1. 1 Social Worker’s Guide to the Marketplace: Getting clients enrolled in the Health Insurance Marketplace, Medicaid, and CHIP Social Worker’s Guide to the Marketplace: Getting clients enrolled in the Health Insurance Marketplace, Medicaid, and CHIP [Presenter Name] [date]

2.  Background information on the Marketplace, Medicaid, and CHIP  Eligibility requirements  Enrollment checklist  Enrollment period, exceptions and penalties  Opportunities to assist with enrollment  Tips on how to encourage your clients to enroll  Resources Today’s Presentation Covers 2

3. Why Help Clients Get Covered? 3 Coverage helps prevent illness Marketplace plans cover 100% of the costs of:  15 preventive services for adults, such as screening and counseling for tobacco use, substance misuse, and obesity.  22 preventive services for women, such as screening for breast cancer and osteoporosis.  26 preventive services for children, such as hearing screening, and immunizations. Source: https://www.healthcare.gov/what-are-my- preventive-care-benefits/adults/https://www.healthcare.gov/what-are-my- preventive-care-benefits/adults/

4. Coverage protects against high health care costs  The average cost of a 3 ‐ day hospital stay is $30,000.  Fixing a broken leg can cost up to $7,500. Why Help Clients Get Covered? 4

5. Coverage brings peace of mind  80.1 million people in the U.S. have unintentional injuries every year.  10.3 million U.S. children experience asthma.  117 million adults (about 50% of adults) have one or more chronic conditions. Why Help Clients Get Covered? 5 Sources: http://www.cdc.gov/nchs/fastats/injury.htm http://www.cdc.gov/nchs/data/series/sr_10/sr10_258.pdf http://www.cdc.gov/pcd/issues/2014/13_0389.htm

6. Getting coverage is simpler with one single application through the Marketplace Why Help Clients Get Covered? 6 Enroll (Medicaid/CHIP) Enroll (Marketplace) Submit single, streamlined application Verify and determine eligibility Eligible for Marketplace or Medicaid/CHIP Online, Phone, Mail or In Person

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8.  A website where individuals and families can directly compare private health insurance plans and enroll in a plan.  Some states operate their own Marketplace. Everyone can get to the right Marketplace by going to https://www.HealthCare.gov and entering the state they live in.https://www.HealthCare.gov What is the Marketplace? 8

9.  Step 1: Create a user account  Step 2: Complete the application  Step 3: Shop for a plan  Step 4: Enroll To find in-person local assistance, go to https://Localhelp.HealthCare.govhttps://Localhelp.HealthCare.gov or contact the Call Center 1-800-318- 2596 How Does the Marketplace Work? 9

10. 10 A person is eligible for coverage if he or she:  is not eligible for job-based coverage.  has job-based coverage that does not meet minimum coverage.  is a U.S. citizen or is a lawful resident.  is under 26 years of age and is not claimed as a tax dependent by parents.  is not incarcerated at the time of enrollment. Who is Eligible for Marketplace Coverage?

11. 11 Advanced Premium Tax Credit. Households earning between 100% and 400% of the federal poverty level (from about $23,850 to $95,400 for a family of four in 2014) can get financial assistance in the form of a tax credit. Cost Sharing. Households that earn up to 250% of the federal poverty level (about $29,175 for an individual and $59,625 for a family of four) are eligible for cost-sharing assistance. Cost sharing limits the amount a household has to pay for out-of-pocket costs. Saving Money on Coverage

12. Marketplace Enrollment Checklist 12 Social Security numbers (or document numbers for lawfully residing residents) Date of birth Health insurance policy numbers Income An “Employer Coverage Tool” completed by the employer(s)

13. Marketplace Enrollment Period 13 2014 HEALTH INSURANCE COVERAGE ENDS OPEN ENROLLMENT PERIOD FOR 2015 BEGINS FIRST DAY OF COVERAGE FOR 2015 BEGINS OPEN ENROLLMENT PERIOD FOR 2015 ENDS

14. Individual Shared Responsibility Payment 14 *After 2016, increase is based on cost of living. 1% of your yearly household income — OR — $95 per adult, and $47.50 per child under 18 In 2014, you pay the greater amount of: 2% of your annual household income — OR — $325 per adult, and $162.50 per child under 18 In 2015, you pay the greater amount of: 2.5% of your annual household income — OR — $695 per person, and $347.50 per child under 18 In 2016* you pay the greater amount of:

15. A person is exempt from the penalty if he or she:  was uninsured for less than 3 months of the year.  would have to pay more than 8% of household income.  is not required to file a tax return.  would have been eligible but was denied Medicaid because they live in a state that has not expanded its Medicaid program.  opposes insurance for religious reasons.  was incarcerated.  a member of a federally recognized tribe or eligible for services through an Indian Health Services provider.  experienced extreme hardship, such as homelessness. Fee Exemptions 15

16. Special Enrollment Period 16 Qualifying life event  Getting married or divorced  Having or adopting a baby  Moving  Gaining citizenship  Rejoining the community after incarceration  Involuntarily losing other health coverage, such as by losing a job or aging off of a parent’s plan

17. How to Motivate Clients to Enroll 17 I can’t afford it It’s too complicated I don’t know where to go for help I don’t need healthcare, so I don’t need insurance I would rather pay the fee than enroll in healthcare I struggle reading English

18. 18 Questions about the Marketplace?

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20.  A partnership between the federal and state governments to provide free or low-cost health coverage.  There are minimum core Medicaid coverage and eligibility requirements that apply across all states.  No two states are alike. Each state may elect to expand coverage to include different groups or income levels, or to increase covered services. What is Medicaid? 20

21. Who is Eligible for Medicaid? 21  Low-income pregnant women  Low-income children  Low-income parents  Adopted children, those in foster care, or those who aged out of foster care and are under 26 years old  People who receive Supplemental Security Income  People on Medicare who have low incomes (dual-eligible)  Childless Adults (in certain states)

22. How the Medicaid Expansion Affects Your Clients 22  If you live in a state that's expanding Medicaid, your clients probably qualify if they make up to $16,105 a year for 1 person ($32,913 for a family of 4).  If they live in a state that hasn't expanded Medicaid, qualifying will depend on income.  Even if your state hasn’t expanded Medicaid coverage, they should still apply. They may qualify under your state’s existing rules.  States are continuing to make coverage decisions. They could expand Medicaid in the future.

23. Medicaid Enrollment Checklist 23 Citizenship or eligible immigration status Foster care status Identity Income Pregnancy status State residency Tribal memberships

24.  Clients can sign up for Medicaid through the Marketplace or through their state agencies at any time of the year.  If they qualify for coverage, Medicaid may retroactively cover their medical expenses for up to three months, as long as they qualified for Medicaid at the time the expenses were incurred. Medicaid Enrollment Period 24

25. How to Motivate Clients to Enroll 25 I have to wait until open enrollment to enroll in Medicaid? Medicaid is only for people on welfare I’m an immigrant so I can’t get Medicaid Too much paperwork I already have Medicare so I don’t need Medicaid I struggle reading English Where can I get more information on Medicaid?

26. 26 Questions about Medicaid?

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28.  CHIP provides health coverage for children whose families earn too much to qualify for Medicaid yet do not have access to affordable insurance through their employers.  At minimum, CHIP covers check- ups and preventive care, immunizations, hospitalization, lab and x-ray services, and dental care at no cost to families. Other health care may require copayments. What is CHIP? 28

29.  Children and teens 18 years of age and younger.  Children in families earning about $47,700 a year for a family of 4 are generally eligible. Who is Eligible for CHIP? 29

30. Streamlining Eligibility 30 Allows states to use findings from “express lane agencies” to enroll children in CHIP. Express lane eligibility Allows health care providers to make a rapid assessment of a child’s eligibility and provide temporary eligibility until an official determination is made by the state. Presumptive eligibility Means that children who are already enrolled in CHIP can be covered up to a full year, regardless of changes in family status. Continuous eligibility

31. CHIP Enrollment Checklist 31 Age Child’s citizenship or eligible immigration status Identity Income Other health insurance a child might qualify for Pregnancy status State residency

32.  Your clients can apply for CHIP through the Marketplace at www.HealthCare.gov or calling 1-800-318-2596.www.HealthCare.gov  They can also go through their state agencies or by calling 1-877-KIDS-NOW (1-877-543- 7669).  Enrollment is available year round CHIP Enrollment Period 32

33. How to Motivate Clients to Enroll 33 I’m not poor, so my children won’t qualify I don’t want to sign up now because soon I’ll have a better job with good benefits I’m too busy to enroll; I have too many things to deal with already I can’t verify my income; I get paid in cash I don’t want to get deported if I try to enroll my child I don’t read English very well I don’t have a computer at home My kids are teenagers; they really don’t need health care I applied once before, but I didn’t qualify

34. 34 Questions about CHIP?

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36. There is a document called Resources for Special Populations with additional information. Populations include but are not limited to:  African American  Agricultural/Migrant workers  Formerly incarcerated individuals  Hispanics/Latinos  Homeless people  Immigrants  Students/Young adults Resources to Help Enroll Special Populations 36

37.  From Coverage to Care http://marketplace.cms.gov/technical-assistance- resources/c2c.html http://marketplace.cms.gov/technical-assistance- resources/c2c.html  What If I Have New Medicaid or CHIP Coverage? https://www.healthcare.gov/what-if-i-have-new- medicaid-or-chip-coverage/ https://www.healthcare.gov/what-if-i-have-new- medicaid-or-chip-coverage/  Using Your New Insurance Coverage https://www.healthcare.gov/using-your-new- marketplace-coverage/ https://www.healthcare.gov/using-your-new- marketplace-coverage/ Resources for Newly Insured Clients 37

38.  Use social media to share links with partners and clients  Display HealthCare.gov and Marketplace.cms.gov materials in your office or website  Share resources with client during in-person meetings and through professional networks  Become a Champion for Coverage organization  Become a Certified Application Counselor (CAC) organization How You Can Help 38

39.  What is it? An organization whose staff and volunteers help people understand, apply, and enroll for health coverage through the Marketplace.  What are the qualifications? Your organization needs to be a community health center or other health care provider, hospital, a non-federal governmental or non-profit social service agency in a state with a Federally-facilitated Marketplace or a State Partnership Marketplace Become a Certified Application Counselor Organization 39