HRSA PCA Outreach and Enrollment (O/E) Technical Assistance Call August 12, 2013 Updated August 22, 2013

Presentation Overview –Review of HRSA’s O/E expectations of PCAs –Training requirements for health center O/E assistance workers –PCA-HRSA real time information sharing –Health center and PCA reporting requirements –Grantee enrichment series and other TA opportunities –Questions and answers

HRSA’s O/E Expectations of PCAs Training information: Ensure that health centers have timely and necessary information about their state’s consumer assistance training requirements and rollout of new affordable insurance options; Coordination: Coordinate health center outreach and enrollment activities with other consumer assistance efforts in the state; Technical Assistance: Provide technical assistance and training on effective health center outreach and enrollment strategies, including support for health centers that experience challenges in meeting outreach and enrollment projections; Real-Time Intelligence: Monitor successes and barriers to health center outreach and enrollment activities and provide real-time intelligence to HRSA via participation in biweekly calls and through HRSA’s O/E PCA distribution list; Reporting: Report on successes and barriers of health center outreach and enrollment activities to provide HRSA with state-wide and regional-based information necessary to maximize the impact of health centers’ outreach and enrollment efforts.

Training

Health Center Training Requirements and Related Expectations Health center outreach and enrollment (O/E) assistance workers are any health center staff, contractors or volunteer personnel who will educate consumers and help them complete applications for coverage All health center O/E assistance workers supported as part of the HRSA O/E supplement, (both newly hired and existing health center staff), must complete all required federal and/or state requirements for health center O/E assistance workers. Training requirements apply to both health Center Program grantees supported by the O/E supplement and health centers that choose to conduct outreach and enrollment activities, e.g., look-alikes. Slide updated 8/22/13

PCA Support of Health Center Training and Related Expectations We are relying on PCAs to ensure that all health centers have timely and necessary information about all training and related requirements in the state. If you encounter any barriers to health centers’ ability to access training or otherwise complete requirements, please contact the HRSA OE team at

A Note about Navigators If Navigator, IPA or other training beyond the minimum required for individuals who will facilitate enrollment of individuals into affordable insurance options offered through the Marketplace, Medicaid, and CHIP in that state, health center O/E assistance workers can participate in that additional training and perform any additional functions afforded by that funding opportunity i.e., to hire O/E assistance workers and facilitate enrollment of individuals into the Marketplace and/or CHIP. Health centers must be accountable for the HRSA O/E supplemental dollars and use them consistent with allowable costs and the intent of the funding, i.e., to hire O/E assistance workers and facilitate enrollment of individuals into the Marketplace, Medicaid and/or CHIP. HRSA O/E supplemental dollars must not supplant other federal or state Navigator related funding or vice versa. Any additional funding for enrollment assistance must be additive. Slide updated 8/22/13

Training Requirements for Health Centers in FFM/SPM States Health centers in FFMs must at a minimum apply for and be designated as a CAC organization and ensure that all health center O/E assistance workers successfully complete the federal CAC training. In SPMs, health center O/E assistance workers may be required to complete a state-specific training program in lieu of and/or in addition to the federal CAC training in order to facilitate enrollment. Health centers in FFMs or SPMs that have the option of participating in training beyond that which is required for CACs can pursue this training and perform any additional functions afforded by that higher level of training, as long as they remain consistent with the intent of the HRSA O/E supplemental funding opportunity i.e., to hire O/E assistance workers and facilitate enrollment of individuals into the Marketplace, Medicaid, and/or CHIP. If you have not done so already, it is important to apply for designation as a CAC organization as soon as possible. Slide updated 8/22/13

*The following slides apply to states located in Federally-facilitated Marketplaces (FFMs). The Federally-facilitated Marketplace (FFM) will designate organizations to certify application counselors who perform many of the same functions as Navigators and non-Navigator assistance personnel— including educating consumers and helping them complete an application for coverage. Certified Application Counselors * Slide updated 8/22/13

 CACs will provide information to consumers and to help facilitate consumer enrollment in QHPs and insurance affordability programs  The process provides assurance to consumers that they are receiving assistance from persons trained by the Marketplace who are overseen by organizations that are required to protect personally identifiable information  All Marketplaces must have a certified application counselor program * Applies to FFM states Certified Application Counselor (CAC) Details *

 For the FFM and State Partnership Marketplaces (SPM) Applications are now available for interested organizations to complete Must be submitted online to the applicable Marketplace *Applies to FFM states. How Organizations Can Apply to be a CAC *

 Organization’s name and contact information  The nature of the organization’s business  Whether the organization has already been designated by a state Medicaid or CHIP agency as a Medicaid or CHIP application assistance program  Whether the organization is a governmental entity or organized under 501(c) of the Internal Revenue Code  Whether the organization screens the employees and volunteers it will certify as application counselors  Whether the organization or the employees and volunteers it intends to certify already handle personally identifiable information  The organization’s experience, if any, assisting individuals applying for health coverage * Applies to FFM states. CAC Application Information *

 Organizations apply to the FFMs to participate in the CAC program  A Marketplace may designate organizations to certify staff or volunteers to perform CAC duties  The FFMs will only designate organizations that Have processes in place to screen staff and volunteers who are CACs to ensure they protect personally identifiable information Are positioned to help those they serve with health coverage issues Have experience providing social services to the community  State-based Marketplaces (SBM) may follow Federal or establish their own processes for their CAC program * Applies to FFM states. CAC designation process *

 Must enter into a written agreement with the FFM FFMs will establish a standard agreement Agreement must be signed by authorized agency representative  Will be required to have their individual CACs sign an agreement promising to keep personal consumer information private and secure  Will have contact info listed on HealthCare.gov * Applies to FFM states. Designated CACs *

 Will be available August 1 for Agents and Brokers August 15 for CACs August 28 for Navigators and in-person  Training information will be provided to designated organizations * Applies to FFM states. Web-Based Training for Assisters * July 30, 2013

Training Requirements for Health Centers in SBM States At a minimum, health centers and health center O/E assistance workers in State Based Marketplaces (SBMs) must complete all requirements in their state that will allow health center O/E assistance workers to facilitate the enrollment of individuals into affordable insurance options offered through the Marketplace, Medicaid, and CHIP in that state. Health centers in SBM states are not required to apply to CMS for CAC designation. Slide updated 8/22/13

PCA-HRSA Real Time Information Sharing

PCA Bi-Weekly Calls and Distribution List Bi-weekly calls to provide federal updates, share progress in resolving challenges, and identifying emerging and anticipated issues will begin in early September. Our distribution list of PCA O/E contacts will be our mechanism –Get input from PCAs to inform call agendas and identify pressing needs; –Share bi-weekly call agendas; and –Provide HRSA updates and share relevant O/E resources. HRSA will send updates via the PCA O/E distribution list on “off” weeks and more frequently if needed.

PCA Bi-Weekly Calls and Distribution List If you haven’t given us your O/E contacts, please do so. We’ll use the CEO in the meantime. We need active participation from all PCAs. If you can’t participate in a call, let us know at We will also look to PCAs for feedback on what is and isn’t working with the bi-weekly calls so we can adjust as needed.

Health Center and PCA Reporting

Health Center O/E Quarterly Progress Reports (QPRs) TRAINING: Number of health center O/E workers trained as health center O/E assistance workers. –This includes all O/E assistance workers (staff, contractors, volunteers) who will be providing O/E assistance. ASSISTANCE: Number of individuals assisted in any part of the enrollment process, e.g., individuals or families assisted to set up a profile in the portal, helped to file affordability assistance information, receiving an eligibility determination, and/or facilitating enrollment into affordable health insurance. –Outreach or education can only be counted for interactions that occur face-to-face, in person, with a trained health center O/E assistance worker. These can take place in small group settings which are small enough to allow for customizable interactions to address specific questions ELIGIBILITY: Number of individuals assisted who receive an eligibility determination regardless of the outcome of the determination. ENROLLMENT: Number of individuals who enroll (e.g., select a qualified health plan or Medicaid/CHIP). Slide updated 8/22/13

Counting individuals vs. families The estimated total number of consumers assisted through the eligibility and enrollment process should include individuals who are represented by another member of their family during the session (e.g., an adult receives assistance from the O/E assistance worker for all 5 members of their family, even though all 5 members are not present).

Health Center O/E Quarterly Progress Reports (QPRs) Health centers will also describe significant barriers and successes in a brief narrative. Health centers’ first QPR will be due in October and will primarily capture training metrics and any Medicaid/CHIP enrollment that has taken place prior to the open enrollment period. HRSA plans to share the health center O/E QPR data with PCAs.

PCA Quarterly Reports PCAs will report to HRSA via quarterly progress reports (QPRs). PCA O/E QPRs will provide a summary of state barriers and successes informed by health center reporting and additional state context provided by the PCAs.

Upcoming TA Opportunities HRSA will continue its O/E Grantee Enrichment Series. We anticipate the second in the series will take place in September. To access the first in the series, “Health Insurance Marketplace and Medicaid Expansion Outreach and Enrollment in Health Centers Part 1”, go to We will continue to host TA calls specific to the O/E supplemental funding requirements and expectations as needed and to update the BPHC O/E supplemental funding website regularly

Q&A Questions?

For More Information Outreach and Enrollment Inbox (for general O/E questions) PCA Outreach and Enrollment Inbox (for PCA questions and issues) CMS CAC Inbox (for CAC application questions) BPHC O/E supplemental funding technical assistance web page Other important websites: /