1. Certified Application Counselor Program Status Meeting
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April 28, 2014

2. Certified Application Counselor Program
Status Meeting
April 28, 2014

3. AGENDA Welcome/Introductions Medicaid Update Workflow Processes
Analysis of CAC numbers
Training Updates
MHC Call Center
Assisting Consumers
Q & A

4. Welcome Application Counselor Sponsoring Entities!
Leslie Lyles Smith
MHBE Director of Operations
Jody Zoeller-Hartzell
MHBE ACSE Program Manager
Tia Witherspoon
MHBE Training Manager
Debbie Ruppert
Manager Medicaid Enrollment, DHMH
Rita Dyer
Call Center Coordinator
Ginny Seyler
Manager Connector Entity Program
Aaron Jacobs
MHBE Deputy Director of Operations

5. Medicaid Update

6. Debbie Ruppert will give updates on Medicaid
Medicaid Update
 Debbie Ruppert will give updates on Medicaid

7. Workflow Processes

8. Workflow Processes Special Enrollment for Life Events
Link to Public Comment: comment/
Triggering life events include birth, marriage, certain types of loss of coverage, change in income, or change in citizenship. A special enrollment period can also be triggered by other circumstances, such as application or enrollment errors and carrier misconduct. A consumer will need to work with a consumer assistance worker; a self-help method will not be available initially.
A consumer will report a qualifying life event to a call center representative, navigator, or other assistance worker who will then talk the consumer through the needed documentation.
The consumer will then send the documentation to the call center (FAX # ), and the assistance worker will help the consumer complete an application and shop for a plan. Once the MHBE verifies the application and supporting documentation, and a plan is selected, the consumer’s information will be sent to the carrier.

9. Workflow Processes Termination of Qualified Health Plan Coverage
Link to Public Comment:
Enrollee-Initiated Terminations
A. An enrollee may terminate his or her coverage in a qualified health plan, including as a result of the enrollee obtaining other minimum essential coverage, with appropriate notice to the Exchange or the qualified health plan.
B. The Exchange will provide an opportunity at the time of plan selection for an enrollee to choose to remain enrolled in a qualified health plan if he or she becomes eligible for other minimum essential coverage but does not request termination in accordance with subsection A of this Regulation. If the enrollee does not choose to remain enrolled in the qualified health plan through the Exchange, the Exchange must initiate termination of his or her coverage upon completion of the redetermination process specified in 45 CFR §

10. Workflow Processes Termination of Qualified Health Plan Coverage
Termination by the Exchange
The Exchange may initiate termination of an enrollee's coverage in a qualified health plan, and must permit a qualified health plan issuer to terminate such coverage, in the following circumstances:
A. When the enrollee is no longer eligible for coverage in a qualified health plan through the Individual Exchange, the last day of coverage is the last day of eligibility, as described in 45 CFR § (f), unless the individual requests an earlier termination effective date pursuant to Section .02.
B. When the enrollee has not paid the premiums for his or her qualified health plan coverage, and any available grace periods have been exhausted.
1. For individuals receiving the three-month grace period for individuals receiving advance payments of the premium tax credit pursuant to 45 CFR § (g), the last day of coverage will be the last day of the first month of the three-month grace period.
2. For any other applicable grace periods, the last day of coverage will be consistent with existing State laws regarding grace periods;
C. When the enrollee's coverage is rescinded in accordance with 45 CFR § , the last day of coverage is the last day of the coverage month in which the coverage is rescinded;
D. When the qualified health plan terminates or is decertified as described in 45 CFR § , the last day of coverage is the last day of the coverage month in which the qualified health plan is terminated or decertified; or
E. When the enrollee changes from one qualified health plan to another during an annual open enrollment period or special enrollment period in accordance with 45 CFR §§ or and State policies, the last day of coverage in an enrollee's prior qualified health plan is the day before the effective date of coverage in his or her new qualified health plan.
Other Termination Events.
A. When an enrollee’s coverage is terminated due to death, the last day of coverage is the date of death.
B. Where an enrollee is newly eligible for Medicaid or CHIP, the last day of qualified health plan coverage is the day before the individual is determined eligible for Medicaid or CHIP.

11. Analysis of CAC by Entities

12. CAC by the numbers

13. Training Updates

14. 3 day Webinar Series & 1 day MHC Systems Webinar
Future training dates; future testing sites
3 day Webinar Series & 1 day MHC Systems Webinar
1 additional session will be scheduled for each webinar. This will conclude CAC training.
You will be notified by when enrollment is open.
Future testing Sites & Dates
Timonium
Session #1 : May 8th
Session#2: May 9th ** This session is reserved for only those who need to re-take the CAC Exam.
You will be notified via when enrollment is open

15. CAC Exam Results
CAC Exam Pass Rate
In reviewing passing rates, it is important to remember that candidates are evaluated against an established standard of competence.
First-Time Test Taker Pass Rate: 66%
Second-Time Test Taker Pass Rate(less than 100 takers): Significantly Lower
Because the performance of small numbers of examinees can have a significant effect on results, pass rates for examinations with less than 100 takers should be interpreted cautiously

16. Study the Participant Guide Dedicate extra time to study
CAC Exam
Tips for Success
Study the Participant Guide
All of the content on the exams come directly from the Participant Guide
Dedicate extra time to study
In addition to the training, CAC’s will need to set aside time to review the Participant Guide
Be Prepared
The Buddy System
Partner with Application Counselor’s in the organization or community who have successfully passed the examination

17. What happens after 3 attempts?
CAC Exam
Exam Policy
CAC’s can take the exam up to 3 times.
The passing score is 70% or better.
What happens after 3 attempts?
You will be required to repeat training.
You are required to wait 1 year from you last attempt to re-take the examination.

18. MHC Call Center

19. MHC Call Center
The call center has a list of certified application counselors that is updated as new certifications are processed.
When calling on behalf of a consumer introduce yourself by name. I am a certified application counselor and my certification # (the alpha number combination called ACSE ID: or Certified ID: on your letter) and I am calling on behalf of consumer’s name.

20. Assisting the consumer

21. Assisting the consumer
Now that open enrollment is closed, there are several ways to assist the consumer:
If they are low income they may be eligible for Medicaid, enrollment is year-round and coverage is retroactive to the 1st of the month they are eligible. Perform hand off to local health department, local department of social services or the Call Center.
If they have had a life event that changes their circumstances with respect to insurance coverage, such as job loss, change of income or divorce, they may be eligible to enroll in QHP through a “Special Enrollment Period.” Perform hand off to the Call Center.
If a consumer is already enrolled in insurance through MHC and has experienced a life event, perform a hand off to the Call Center.
If you are unsure or the customer would like in-person assistance, perform a hand-off to the regional Connector Entity.

22. QUESTIONS ?

23. Contact Information
Leslie Lyles Smith, Director Operations or
Jody Zoeller-Hartzell, ACSE Program Manager or