CEE AND CEC WEEKLY WEBINAR ~ JANUARY 9, 2014

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2 CEE AND CEC WEEKLY WEBINAR ~ JANUARY 9, 2014

3 AGENDA Webinar Topic: Consumer Privacy CEE Agreement and Payment Updates Announcements and Updates o Important Payment Dates o Opt Out of Medi-Cal o Paper Applications o Update on Covered California System Issues o IPAS Updates o Resources Upcoming Webinars Questions 3

4 CONSUMER PRIVACY 4

5 COVERED CALIFORNIA PRIVACY REQUIREMENTS Notice of Privacy Practices Covered California s (CC) Notice of Privacy Practices informs consumers of their rights and how CC uses and shares their information. Covered California is required by law to: Maintain the privacy of consumers personal information Give consumers notice of CC s legal duties and privacy practices Notify consumers following a breach of unsecured protected health information. 5

6 INFORMATION COVERED CALIFORNIA MAY COLLECT Information Covered California May Collect When a consumer visits the coveredca.com website, talks to a representative, or sends CC an application, the personal information CC collects may include, but is not limited to: Name Address address Telephone number Social Security Number Demographic information Health information Financial information 6

7 PERSONALLY IDENTIFIABLE INFORMATION What Is Personally Identifiable Information (PII) PII is any information that identifies or describes an particular individual. Following are examples of PII: Full name Birthplace Address Vehicle registration plate number Credit card numbers Country, state, zip code, or city of residence Name of schools attended or workplace Grades, salary, or job title Date of birth Social Security Number National Identification number Driver s license number Age Mother s maiden name Biometric records 7

8 PII FEDERAL REGULATIONS Federal Regulations Requiring Covered California to Safeguard PII Federal regulations require CC to safeguard the PII it collects, maintains, and uses in order to prevent unauthorized access to this information. CC must also protect the integrity of this information to prevent it from being altered or destroyed by unauthorized users. State Regulations Requiring Covered California to Safeguard PII California law regulates the collection and use of personal information by state government agencies, as specified in the Information Practices Act of 1977 (IPA). 8

9 Important Things to Remember Do not discuss private personal, financial or medical matters in an open/non private area Do not collect documents with PII and leave them unattended Do not PII Do not screen shots with PII present Do not leave a computer screen unattended with PII present Do not discuss consumer application information with others After assisting consumer, destroy all scans, cell phone photos or copies of documents containing PII. 9

10 PROTECTED HEALTH INFORMATION (PHI) What Is Protected Health Information Includes documentation in any medium: written, oral, or electronic (e.g., paper, CDs/DVDs, flash drives, smart phones, and laptops). Consists of the following past, present, or future information about the physical and mental health of an individual: o o o Condition of the individual Provision of health care to the individual Payment for health care by the individual 10

11 DOCUMENT UPLOADING TIPS Tips for Securely Uploading Documents for Covered California Important: For your security, CC cannot accept documents for upload via . Also, do not upload individual documents in multiple files. If a document is too large to upload, try one of the following options: o Rescan the document at a lower resolution (recommended resolution: 200 dpi). o Use free compression software, which can be downloaded online. (This can reduce the size of the document by 30 to 50%.) o If you have Adobe Acrobat Pro (not Adobe Reader), you can decrease the size of the document by: 1. Opening the file in Acrobat Pro. 2. Going to File->Save As Others->Reduce Size PDF. 11

12 DOCUMENT UPLOADING TIPS If Your Upload Is Timing Out If your upload is timing out before completion, check the following: Your Internet connection may be too slow. Slower connection speeds coupled with large file sizes frequently result in a timeout. Be sure you are using Google Chrome or Mozilla Firefox as your browser. Only attempt one file upload at a time. The file size of the document must be less than 40MB. 12

13 SOURCES Covered California Participant Guide, Privacy and Security, Version 2.0, pp

14 REMINDER Do NOT sensitive personal information is not a secure form of communication Do not CEC, Consumer, or other PII to Covered California, the Help Desk, or any other organization PII on screenshots for trouble tickets should be removed Open the screenshot in a document or editing software, delete the PII, and save the new document Print a copy, black out the PII, scan it back to your computer All change request and other forms should be faxed to (559)

15 CEE AGREEMENT AND PAYMENT UPDATE

16 CEE AGREEMENT AND PAYMENT UPDATES CEE Agreement Status Executed Agreements have not been mailed but will be soon. CEE Agreement Amendments All CEE Agreements will be amended to reflect the following changes: No application assistance payment for Medi-Cal renewals. No application assistance payment for individuals who were enrolled in Medi-Cal in the prior 12 months. Application assistance payments for Medi-Cal enrollments will be issued when Covered California receives payment from DHCS. 16

17 CEE AGREEMENT AND PAYMENT UPDATES Reminder CEE Payment Terms: Exhibit B, Section C and D of CEE Agreement C. DHCS Budget Contingency Clause 1. If funding for any fiscal year is reduced or deleted by the California Department of Health Care Services for purposes of this program, the State shall have the option to either cancel this Agreement with no liability occurring to the State, or offer an agreement amendment to the Contractor to reflect the reduced amount. 17

18 CEE AGREEMENT AND PAYMENT UPDATES D. State Budget Act Contingency Clause 1. It is mutually agreed that if the Budget Act of the current year and/or any subsequent years covered under this Agreement does not appropriate sufficient funds for the program, this Agreement shall be of no further force and effect. In this event, the Exchange shall have no liability to pay any funds whatsoever to Contractor or to furnish any other considerations under this Agreement and Contractor shall not be obligated to perform any provisions of this Agreement. 18

19 CEE AGREEMENT AND PAYMENT UPDATES 19

20 CEE AGREEMENT AND PAYMENT UPDATES 20

21 CEE AGREEMENT AND PAYMENT UPDATES Application assistance payments for coverage effectuated in Covered California Plans (QHP) will be paid in mid-february. Application assistance payments for Medi-Cal enrollments will be paid at a later date when Covered California receives payment from DHCS. 21

22 ANNOUNCEMENTS AND UPDATES

23 IMPORTANT PAYMENT DATES Consumers now have until January 15, 2014 to make their first month s premium payment. Consumers may use the services covered by their health plan starting January 1 st 23

24 IMPORTANT PAYMENT DATES Refer consumers to the CoveredCA.com site for information about paying. 24

25 OPT OUT OF MEDI-CAL Consumers have the option to opt out of Medi-Cal and select a plan. On the Apply For Benefits screen select NO NOTE: The consumer will not be eligible for premium assistance. 25

26 PAPER APPLICATION DO NOT SUBMIT PAPER APPLICATIONS CECs may use paper applications to start an application for a consumer CECs should enter all paper applications on the CoveredCA.com site Follow-up with the consumer to obtain any information needed to complete the application 26

27 UPDATE ON COVEREDCA.COM SYSTEM ISSUES Access Codes There is a known issue with consumer access codes not being generated. CoveredCA.com is working on a fix. Consumers have to call the Service Center at (800) to receive their access codes. CEC Dashboard There is a known issue with applicants not showing in the CEC dashboard. CoveredCA.com is working on a fix. CECs can expect delays of up to a day for their applications to appear on their dashboards. 27

28 COVEREDCA.COM TIPS Eligibility Calculator The eligibility calculator in the application is functioning. If the consumers are married, they have to mark Married- Filing Jointly to be evaluated for APTC APTC is a premium tax credit. If they are not filing taxes they are not eligible for the tax credit. Shop and Compare Calculator Differences There are two Shop and Compare calculators and there may be differences between the results It is only an estimate for informational purposes. Income Reminder: Have the consumer project their income for

29 UPDATE ON COVEREDCA.COM SYSTEM ISSUES Medi-Cal Do not exclude household members on Medi-Cal If the parents want Medi-Cal and the children already have it everyone needs to be included in the application. Children should not be excluded from the application. Medi-Cal will know that the children already receive Medi-Cal. The system will provide a notification at the end of the application that the children are not eligible because they already have existing Medi-Cal. Medicare If the consumer is on Medicare they are not eligible to apply on CoveredCA.com. If they are Medi-Cal eligible they need to go to the county office. 29

30 IPAS UPDATES Updated information on the IPAS homepage: 30

31 WEBINAR INDEX 31

32 WEBINAR INDEX 32

33 RESOURCES CEE Resource Your Entity s assigned Enrollment Assistance Specialist Call: to find your EAS contact information Purpose for Contact All Certified Enrollment Entities have been assigned an Enrollment Assistance Specialist (EAS) who are well equipped to answer questions and provide help Enrollment Assistance Help Desk Call: assisterinfo@ccgrantsandassisters.org General questions about the Enrollment Assistance program and process Enrollment Entity application process questions Delegation Codes questions Certified Enrollment Entity application and resource website: Find resources such as recorded informational webinars, checklists and worksheets Application Change Request Form Check that status of applications submitted Consumer Help Desk Phone: (Staffed with Service Center Staff who speak multiple languages) Consumer or CEC general questions about health plan applications, enrollment, benefits or current coverage Online CoveredCa.com use the Shop and Compare Tool to help consumers review plan options or download FAQs to answer questions To access tools online to assist the consumer: 33

34 RESOURCES CEC Resource Enrollment Assistance Help Desk Call: Purpose for Contact General questions about the Enrollment Assistance program and process Enrollment Entity application process questions Delegation Codes questions Learning Management System (LMS) and Training Help Desk Call: Link: Login assistance Help with Instructor-Led Training/Self-Guided Training Registration Questions on the (2) Computer-Based Training Assistance with the Certification Exam Live Scan Covered California s Fingerprinting Provider Criminal Disclosure Form: To find locations for fingerprinting Schedule appointments Check the status of your background check clearance Download Live Scan request form Consumer Help Desk Phone: (Staffed with Service Center Staff who speak multiple languages) To access tools online to assist the consumer: Consumer or CEC general questions about health plan applications, enrollment, benefits or current coverage Online CoveredCa.com use the Shop and Compare Tool to help consumers review plan options or download FAQs to answer questions 34

35 UPCOMING WEBINARS All Webinars are scheduled for Thursdays 10:00-11:30 am o January 16, 2014 o January 23, 2014 o January 30,

36 QUESTIONS QUESTIONS? 36

37 QUESTIONS Application I have been working with consumers who set up accounts, selecting me as their CEC and then completing the application. Who should be signing the application with the PIN number? One of my applicants' data does not appear in my account. During the application process the system did not provide a code for the consumer to access her account. I have application and case numbers of the individual but have no access to the account. What telephone number do we call, as CECs, when we need assistance or have an error code/message on an application? When we use the add a new individual, the client no longer shows on our active list. The CEC should sign the application and enter their PIN. The consumer must contact to secure their access code. For general application assistance please call the CEE/CEC Help Desk at If you encounter an error code or message in an application, please the CEE/CEC Help Desk to have a Trouble Ticket submitted. The should contain a screen shot (with all PII redacted) and include an application number (if applicable) assisterinfo@ccgrantsandassisters.org This was due to a system issue. A data fix is being run periodically until the issue is resolved. Please expect delays with individuals appearing on your dashboards until the issue is resolved. Individuals should show up within 1-2 business days. Why are some of my consumers missing from my dashboard? What is the best web browser or way to enroll people online? Why can t I get through to the help desk using the chat feature? Google Chrome. The chat is not intended for CECs. 37

38 QUESTIONS Medi-Cal What is the timeline for the Medi-Cal application process? For people that are Medi-Cal eligible, what s the average wait time before they are contacted by Medi-Cal? When Medi-Cal contact clients about their coverage? Typically the county will contact the consumer within 45 days of application. If the consumer has not been contacted, please refer them to their local DSS County office. How do I enroll someone for Medi-Cal when they have Medicare using CoveredCA.com? Will there always be a county eligibility worker portion of the process (outside of the CoveredCA.com system). Why does Covered CA tell those eligible for Medi- Cal they must sign up for a plan, but have a link that doesn't show any plans they can sign up for? Persons with Medicare are not eligible to enroll in Medi-Cal through CalHEERS. They must go to the County to apply. There will be a county eligibility worker portion of the process. The functionality to allow them to sign up for a plan has not been available to date. This functionality is coming in April. 38

39 QUESTIONS Medi-Cal If one person in the household qualifies for Medi-Cal, don't all the rest of the family members qualify? Why is it that some members are qualified for Medi-Cal and others are not? How does this work? For consumers who previously have been enrolled in Medi-Cal but have been dropped for one reason or another and told they need to fill out new paperwork, can they apply (re-apply) through the Covered California website? For consumers who are enrolled in County Medical Services Program (CMSP) in Sacramento County: Will they be moved into Medi-Cal? If so, will the process be automated or do consumers need to enroll? Not all members qualify at the same level of income. Some family members, for example will only be eligible for Medi-Cal up to 138% of the Federal Poverty Level (FPL) whereas pregnant women and children are eligible up to 266%. Because Medi-Cal eligibility depends on other factors in addition to income, eligibility is specific to the circumstances of each individual. Yes, consumers may enroll in Medi-Cal through CoveredCA.com. The County Medical Services Program (CMSP) is a Medi-Cal Program. For more information about CMSP, please visit their website at: or the Department of Health Care Services at 39

40 QUESTIONS Eligibility Do individuals who are on unemployment, but own a house, car or have a 401K account qualify for Medi- Cal? Can a student who is working and is claimed as a dependent of their parents enroll? If a client s income is between 300% and 400% and they are eligible for tax credits, are they not eligible for Advance Payment of the tax credits? The eligibility outcome says that they are eligible but that $0 is available for tax year Individuals with incomes up to 138% of the Federal Poverty Level qualify for Medi-Cal without regard to existing assets. A student claimed as a tax dependent can enroll under his/her parents plan up to the age of 26. Premium assistance is calculated based on the second lowest silver plan in the zip code. In cases where a consumer s fair share is greater than the premium rate they would be charged, they will not receive APTC because their premium is already considered affordable. This occurs most in regions with low premiums. In these cases fair share of 9.5% can max out well under the 400% income level. For example: An individual making $37,000 in Sacramento County has a Fair Share of $292. The second lowest silver plan on which the APTC is based is $270 for a 26 year old which means it s below the consumers fair share amount and they will not receive premium assistance. 40

41 QUESTIONS Eligibility Eligibility of Mixed Families: Where one parent/spouse is AI/AN and the other is not AI/AN, does the system allow so that they can have one application together? We have families that will purchase the insurance or Catastrophic coverage for the non AI/AN spouse and no coverage for the AI/AN spouse as they await the fix. We have other families that are choosing to wait hoping that the fix will occur before the 03/31/14 deadline. Do we have a projected date for the fix? What are the eligibility options if you are 65 or older? (For example, recently, had a client that is 65 without Medicare, AI/AN, has Veterans benefits, makes $31,221/yr. He wanted to know if he would qualify for Medi-Cal or any other Medi-Cal program. The eligibility outcome gave him an option of a AI/AN Bronze plan for $40.37 premium payment with $ advance payment of tax credits with no copy/ded, can he chose this option?) We need to review this particular case in order to give a specific answer. However, you should not file multiple applications for one tax household. All members of a tax household should be included on one app despite applying for different programs. The eligibility system will determine the correct eligibility for the program they are eligible for. The latest update to CoveredCA.com includes the ability to select multiple plans for each individual of the household. In this example, the individual may be eligible for non- MAGI Medi-Cal (traditional Medi-Cal) as evaluated by the county. He may be eligible for APTC and CSR. However, he can choose one or the other, not both. A consumer may also choose to opt out of Medi-Cal, but choosing this option would opt the consumer out of ATPC and CSR if they were determined to be eligible for those programs. 41

42 QUESTIONS Immigration What can we do about clients who do not have an expiration date printed on their green card? Nor do they have a card number, only an A#. For green cards that have no expiration date or number, please use 12/31/9999 as the expiration date and AAA for the number. The following link is helpful when assisting consumers in entering their Immigration Document information on the application: Do foreign students need to enroll in insurance here if they have insurance from their native country? It isn't insurance bought here or through their school, it is separate foreign health insurance. Will they be penalized? IRS in its final rules on exemption from the Individual Mandate (specifically provides, in the middle column of page 53651, that coverage or a plan provided by a foreign insurance issuer to foreign nationals lawfully present in the United States for an extended period of time that is not offered within a state in the United States is neither an eligible employer-sponsored plan nor a plan in the individual market. Therefore, those foreign nationals lawfully present in the United States are subject to the Individual Mandate and the imposed tax penalty if they do not maintain minimum essential coverage in the state in which they reside. What can we do about clients who lost their naturalization certificate and therefore do not know their number? The client should contact the issuing agency for a new certificate. 42

43 QUESTIONS Other What can be done if the county refuses to write a non-incarceration letter? Marin County refused to provide a letter for an applicant. I submitted a letter from an alternative organization to prove that the person was not in custody. CoveredCA Why does Covered CA give a client the choice to be contacted by and instead sends them notices to their secure inbox on the CoveredCA site? Some receive mailed notices even when they requested . Plan Options How long should a consumer expect to wait to hear from their health plan send information regarding their first month s premium payment? Some companies do not offer online payment methods. If the applicant does not have discharge papers because they have never been to jail or prison they should call the Service Center and attest to never having been in jail. This is verification is fully attestable. The only messages that will ever go to the Secure Inbox are the same notices that are mailed out. For now, they receive the notice by mail and they may also get copies sent to their inbox. If a consumer has not heard from their health plan they may contact the health plan directly. Payment information is available on the Covered California website: 43