Process for Financial Assistance at Go-Live Marketplace Training

Today’s Topics Objectives of this training Functions and Features at Go-Live Key Points re: financial assistance process Overview of medical assistance programs Steps required to get an eligibility determination Choices and Tips for applying for financial assistance Q&A

Objectives of this Training Provide a technology and process refresh for Agents/Brokers and Health Coverage Guides who will support the Marketplace at go-live on October 1st Provide training on the most up-to-date system and process steps Go deeper about how to expedite and successfully obtain financial assistance for your customers Explain how C4HCO’s Service Center will facilitate these financial assistance determinations

4 4 Key Dates to Remember Dates to plan by: o C4HCO opens 10/1/2013 o Plans and payment needed by 12/15/2013 o First effective date for coverage 1/1/2014 It is important to get serious about completing an application in November and December to ensure consumers have benefits starting January 2014

5 5 Ongoing training and support Watch for Open Labs and Webinars to help you come up to speed on our live system before October 1 st and throughout the month of October!

6 Terms and Definitions Advance Premium Tax Credit (APTC): financial assistance with monthly premium costs in the form of a tax credit Cost Sharing Reductions (CSR): reductions in out of pocket costs like copayments and deductibles that are automatically included in the health plan for eligible individuals CHP+: Child Health Plan Plus program, a state medical program available to pregnant woman and children up to 18 years old Financial assistance: includes programs where people are eligible to receive medical care at no or low cost (Medicaid or CHP+) or get help paying for private insurance (APTC and CSR) Qualified Health Plan (QHP): plans that include the required essential health benefits that will be sold both inside and outside the Marketplace Single Streamlined Application (SSAp): the application for insurance affordability programs Marketplace or C4HCO: Connect for Health Colorado PEAK: Program Eligibility and Application Kit

Go-Live Functions and Release Plans Features ready on Oct 1st: o Small Business Marketplace Employers can set up accounts and select plans to offer Employees can shop for plans offered by employer o Individual Marketplace Browse Plans Quick Eligibility Calculator and browse plans Account Creation Complete application and plan selection with and without financial assistance

Go-Live Functions and Release Plans C4HCO will offer extra support through our customer service network for individuals shopping with financial assistance, because: o The path for financial assistance is new and for most, uncharted territory o With ongoing testing, we want to ensure accuracy and a good customer service experience o APTC determinations and amounts can be calculated in the C4HCO service center The full path for financial assistance will be widely deployed early Nov

9 9 Early Focus Activities to focus on in October o Get more familiar with the shopping experience and health plans o Help customers set up accounts on the Marketplace o Help customers get their questions answered about plans o Help customers see if they qualify for help paying for medical coverage using the quick calculator It is very important to ”associate” yourself with the account in the system when you are offering assistance!

Overview of Medical Assistance Programs Through new laws, the realm of financial assistance programs for medical coverage has expanded Former (pre Oct 1 st 2013) New Market (starting Oct 1 st 2013) Medicaid Child Health Insurance Plan (CHP+) Medicaid CHP+ Advance Premium Tax Credits Cost Sharing Reductions Starting October 2013 a person can see if they qualify for financial assistance by completing an application How? Online Phone Paper Available from the State of Colorado Available in the Marketplace

Eligibility Determinations for Various Programs When a person submits the financial application, eligibility determinations will be made for the following programs: MedicaidCHP+ Advance Premium Tax Credits & Cost Sharing Reductions Available from the State of ColoradoAvailable through C4HCO OR Customers can only be eligible for one program

Eligibility Determination and Enrollment If Medicaid/CHP+ EligibleIf Denied Medicaid/CHP+, check APTC/CSR eligibility Enrolled in Medicaid/CHP+ program Range = under 133% FPL Medicaid up to 250% FPL CHP+ Consumer will receive benefit information and be enrolled* *Some people eligible for CHP+ are required to pay initial premium to complete enrollment Return to Connect for Health Colorado to determine eligibility for APTC/CSR, shop and buy insurance Determine APTC credits: Range = 133% - 400% FPL

13 Online experience to apply for medical financial assistance C4HCO will be using the state’s online portal called PEAK to get a determination for Medicaid/CHP+ as the first step in the application process PEAK is a website that allows people to apply and access all public assistance programs in Colorado, including: o Colorado Works o Food Assistance o Medical Assistance (connection with C4HCO) o Adult Financial

More about PEAK PEAK’s system has undergone significant improvements in 2013: o Re-launch 9/27 o Design of web-pages o Functionality and usability o Ability to process real-time determinations for some MAGI applicants o Co-branded with C4HCO to support medical-only applicants that start in the Marketplace

15 You choose how involved you want to be in the first step in the financial assistance path Agents/Brokers and Health Coverage Guides have some choices to make about how active they want to be in the financial assistance application process in October o Choice #1: When someone wants to complete the financial assistance application you can decide to connect the applicant to our Customer Service Center to walk them through all the steps o Choice #2: Actively manage the financial application process by helping customers start the application in PEAK for a Medicaid/CHP+ determination

16 Customer Service Involvement in APTC/CSR determination (for October) C4HCO’s Customer Service Center will then help customers fill out a short form to gather additional information for APTC/CSR determinations and upload this information to the customer’s account The Customer Service Center will then use the application information from PEAK and the additional APTC/CSR questions gathered to make the initial APTC/CSR determination and support the customer to finalize plan selection (through early November) You will be informed when the determination is complete

Eligibility determination steps using financial application Step 1. Create Account in C4HCO and associate Step 2. Start Financial Assistance Application (Choice #1) Step 3. Start PEAK medical-only application to complete the Medicaid /CHP+ determination (Choice #2) Step 4. Screen shot PEAK eligibility results page and upload to customer account (Choice #2) Step 5. If a customer is ineligible for Medicaid/CHP+ additional questions will be asked to determine eligibility for APTC /CSR. Fill out short questionnaire with APTC/CSR specific questions. This will be completed by Customer Service Center representative

18 Eligibility determination steps using financial application Step 6. C4HCO Customer Service Center representative will upload PDF of PEAK application and APTC/CSR short questionnaire to customer’s C4HCO account Step 7. C4HCO Customer Service Center will complete steps to determine APTC/CSR eligibility and send notice of preliminary determination Step 8. Customer Service Center will assist the customer to shop and select health plan

19 Financial Assistance  Through the Marketplace Day 1 through early November Create an account in Connect for Health Colorado Associate Broker/HCG/ Authorized Rep as appropriate Start application and review privacy language Want to see if you qualify for financial help for your medical coverage? Have you already been denied for Medicaid/CHP+ since October 2013? Complete Non- Financial Application Contact Service Center Start first step in application – check for Medicaid/CHP+ eligibility in PEAK Start first step in application – check for Medicaid/CHP+ eligibility in PEAK Medicaid eligibility results displayed in PEAK Contact Customer Service Center for APTC determination Walk through APTC/CSR determination N Y Y N = Broker/HCG or Service Rep = PEAK system = Service Rep LEGEND Select Plan(s) If not MedicaidCHP+ eligible, answer additional questions needed for APTC/CSR Shop for Plan(s)

20 Step 1: Account creation in C4HCO and associate

21 Step 1: Account creation in C4HCO and associate Associate screen shot

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26 Shop and preview health plans

27 Training for Choice #1 and Choice #2 If you choose Choice #1... o You do not need to complete mandatory PEAK training in late Sept/early October If you choose Choice #2... o You need to be comfortable using PEAK and uploading documents to the customer’s C4HCO account in early October o You also need to follow the tips in this training!

28 Step 2: Start financial assistance application in C4HCO

29 Step 2: Start of financial assistance process in C4HCO From this “Continue” button, the customer will be sent to the PEAK website and instructed to create an account in order to apply for Medicaid or CHP+. Choice #1—Call Customer Service Center at this point in the process!!!

30 PEAK Application steps Submit Review application information Other bills Housing bills (answer if disabled) Other income Job income Liquid and other assets (answer if disabled) People applying for coverage Identify who is offering application assistance

31 Choice #1 Steps Steps 3-7 are completed at the Customer Service Center You will be informed when a determination is made

32 C4HCO prefers applications are submitted online The customer has options about method to submit application (online, mail or fax) o PREFERRED METHOD—SUBMIT ONLINE Increases likelihood of getting real-time determination for Medicaid/CHP+ and quick APTC determination If you use other method, mail or fax it right away. Applications process faster when received same-day

33 12 Customers can decide to take the tax credit up front or when filing taxes Some customers who can qualify for the tax credit might be ok receiving their tax credits at the year end, instead of up front and pay the full premium throughout the year. This option is beneficial for customer with unstable income or customer who does not want to report income changes during plan year If so, they can use the non-financial application. The plan needs to purchased through C4HCO to receive the tax credit at the end of the year

34 Key Takeaways! Create accounts, browse and select plans starting October 1st Associate yourself with customer in account Answer customer’s questions about available financial assistance and use the quick eligibility calculator If customer wants to go through financial application, preferred method is to submit online You have a choice how active you want to be in the financial application process in October The Individual non-financial application path functionality is ready for everyone to use online Eligibility determinations for all programs can be made with support in October

Contact Website: Questions: Service Center PLANS-4-YOU ( ) Social (stakeholders)

36 Next Steps Choice #2—PEAK training will commence through webinar last week of September Open labs will also be available to cover the following throughout October: o PEAK overview and demo o C4HCO live system Watch for announcements about upcoming webinars and open labs