Marketplace Streamline Application Webinar
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Marketplace Streamline Application Webinar


So what we’re going to talk about, the
agenda for today is really pretty simple. I’m gonna walk through the
online application. I’m going to show you some pieces of the eligibility
portion as well as when people enroll in a qualified health plan and
what that looks like. So the first piece that we want to do is
just give you a little high-level overview of how the online application works
and what it’s function is. One of the key things to know is that questions
are displayed based on the information of the applicants provide. So that
means it’s dynamic and it will show and hide questions based on the applicant’s
particular circumstances. It will show and hide questions based on the
eligibility rules for the states as well as what program they likely qualify for,
also known as financial assistance. And the other is applying to enroll in a
Qualified Health Plan without financial assistance. And those two paths, one
single streamlined application, which is how we refer to it, but it does present
different questions based on how you’ve responded. On the financial
assistance path, particular questions are only asked if people who are likely
eligible for advanced payments of the premium tax credit, otherwise known
as APTC and cost sharing reduction or enrolling in a qualified health plan.
After the consumer views their eligibility results, there are further
steps to enroll in a Qualified Health Plan. If someone is eligible for
Medicaid or CHIP (Children’s Health Insurance Program), questions will
appear that only asked for Medicaid or CHIP eligible people and the
information is automatically forwarded to the State and the State will follow
up with the consumer. In certain States, the final Medicaid and CHIP
eligibility determination is made by the State instead of
the Marketplace. Okay, so the next slide is the online
application flow. And this is to show you a high-level picture of what the
structure of the online application is, so you have a picture in your head a
little bit as we walk through different slides cause as you know, it’s an
application that has many facets to it and we won’t have time to go through
every single screen and I wanted to highlight different things. But before
we do that, I wanted to give you a little framework
to orient you. So these different boxes that you see in
front of us show, they depict the online application process. It begins with
account creation and includes identity proofing. For someone who is applying
on behalf of other people or for themselves, they need to go through a
process of identity proofing. That means answering questions that they
would only know the answers to and ends with the consumer seeing their
eligibility results and continuing to plan enrollment if they are eligible. At the
beginning of the application, the person fills out the application and
completes their contact information and indicates whether they are
receiving help from an assistor, navigator, agent or broker. They then
indicate whether they want to apply for financial assistance or not. And they
enter the list of people who are applying for coverage and provide
additional details about their household. At the end of the process, the
consumer views the information they entered and make changes as they
need to and sign and submit their application. After they submit the
application, they see their eligibility notice that tells them which programs
they may be eligible for. And then the consumer then can move on to select a
Qualified Health Plan if he or she is eligible. If they qualify for Medicaid or
CHIP, the Marketplace transfers the information to the State Medicaid or
CHIP agency, follow-up for information or send enrollment information to the
consumer. So that is the online flow, And then they come to this page where
they are asked whether or not they can get help paying for health coverage.
And in our scenario, I have selected, yes, they can be evaluated for CHIP or
Premium Tax Credits, or Cost Sharing Reductions. They would then select no
if the applicant wants to enroll in a Qualified Health Plan and does not
want help paying for coverage. The last option down at the bottom is “I’m Not
Sure”, which takes them through a screening tool and that helps them
decide which path to take. Next slide,
please. So on this next slide, the person is
asked to enter the people who are applying for coverage. And they enter
their name, date of birth, and their relationship to the household contact.
It’s a simple screen of which shows who is applying for coverage. So it
shows you the name of the person and the date of birth and you can kind of
both add people and pre-populate the name of the person who is the
household contact if they said they were the person who is applying for
coverage as well as other people. Otherwise, it will just ask you to add
people and so you would add the person’s name and their date of birth
here, and the relationship to the person who is the household contact.
So you’ve entered all these people who are in here. And this is just again just to
clarify, these are the people who are applying for health coverage. There are
other people who are needed on the application for purposes of eligibility
when you go down the financial assistance path. And so the system is
smart enough to kind of identify who those people are that it needs to know
about and it will ask you about them but now you are just putting in who
wants to get health coverage. So, after this section, after they have entered
the family and household section, they enter additional details about each
person, such as, their sex, social security number if they have one,
citizenship/ immigration status and their asked an optional question about
race and ethnicity and since they are applying for help based on coverage,
they will be asked question such as whether they plan to file taxes, who’s
in their tax household and who they live with, and that’s for purposes of
Medicaid and CHIP as well as other questions. Household members who
don’t want to apply for coverage but need to be included for eligibility
purposes will be identified during the Family and Household section. And
that is just so you are aware for purposes of determining household
sides as well as income for the different programs.
Next slide, please. So as part of the Family and Household
Section, there is some additional questions to determine whether
anyone is pregnant or a full-time student, disabled, or need long-term
care. These are related to Medicaid eligibility. And right after that is this
question, which is about whether anyone on the application is American
Indian or Alaska Native. The purpose of this question is to help prompt the
system logic to ask additional question about determining eligibility for
additional benefits. Next, I will show you pages that appear about someone
having selected an individual as American Indian or Alaska Native.
Again, this is just to give the system the knowledge that this person identifies
as American Indian/ Alaska Native and therefore, other questions will appear
based on which programs they are likely eligible for.
Next, slide please. So this screen is to show you what it
looks like when someone adds their income for the financial assistance
path, need you to know what someone’s income is in order to figure
out what programs they may be eligible for. And this is a screen that
just shows you the list of the different types of income that are asked and the
person clicks to edits or add additional income and they list what their
frequency is for the amount of income that they make and whatever
frequency or amount it is whether it is hourly or weekly, quarterly, or
however they receive their income. And the system does the math to
figure out. I’ll tell you just for your information, it’s not something
someone needs to know, but in order to get to the process, that the system is
basically looking at two things. Looking at someone’s current monthly income
for the purposes of Medicaid and CHIP, so it looks at what they make this
month, and then it is also looking at the yearly income to figure out what
they may be eligible for in terms of tax credits and cost sharing reductions. So,
for example, we are in 2014 right now and we’d be looking at the year of
2014, how much someone estimate that they are going to make for that
year and that’s how we figure out how much tax credits or cost sharing
reductions they are eligible for. Next screen,
please. So there is also this question that
appears in the income section and this is one of the first examples of
questions that will appear based on whether someone identified as
American Indian or Alaska Native. So it’s a question that is to determine
whether someone has received income from any of these sources and I will
read it for you in case you can’t read the screen. It says, Per Capita, has
anyone received income from these sources and it says Per Capita
Payments from the tribe that come from natural resources, usage rights,
leases or royalties. Payments from natural resources, farming, ranching,
fishing, places from royalty land designated as Indian Land by the
Department of Interior, including reservations and former reservations.
And money from selling things from cultural significance. And so if someone
says that they have money from any of those incomes sources and they say yes,
then it pre-populates the income they already have told us about and
then it asks us how much of that is from these sources. And the reason it
is doing that is, it is actually going to deduct that amount from their current
monthly income for purposes of Medicaid and CHIP. So it is actually to
their benefit to report that income to us so that we can reduce their income
by that amount, and it means they are more likely to get better chances to
qualify for Medicaid or CHIP. So that is the purpose of that screen is. If
you could go to the next slide, please. So another question that appears is if
someone that has indicated that they are American Indian or Alaska Native, is
that they have a question about, and this is if someone has gone down, so
let me repeat that if they passed the point of where we’ve collected your
income, and they have already told us that they are identifying as American
Indian or Alaska Native, and as a result, we have looked at their income and it
looks like that, based on their income, they are eligible for tax credits and cost
sharing reductions as opposed to Medicaid or CHIP. So, we send them
down a path of additional questions based on their income. And this is one
of the questions that appears if someone indicates that they are
American Indian or Alaska Native on that path for tax credits. So it asks the
question of any of these people are members of a federally recognized
tribe, because you have to be a member of a federally recognized tribe
in order to be eligible for a tax credit or cost sharing reduction. So, they
indicate here, they select the person’s name that are identified of a federally
recognized tribe. And then if you go to the next screen,
after clicking save and continue, they see a screen like this where they can
select the state in which the tribe that they are a member of is located. And it
doesn’t matter if they don’t actually live in that state, they can select
whatever state their tribe is in, and then they can see a list of tribes
associated with this. And just so you know, this is one of the areas where I
know many people have helped us in making sure that this list can be
improved and updated and reflects the most accurate list it can be. And so that
is some that, up until recently I think we had another update to it that some
folks helped us with and so thank-you to that for keeping on track in keeping
this list as accurate as possible. So, basically what the person does is select
the State, select the tribe and then click save.
And if you could go to the next slide. Then they just select the names of the
people who are a member of that tribe. And then if there was other
tribes, do the same thing for other people are members of. And then you
just click save and continue. The system stores that information.
If you could go to the next screen. So this screen has the, again switching
gears, has the path of someone who is looking eligible for tax credits or cost
sharing reductions. Now you are looking at a screen if they were
potentially eligible for Medicaid or CHIP based on their income. And on
this screen you can see, the person sees a couple of additional questions
that ask whether or not they have ever gotten health service from Indian
Health Service, a tribal health program, or urban health program or through a
referral for these programs. And then if they say no to that question, then
another questions appears that asks whether they are eligible to receive
services from an Indian Health Service, Tribal health program or Urban health
program or referral for these programs and those are for getting certain
benefits for Medicaid and CHIP, different cost sharing benefits for
people who are eligible to receive Medicaid and CHIP.
Next screen please. So once they have gotten though the
additional questions, they get to this eligibility results screen and this is
where they find out what they might be eligible for or what they are eligible
for, and this is where they click on that button that says ‘View Eligibility
Results” and it gives them a notice and I just gave you a little screen shot of
the portion of the notice, and the notice is more a PDF file that they can
download and print if they care to. And this table shows you kind of an
example of what somebody might see. It shows the person’s name, it explains
that they are eligible for a special enrollment period, and just to highlight
something there, if someone indicates that they are American Indian or Alaska
Native, the system know that they are American Indian or Alaska Natives are
eligible for special monthly enrollment periods, and so once the people who
have identified as a member of a federally recognized tribe, those
people would show up here that are eligible for special enrollment period.
And then it talks about cost sharing reductions as the next thing, where it
says choose a health plan with lower co-payments, that’s showing the
person that is eligible for cost sharing reductions. Just to talk about cost
sharing reductions for a second, and I will also show you this when we get in
the plans section, people who are American Indian or Alaska Native are
eligible to receive zero cost sharing reductions for people under 300% of
the federal poverty level. Or they have limited cost sharing benefits. And then
the next part of the box talks about the person being eligible for tax credits and
tells them how much of a tax credit they’d be eligible for the year. And so
that just gives you a sense of the kind of information they would see if they
were eligible for Medicaid and CHIP. Clearly it would say that they are
eligible for Medicaid and CHIP and that the State will be following
up with them. So after they review their notice, they
will click on the Continue to Enrollment button, and one thing I want to
highlight here, sorry about the notice, is that there is information on the
notice for American Indians and Alaska Natives asking for documentation to be
sent to the Marketplace to provide proof of their membership in a
federally recognized tribe. And it gives them instructions and documents that
are possible to send in to provide that documentation.
Next slide, please. So after the eligibility results, they get
to the “To-Do List” and this page kind is like an instruction sheet, it gives you
various steps to go through in order to enroll in a plan. The top parts kind of
talks about different coverage start dates, so that part is now gone, so my
slide is a little out of date since we are almost to the end of the open
enrollment period. And then at the very bottom where it
says Choosing a health plan, where it says set premium tax usage. So each
one of these is little steps to walk the person through the process of selecting
a plan. Before they do a selection of a plan, they select the tax credit
premiums and they answer a question, so this is a little step that they have to
go through. So let’s imagine a person is eligible for a tax credit and they click
on that little button that says Set, and then they do that, they come to the
Plans Compared section, where they can select how much APTC they get.
So if you go to the next slide, So this shows you a screen of what it
looks like when someone is eligible for a tax credit and in our scenario, we
have Charles and Ruthie and they are currently eligible for a 299 dollar tax
credit each month to be applied toward their premium and that gets
paid directly to the plan to reduce the cost of their premiums. And so they
can choose to either use all of that tax credit and by saying yes, they use all of
that tax credit towards their premium every month or they can say no. Some
people prefer to say No if they think their income might change in the
middle of the year and they would rather be conservative about how
much tax credit they get in advance. They can choose to use less of it in
advance and when the IRS reconciles their taxes when they submit them for
2014, they can potentially, depending on the income, remains the same. They
can get some tax credits back through their taxes or conversely, someone
could find out they underestimated how much income they had and then
they might own a little back at the end of when the IRS reconciles their taxes.
So after this section they would have actually gone back to the To-Do List
that I showed you and it will walk them through the next step, which will
provide additional information and this is the question that appears about
tobacco use. And so it asks the questions about whether within the
past six months, have you used tobacco regularly? And it also has a
little clarification there about what that means and it says four or more times
per week on average excluding religious or ceremonial usages. And so
the person can either say yes or no to that and this is one of the few times we
ask about people who provide this kind of information because it can impact
their premiums, as it informs you down there at the bottom. So they indicate
that whether or not they use tobacco or not.
And if you go to the next slide. They move on to the next step which is
the selecting of plans. So they select a plan and they can view their monthly
premium as you see here. And it can show what it looks like with the tax
credit applied. It shows them what the amount is and what it looks like with
the amount of tax credits applied. So actually their monthly premium that
they would be paying after the tax credit is applied, is 33 dollars and
eighty-six cents. So it is helpful that it informs them of
what it looks like with or without the tax credit applied. And also it shows
you here where the co-payments and there is additional information down
below that shows what their deductibles are going to be as well as
what the out-of-pocket costs are. So the co-payments here show zero and
this is an example to show what it would look like for someone who says
they are a member of a federally recognized tribe and their income is
under 300% of the federal poverty level. They will qualify for zero
cost sharing, so it shows you the co-payments
are zero. So if you could go to the next slide,
This is actually the last slide, this is the enrollment To-Do List again, but after
this time, you’ve gotten to the last of the steps and it’s just showing you that
you need to go ahead and pay your premium in order for your plan to take
effect and so you click on the button that says Pay for Health Plan. And also I
just want to highlight a few things, so that is really the last step as the person
follows through and when they click Pay for Health Plan it will either take
them to the plan’s Website if they have an online payment system or it will
take them to steps on information on how to pay the payment for their
health plan. So I just wanted to highlight a couple things. We also have
new functionality, it allows them to submit changes to online applications
and if someone newly indicated that they are American Indian or Alaska
Native, the system will determine them eligible for the monthly special
enrollment periods where they can change plans if they choose to. And
also, I want to point out that I didn’t cover the paper application today, but
the paper application covers the same information as you see online.
Appendix B- if someone is filling out the application. is really the key
important thing to highlight for you guys which is that part of that paper
application that is submitted for people who identify as American Indian or
Alaska Native and it asks similar questions like what the online version
does in asks if you are a member of a federally recognized tribe, whether
they have ever gotten services from IHS, etcetera, whether they might have
any money that is considered from tribal sources that they can be deducted
from their Medicaid or CHIP amount.

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