Connect for health Colorado CBMS training

1. Connect for health Colorado CBMS training October 28, 2015

2. Topics for today’s training • Key Marketplace Terms • MEC, APTC, CSR, QHP, CYA • QLCE and SEP • Marketplace Household Composition • Life Change Events • Reporting and Effective Begin Dates • Specific Populations • Non-Citizens • American Indians/Alaskan Natives • Marketplace Eligibility • Income • Expedite vs. Standard • Expenses • Marketplace Programs and CBMS Functionality • Customer Experience • Basics in Marketplace Plan Enrollment • Where to Find Help

3. 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).

4. Connect for Health Colorado CBMS Training Key Terms

5. 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*

6. Key Marketplace Terms • 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.

7. Key Marketplace Terms • 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

8. Connect for Health Colorado CBMS Training Marketplace Household Composition

9. Marketplace Household Composition • Based on tax filing status: self-attested – no verification required at application • An individual may be eligible for APTC/CSR if: • File taxes as Single, or • Married Filing Jointly, or • Filing as a Head of Household*, or • Qualified Widow(er) with Dependent Children, or • Claimed as a Tax Dependent • An individual will not be eligible for APTC/CSR if: • They are not filing taxes, or • They are married and filing separately*, or • They are not claimed as a tax dependent • Tax filer and tax dependent • 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

10. Marketplace Household Composition

11. Marketplace Household Composition

12. Marketplace Household Composition

13. Marketplace Household Composition

14. Connect for Health Colorado CBMS Training Life Change Events

15. 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 daysfrom 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

16. 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

17. Examples of Life Change Events Circumstance Changes • Marriage • Birth, adoption, or placement for foster care • Becoming a citizen, national, or lawfully present individual • Permanent move in residence (if access to new QHPs is gained) • Loss of a dependent through death or divorce • Loss of Minimum Essential Coverage (MEC) • Loss of eligibility for employer coverage, Medicaid, CHP+, COBRA expiration • Loss of coverage due to divorce/legal separation, loss of dependent status (e.g., dependent turns 26), or death of policy holder • An enrollee in an employer plan becomes newly eligible for subsidies because employer plan is no longer available or is not considered affordable • Does not include voluntary termination of employer-sponsored plan • Other • Certain errors/inactions by the Marketplace, Broker/Agent, HCG, CAC • Exceptional circumstances • Special rule for American Indians and Alaska Natives

18. Entering Life Change Events In CBMS

19. Entering Life Change Events In CBMS

20. Entering Life Change Events in CBMS

21. Entering Life Change Events in CBMS

22. Entering Life Change Events in CBMS

23. Connect for Health Colorado CBMS Training Specific Populations

24. Entering Non-Citizen Information in CBMS

25. Entering Non-Citizen Information in CBMS

26. Entering Non-Citizen Information in CBMS

27. Entering Non-Citizen Information in CBMS

28. Entering Non-Citizen Information in CBMS

29. Entering Non-Citizen Information in CBMS • After authorization verification checklist will be sent with C4HCO information • C4HCO CBMS contractors will verify non-citizen information

30. 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. • May qualify for CSR above 250% FPL • 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

31. American Indians and Alaskan Natives

32. Connect for Health Colorado CBMS Training Marketplace Eligibility

33. APTC Income in CBMS • APTC/CSR Income • C4HCO uses annual income and Medicaid/CHP+ use monthly income • In some instances income is counted differently and CBMS is programmed with the appropriate rules for each program • If the customer is unsure what to include in the total annual income, they should seek the help of their tax professional

34. APTC Income in CBMS • Standard Income Path • Collects monthly income/expenses to determine eligibility for Medical Assistance program • MAGI/Non-MAGI Medicaid, CHP+ • APTC/CSR (annualized amount) • Expedite Income Path • All individuals on the application must be citizens or lawfully present • Must file taxes (Single, Married Filing Jointly, Head of Household) • Uses adjusted annual income to determine eligibility for APTC/CSR only • Single amount input at the time of application that represents the entire taxable income for the whole household applying for Marketplace programs

35. APTC Income in CBMS

36. APTC Income in CBMS

37. APTC Income in CBMS

38. APTC Income in CBMS

39. APTC Income in CBMS

40. APTC Income in CBMS No APTC amount prior to authorization

41. APTC Income in CBMS APTC amount post authorization

42. APTC Expedite Income in CBMS

43. APTC Expedite Income in CBMS • SES PDF will show the threshold amount and the client’s annual Modified Adjusted Gross Income

44. APTC Expedite Income in CBMS

45. Past Expenses in CBMS

46. Connect for Health Colorado CBMS Training Marketplace Programs and CBMS Functionality

47. Marketplace Programs and CBMS Functionality • CBMS Case Status • 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 • Mixed eligibility cases (Medicaid/CHP+ and APTC) will remain “Open” if benefits are approved • IEVS and APTC/CSR • IEVS income only will start counting for APTC/CSR eligibility if income verifications are not provided for a Reasonable Compatibility discrepancy

48. Marketplace Programs and CBMS Functionality • Marketplace Renewals • 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 • 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) • 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

49. Marketplace Programs and CBMS Functionality • CBMS Case Transfers • Please send your case transfer requests to debra.fitzsimmons@sc.connectforhealthco.com • 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.

50. Marketplace Programs and CBMS Functionality • The “Push To C4/Cty” button should be used to transfer APTC cases