Presenters: Kathy May, Virginia Consumer Voices for Healthcare

1. Certified Application Counselors: Enrolling VirginiaAdvocate/Stakeholder WebinarSeptember 5, 2013 Presenters:Kathy May, Virginia Consumer Voices for Healthcare Massey Whorley, The Commonwealth Institute Tricia Brooks, Georgetown University Health Policy Institute

2. In Brief Beginning 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).

3. Topics What 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&A

4. What changes are happening this fall? • Some of the ACA’s most significant changes are taking effect this fall. Nov Aug Sept Dec Jan Oct March Feb Open enrollment Navigators announced Training available Marketplace opens October 1, 2013 Coverage begins January 1, 2014

5. Who can enroll in the marketplace? • Uninsured & under-insuredVirginians 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.

6. Who will fall into the coverage gap?

7. What does this mean for consumers? • Many consumers will need help understanding new terms and options. • Cost-Sharing Reductions • Advance Premium Tax Credits • Essential Health Benefits • Catastrophic Coverage Marketplace • Qualified Health Plans • Actuarial Value • Metal Tiers • Modified Adjusted Gross Income

8. Topics What is happening? What are the opportunities for consumer assistance? How can your organization become a CAC? What are the next steps? Q&A

9. What are the opportunities for consumer assistance? • Navigators • Certified Application Counselors (CACs) • Champions for Coverage

10. Who are Virginia’s navigators? • Virginia Poverty Law Center (VPLC) • 1.3 navigators at VPLC, including project manager • 13 navigators at 8 legal aid programs around the state • 2 navigators with the Young Invincibles, focusing on NOVA community colleges • Advanced Patient Advocacy, LLC • Existing and new staff will work with Bon Secours, Sentara, and HCA

11. Who can be a CAC? Trusted, community-based organizations that are interested in: • Connecting families with health coverage and other benefits • Promoting the historic opportunity to expand coverage • Contributing to the success of health reform

12. Who 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

13. Topics What is happening? What are the opportunities for consumer assistance? How can your organization become a CAC? What are the next steps? Q&A

14. What are the duties of CACs? • Provide information about full range of QHP options, Medicaid, and CHIP • Assist individuals through a QHP in the marketplace and the insurance affordability programs • Help facilitate enrollment in a QHP, Medicaid, or CHIP

15. What other requirements must CACs meet? • Serve consumers’ best interests • Comply with privacy and security standards • Disclose all relationships with QHPs, and potential conflicts of interest • Complete FFM approved training and pass all FFM certification exams • Serve or refer people with disabilities to navigators or other resources

16. How do Navigators and CACs differ? CACs perform similar but more limited functions: • CACs are not required (but may) do outreach • CACs are not subject to same stringent conflict of interest standards but must disclose potential conflicts of interests • CACs do not have to meet cultural and linguistically appropriate standards (CLAS) beyond other obligations they already have • CACs may refer individuals with disabilities • CACs do not have to refer consumers to ombudsman or other consumer assistance programs

17. How will the CAC program work in Virginia’s Marketplace? • The Federally-Facilitated Marketplace (FFM): • Must have a CAC program in Virginia • Will designate CAC entities that will be responsible for certifying their staff and volunteers • Maintain a registration process and method to track the performance of CACs • Develop procedures to withdraw CAC designation • All CACs will be listed on the Marketplace website (along with Navigators)

18. What 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 standards • Establish procedures to inform applicants of CAC responsibilities • Complete training with passing grade • Disclose potential conflicts of interest • Not impose any fees on consumers

19. What 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 information • Engage in services that position them to help connect people to coverage • Have experience providing social services to the community

20. What are some examples of potential CAC organizations? • Community Health Centers (such as FQHCs) • Hospitals • Health Care Providers • Indian Health Services and Providers • Ryan White HIV/AIDS Providers • Behavioral or Mental Health Providers • Agencies with experience providing social services such as SNAP outreach, energy assistance, or tax assistance, which are: • State and local government entities • 501(c) organizations

21. How 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.

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

23. What is involved in the application process?

24. What is involved in the application process?

25. What is involved in the application process?

26. What is involved in the application process?

27. How long does the application process take? • CMS is working through a backlog of CAC applications • Delay does not reflect likelihood of approval • Organizations should continue to move forward with recruiting and plans for training • Copies of the CAC training are now available http://marketplace.cms.gov/training/get-training.html

28. How do individuals become CACs? • Contact a CAC organization to work or volunteer for them • Complete the organization’s screening process for CACs • Complete the FFM CAC training • Pass the FFM CAC test

29. Does Virginia’s 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 program

30. Topics What is happening? What are the opportunities for consumer assistance? How can your organization become a CAC? What are the next steps? Q&A

31. What are the plans to strengthen the Virginia CAC programs? • Coordinate consumer assistance activities to minimize redundancy, maximize coverage • Connect individuals interested in volunteering with CAC organizations • Provide supplemental training through our partners • Create networking opportunities to share best practices • Promote the collection of feedback from the field

32. What are your next steps? • Consider whether your organization should apply to become a CAC and dedicated staff or volunteers to do CAC work • Plan to monitor on-the-ground experiences of consumers and share feedback • Start education and outreach efforts now

33. What’s 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?

34. Topics What is happening? What are the opportunities for consumer assistance? How can your organization become a CAC? What are the next steps? Q&A

35. Q&A

36. Contact us • Massey Whorley, The Commonwealth Institute • massey@thecommonwealthinstitute.org • 804-396-2051 • Tricia Brooks, Georgetown University Health Policy Institute • pab62@georgetown.edu • 202-365-9148 • Kathy May, Virginia Consumer Voices for Healthcare • kathy@vaconsumervoices.org • 804-592-6438

37. Thank you for attending!