM assuring that it and its CACs will:Comply with all standards, including privacy and applicable authentication and data security standardsEstablish procedures to inform applicants of CAC responsibilitiesComplete training with passing gradeDisclose potential conflicts of interestNot impose any fees on consumers1818What types of organizations can serve as CACs?Final regulations do not specifically restrict the types of organizations, but the FFM will designate organizations that:Have processes in place to screen staff and volunteers who are certified to ensure they will protect personal informationEngage in services that position them to help connect people to coverageHave experience providing social services to the community1919

What are some examples of potential CAC organizations?Community Health Centers (such as FQHCs)HospitalsHealth Care ProvidersIndian Health Services and ProvidersRyan White HIV/AIDS ProvidersBehavioral or Mental Health Providers20

Agencies with experience providing social services such as SNAP outreach, energy assistance, or tax assistance, which are:State and local government entities501(c) organizations20How will CACs be funded?The FFM has indicated that it will NOT provide funding to CAC entities.However, the federal regulations clearly state that CAC entities may receive funding from other sources to support their CAC activities.21

21How does an organization become a CAC?Apply on-line: http://marketplace.cms.gov/help-us/cac.html

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22What is involved in the application process?23

23What is involved in the application process?24

24What is involved in the application process?25

25What is involved in the application process?26

26How long does the application process take?CMS is working through a backlog of CAC applicationsDelay does not reflect likelihood of approvalOrganizations should continue to move forward with recruiting and plans for trainingCopies of the CAC training are now available http://marketplace.cms.gov/training/get-training.html

2727How do individuals become CACs?Contact a CAC organization to work or volunteer for themComplete the organizations screening process for CACsComplete the FFM CAC trainingPass the FFM CAC test2828Does Virginias Navigator law impact CACs?Defines Navigator as an individual or entity described in 42 U.S.C. 1311(i)(2) that is selected to perform the activities and duties identified in 42 U.S.C. 18031(i) in the Commonwealth.Reference is specific to federal Navigator grant program2929TopicsWhat is happening?What are the opportunities for consumer assistance?How can your organization become a CAC?What are the next steps?Q&A3030What are the plans to strengthen the Virginia CAC programs?Coordinate consumer assistance activities to minimize redundancy, maximize coverageConnect individuals interested in volunteering with CAC organizationsProvide supplemental training through our partners Create networking opportunities to share best practicesPromote the collection of feedback from the field3131What are your next steps?Consider whether your organization should apply to become a CAC and dedicated staff or volunteers to do CAC workPlan to monitor on-the-ground experiences of consumers and share feedbackStart education and outreach efforts now3232Whats your level of interest?Is your organization interested in receiving additional information on becoming a CAC?Or is your organization more interested in becoming a Champion for Coverage?3333TopicsWhat is happening?What are the opportunities for consumer assistance?How can your organization become a CAC?What are the next steps?Q&A3434Q&A35

35Contact usMassey Whorley, The Commonwealth Institutemassey@thecommonwealthinstitute.org804-396-2051Tricia Brooks, Georgetown University Health Policy Institutepab62@georgetown.edu202-365-9148Kathy May, Virginia Consumer Voices for Healthcarekathy@vaconsumervoices.org804-592-64383636Thank you for attending!3737