CONNECT FOR HEALTH COLORADO CBMS TRAINING October 28, 2015

CONNECT FOR HEALTH COLORADO CBMS TRAINING

October 28, 2015

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Topics for today’s training

• Key Marketplace Termso MEC, APTC, CSR, QHP, CYAo QLCE and SEP

• Marketplace Household Composition• Life Change Events

o Reporting and Effective Begin Dates• Specific Populations

o Non-Citizenso American Indians/Alaskan Natives

• Marketplace Eligibilityo Income

Expedite vs. Standardo Expenses

• Marketplace Programs and CBMS Functionality• Customer Experience

o Basics in Marketplace Plan Enrollmento Where to Find Help

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And In Case You Forgot…

Open enrollment period for 2016 Coverage: Nov. 1, 2015 – Jan 31, 2016

• The Marketplace determines eligibility for Advance Premium Tax Credits (APTC) and Cost-Sharing Reductions (CSR) all year.

• A person can only enroll in a QHP during Open Enrollment or, if they have a Qualified Life Change Event (QLCE), during a Special Enrollment Period (SEP).

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Connect for Health Colorado CBMS Training

Key Terms

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Key Marketplace Terms

• Advanced Premium Tax Credit (APTC): A tax credit that can help customers afford coverage bought through the Marketplace. Unlike tax credits claimed when filing taxes, an APTC can be used right away to lower monthly premium costs. Eligibility is up to 400% FPL.

• Cost-Sharing Reduction (CSR): A discount that lowers the amount a customer has to pay out-of-pocket for deductibles, coinsurance, and copayments. To get this reduction, income must be below a certain level, and one must choose a health plan from the Silver plan category. Members of a federally recognized tribe may qualify for additional cost-sharing benefits. Eligibility up to 250% FPL*

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• Qualified Health Plan (QHP): An insurance plan that is certified by Connect for Health Colorado, provides essential health benefits, follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meets other requirements.

• Colorado Young Adult Plan (CYA):A catastrophic insurance plan that is available to individuals between the

ages of 18 – 29 that typically has a high deductible and lower premium. It covers 3 primary care visits per year and some preventative services at no cost.

APTC/CSR cannot be applied to a CYA plan.

• Minimum Essential Coverage (MEC):The type of coverage an individual must have to meet the requirements of federal law (ACA: individual responsibility). This includes individual health plans, job-based coverage, Medicare, Medicaid, CHP+, TRICARE and certain other coverage.

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• Qualifying Life Change Event (QLCE): A Qualified Life Change event is an event that makes customers eligible to make a change to their private health insurance plan, whether that is updating their current plan, shopping for a new plan, enrolling in coverage through the Marketplace for the first time, or having their eligibility for financial assistance programs re-determined

• Special Enrollment Period (SEP):Usually a 60 day period where an individual can enroll in a new Marketplace

plan or update their current enrollment. These only occur when someone experiences certain QLCE

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MarketplaceHousehold

Composition

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Marketplace Household Composition

• Based on tax filing status: self-attested – no verification required at application

• An individual may be eligible for APTC/CSR if:o File taxes as Single, oro Married Filing Jointly, oro Filing as a Head of Household*, oro Qualified Widow(er) with Dependent Children, oro Claimed as a Tax Dependent

• An individual will not be eligible for APTC/CSR if:o They are not filing taxes, oro They are married and filing separately*, oro They are not claimed as a tax dependent

• Tax filer and tax dependento If an individual is both a tax filer and a tax dependent, they

will be considered a tax dependent for eligibility purposes

• “Exceptional Circumstances” can apply for victims of domestic violence

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Life Change Events

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Life Change Events

• In general, a customer has 30 days to report changes to Connect for Health Colorado

• If the customer has a QLCE, they must report that change, select and pay for a health insurance plan through the Marketplace within 60 days from the event date

• QLCEs can still be reported more than 60 days from the event date, however they will not be able to shop for a new plan or make changes to their existing plan but if the change alters the amount of APTC/CSR we will update their enrollment with the new amount

• Most changes cannot be reported in advance

• A loss of MEC can reported up to 60 days prior to the loss of coverage

• If the customer reports the loss of MEC 60 days before the loss, CBMS will re-run eligibility within the 60 day period

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Life Change Events

• Coverage start date is based on the “15/16 day rule.” If the customer selects and pays for a plan before the 15th of the month, their plan will be effective the first of the following month. However, if they select a plan after the 15th of the month, the plan would start the first of the second month.

• Example: If the customer is found eligible for APTC/CSR on 11/2/2015, but the customer doesn’t select and pay for a plan until 11/22/15, the customer’s plan will not be effective until January 1st

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Examples of Life Change Events

Circumstance Changeso Marriage o Birth, adoption, or placement for foster careo Becoming a citizen, national, or lawfully present individualo Permanent move in residence (if access to new QHPs is gained)o Loss of a dependent through death or divorce

Loss of Minimum Essential Coverage (MEC)o Loss of eligibility for employer coverage, Medicaid, CHP+, COBRA expirationo Loss of coverage due to divorce/legal separation, loss of dependent status (e.g.,

dependent turns 26), or death of policy holdero An enrollee in an employer plan becomes newly eligible for subsidies because

employer plan is no longer available or is not considered affordableo Does not include voluntary termination of employer-sponsored plan

Othero Certain errors/inactions by the Marketplace, Broker/Agent, HCG, CACo Exceptional circumstanceso Special rule for American Indians and Alaska Natives

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Entering Life Change Events In CBMS

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Entering Life Change Events In CBMS

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Entering Life Change Events in CBMS

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Specific Populations

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Entering Non-Citizen Information in CBMS

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• After authorization verification checklist will be sent with C4HCO information• C4HCO CBMS contractors will verify non-citizen information

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American Indians and Alaskan Natives

• Individuals who are an American Indian, Alaskan Native or a member of a Federally Recognized Tribe may qualify for additional Marketplace benefits.o May qualify for CSR above 250% FPLo May qualify for 100% CSR if receiving services at an Indian

Health Services facility

• Income derived from Tribal Sources may be calculated differently depending upon IRS tax rules

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American Indians and Alaskan Natives

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Marketplace Eligibility

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APTC Income in CBMS

• APTC/CSR Incomeo C4HCO uses annual income and Medicaid/CHP+ use monthly incomeo In some instances income is counted differently and CBMS is programmed

with the appropriate rules for each programo If the customer is unsure what to include in the total annual income, they

should seek the help of their tax professional

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APTC Income in CBMS

• Standard Income Patho Collects monthly income/expenses to determine eligibility for Medical

Assistance program• MAGI/Non-MAGI Medicaid, CHP+• APTC/CSR (annualized amount)

• Expedite Income Patho All individuals on the application must be citizens or lawfully presento Must file taxes (Single, Married Filing Jointly, Head of Household)o Uses adjusted annual income to determine eligibility for APTC/CSR onlyo Single amount input at the time of application that represents the entire

taxable income for the whole household applying for Marketplace programs

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APTC Income in CBMS

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APTC Income in CBMS

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APTC Income in CBMS

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APTC Income in CBMS

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APTC Income in CBMS

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APTC Income in CBMS

No APTC amount prior to authorization

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APTC Income in CBMS

APTC amount post authorization

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APTC Expedite Income in CBMS

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• SES PDF will show the threshold amount and the client’s annual Modified Adjusted Gross Income

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Past Expenses in CBMS

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Marketplace Programs and CBMS Functionality

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• CBMS Case Statuso APTC only cases in CBMS will show as “Closed” even if benefits

are approved• Expedite income cases will close immediately after

authorization– No IVES interface for these cases since there are no monthly

income records• Standard income cases will remain open until first IEVS run

o Mixed eligibility cases (Medicaid/CHP+ and APTC) will remain “Open” if benefits are approved

• IEVS and APTC/CSRo IEVS income only will start counting for APTC/CSR eligibility if

income verifications are not provided for a Reasonable Compatibility discrepancy

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• Marketplace Renewalso Marketplace plan auto-renewals happen outside of CBMS

• Plan must be offered for next coverage year• Tax, income and household comp information must be

verified through IRS interface• Individuals in home must remain eligible for Marketplace

plan– Cannot be newly Medicare, Medicaid/CHP+ eligible

o Examples of why Marketplace customers will not auto-renew• Plan is being discontinued• Individuals have “aged out” of current plan• Household has complex scenario (multiple QHPs for same

family)o Marketplace customers who cannot auto-renew must get new

eligibility determination through CBMS• If case has closed in CBMS with past 15 months they will

use “Report My Changes” in SES to reapply• If case has closed in CBMS for more than 15 months they

will need a new application in SES to reapply

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• CBMS Case Transferso Please send your case transfer requests to

[email protected] If you have the adequate CBMS Security Profile:

• From Case assignment page, select MA, then Intra County Transfer button. • On Intra County page, click on “magnifying glass”, and Search User page will

populate.• Under Office Name, select blank option from drop-down, and type in name to

which caseload is assigned.• Once you do so, it will say no user found, but the County Name box will be

available (it is grayed out at first).• Even if you leave Name field blank, it will still make County Name drop-down

available.• Once box allows you to make a selection from drop-down, select requested

county name from County Name box, select requested office name from Office Name drop-down, and then select Search.

• Select correct selection from options provided, and then Select at the bottom of the page.

mailto:[email protected]

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• The “Push To C4/Cty” button should be used to transfer APTC cases

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Customer Experience

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Basics in Marketplace Plan Enrollment

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Where To Go For Help

• If case is assigned to Connect for Health Colorado (Deb Fitzsimmons) in CBMS, we are responsible for ongoing maintenance for that case

• All customer, broker or health coverage guide inquiries related to a case assigned to Connect for Health Colorado in CBMS should be re-routed to Connect for Health Coloradoo Customers can call 1-855-752-6749 or emailo Brokers/Coverage guides can reach out directly to their liaisons at Connect for

Health Colorado

• Individuals needing in-person assistance applying or enrolling for coverage can find a broker, coverage guide or certified application counselor by going to connectforhealthco.com and selecting the “Resources” drop down and select “In Person Assistance”.

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Thank You!

Documents

CONNECT FOR HEALTH COLORADO CBMS TRAINING October 28, 2015