FACT SHEET for Exceptional Circumstances Special Enrollment Period
 
The U.S. Dept. of Health and Human Services released guidance outlining a new special enrollment period (SEP) for people affected by the 2017 hurricanes, including Hurricanes Irma and Maria. This new guidance will provide individuals who were impacted by either or both of those these weather disasters additional time to enroll or change their ACA coverage for 2018. This guidance only applies to coverage purchased in the Health Insurance Marketplaces created by the ACA.
​
What does this mean for 2018 coverage?
 
The open enrollment period for individuals to enroll in coverage for 2018 began on November 1, 2017 and ends December 15, 2017. BUT people who either currently reside in a disaster-affected area, or did when Irma or Maria hit, will have until December 31, 2017 to enroll for 2018 coverage.
 
There has been some confusion between the hurricane SEP for 2017 coverage and the hurricane SEP which extends access to enrollment for 2018 coverage until December 31, 2017. For information about how to access health coverage which would be effective in the remainder of 2017, please read additional information on our blog.
 
Who is eligible for this extra time to enroll?
 
The guidance makes this SEP available to individuals who “reside, or resided at the time of the hurricane, in any of the counties declared as meeting the level of ‘individual assistance’ or ‘public assistance’ by FEMA.” If you currently live in any Florida county affected by the hurricanes or you lived in that county at the time of the hurricanes, then you are eligible to enroll in 2018 coverage until December 31st, 2017.
 
Do I have to provide documentation that I was affected by the hurricane, such as documents from FEMA?
 
Anyone who lives in a county considered “affected” by the hurricanes (or who lived in the county at the time of the hurricanes) is eligible for the extension and must only attest to living in those areas and to not being able to complete enrollment due to the hurricane. No further documentation will be needed.
 
 
What if I lived in Texas during Hurricane Harvey or in Puerto Rico during Maria but I have now moved to Florida?
 
Anyone who attests to moving from an area affected by a hurricane-related weather event in 2017 (and who lived in that area during the disaster) will be eligible for the extra time to enroll in coverage through December 31, 2017.
 
How can a person enroll using the SEP which extends enrollment access for 2018 coverage?
 
To access this additional time to enroll in coverage for 2018, a person must call the Marketplace Call Center and request the special enrollment period. However, the consumer can complete the application online – either alone or with in-person assistance – prior to calling the Marketplace Call Center. If the consumer’s application is already complete at the time he or she is requesting the extension, the consumer should provide the application number to the Marketplace Call Center. The applicant must tell the Call Center Representative that he or she was affected by the hurricane and requires more time to complete 2018 enrollment.  People may contact the Marketplace Call Center at 1-800-318-2596 or TTY at 1-855-889-4325 to request enrollment using this SEP after December 15, 2017. The call center is open 24 hours a day, seven days a week.
 
Navigators and Certified Application Counselors (CACs) may use the special helpline set up just for assisters:
      *Assister line for Navigators: 1-855-868-4678        
      *Assister line for CACs: 1-855-879-2683
 
Here’s how the process would work:
 
1) A person submits an application for 2018 coverage via Healthcare.gov. In most cases (unless they were found eligible for some other special enrollment period), they would then receive an eligibility determination notice that would say they are ineligible to enroll in coverage because the open enrollment period for 2018 ended on December 15th, 2017.
 
2) They can then call the Marketplace call center and request the special enrollment period which extends the open enrollment for people in areas impacted by Irma or Maria. (This(this request must be submitted by the deadline of December 31, 2017). The applicant must tell the Call Center Representative that he or she was affected by the hurricane and requires more time to complete 2018 enrollment.
 
3) This request will then be forwarded to the Marketplace for review/approval.
 
4) Once the Marketplace has approved the enrollment extension and set the appropriate effective date, the consumer will be alerted via letter and will be able to go back to Healthcare.gov and select a plan.
 
What can I do if I am having trouble accessing the special enrollment period?
If you have questions or are having trouble using the enrollment extension then call Covering Florida at (877) 813- 9115.

 
Despite multiple challenges this year, Open Enrollment for 2018 Marketplace Health Care coverage has been an extraordinary success, exceeding all expectations. Once again, Florida leads the US in enrollment figures. Through the first 6 weeks of the allotted eight-week Open Enrollment period, Florida has signed up over 1 Million consumers who will enjoy full health coverage beginning on January 1st.

 
During these last two days, your Florida Navigators statewide are working long and hard to ensure that everyone gets covered prior to the deadline tomorrow. All of our Covering Florida consortium groups, listed below, are taking appointments right up to the last minute. Call the number above or visit www.CoveringFlorida.org
 
 
The Open Enrollment period was cut in half; advertising and outreach was cut by 90 percent. Our success so far has been helped by the extraordinary efforts of our partners in the media and advocacy groups. Heading into the final week, more people have signed up than ever before during this same time. Enrollment has defied expectations. Here’s the problem - there is very little time left for people to get covered and because of cuts to advertising, many people still don’t know that Friday is their last chance to get covered.

 
We are making a request that everyone reading this release to please share it with your friends, family, neighbors, co-workers, teachers, butchers, bakers and candle-stick makers, particularly in under-served and non-English language speaking areas. Let’s all make sure that anyone who might still need to enroll for coverage is aware of the deadline!
 
 
Let everyone know:
TOMORROW is your last chance to #GetCovered for 2018.

Don’t waste any time: Go to HealthCare.gov TODAY and sign up for affordable health coverage.
 
OUR STATEWIDE PARTNERS
 
90 Works – Serving Escambia, Santa Rosa, Okaloosa, Walton, Holmes, Jackson, Washington, Calhoun, Gulf, and Bay counties
Broward Regional Health Planning Council – Serving Broward County
The Family Healthcare Foundation – Serving Hillsborough, Pinellas, Pasco, and Polk counties
Florida Keys Area Health Education Center, Inc. – Serving Monroe County
Suwannee River Area Health Education Center – Serving Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Levy, Marion, Putnam, Sumter, Suwannee and Union counties
Health Council of Southeast Florida – Serving Palm Beach, Martin, Okeechobee, St. Lucie, and Indian River counties
​ Health Council of South Florida – Serving Miami-Dade 
Health Planning Council of Northeast Florida – Serving Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia counties
Health Planning Council of Southwest Florida – Serving Charlotte, Collier, DeSoto, Glades, Hendry, Lee, Sarasota, Highlands, Hardee, and Manatee counties
Primary Care Access Network – Serving Orange, Osceola, Seminole, and Lake counties
​ United Way of Brevard – Serving Brevard County
University of South Florida Mobile Navigators – Serving Madison, Taylor, Jefferson, Gadsen, Wakulla, Liberty, Franklin, and Leon counties                                                                          
 
The project described was supported by Funding Opportunity Number CMS-CA-NAV-15-001 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services.” “The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.”
 
 

Covering Florida is frequently called upon as an expert in health insurance coverage and health literacy for its ability to reach out to diverse audiences and educate consumers about health insurance coverage and utilization including options under the Affordable Care Act, Children’s Health Insurance Program (CHIP), and Medicaid.  Covering Florida reaches consumers through partner organizations and collaborates with hundreds of organizations, many of which provide direct service to thousands of health care consumers. The organization focuses largely on advocating for and increasing access to care and services via enrollment for individuals with limited English proficiency, individuals with disabilities, populations underserved in the current private health insurance market, and vulnerable populations by employing multi-lingual Navigators, producing brochures in multiple languages, conducting workshops, and providing interviews in various languages. 
 
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For free in-person Navigator assistance state-wide call (877) 813-9115 or visit http://www.coveringflorida.org/   

​“Nav-Lab” open to USF campus, community; anyone with questions about coverage welcome

Tampa, FL (11/28/2017) -- An on-site, free, community outreach and enrollment event to help consumers learn more about their coverage options through the Federal Health Insurance Marketplace will be held 10 a.m. to 3 p.m., November 30, 2017, at the USF Marshall Student Center, 4103 USF Cedar Circle, Tampa, FL 33620.
Navigators from USF Florida Covering Kids & Families (FL-CKF), joined by those from The Family Healthcare Foundation, will be able to assist people with Health Insurance Marketplace enrollment or renewals.  Navigators will offer education about the Marketplace, assist individuals and families with coverage choices and guide those interested in enrolling through the application process.

FL-CKF, a program at the University of South Florida in the College of Public Health was awarded a $4.9 million Navigator grant for the 2017-2018 enrollment period. FL-CKF works with 11 consortium partners across the state to help those who want assistance understanding and enrolling in healthcare coverage available through the Health Insurance Marketplace.

According to Jodi Ray, Director of FL-CKF, “Time is almost up! There are just over 2 weeks left to enroll in affordable health insurance for 2018.” FL-CKF Navigators will assist people with completing Health Insurance Marketplace enrollment or renewals and helping individuals understand their plan choices. Navigators will offer free, confidential education about the Marketplace and guide those interested in enrolling through the application process.
 
The last date to enroll for coverage that begins January 1, 2018 and the final day that 2017 enrollees can change policies before being “auto-reenrolled” in their previous health care coverage plans is December 15, 2017. 

“Nav-Lab” walk-ins are welcome, but registration is recommended, because parking is limited. For more information or to register, please call (813) 803-0628.

Other Important Information:
There will be very limited free parking spaces within Lot 3B off USF Holly Drive. These spaces will be marked off as reserved for this event only. Visitors parking on the USF-Tampa campus are required to purchase a daily parking permit. Parking pay station is located off USF Cedar Drive, Lot 5A. Daily parking for the Marshall Center is located within the Crescent Hill Parking Garage or Lot 3B and 3C off USF Holly Drive. There is also a sheltered Bull Runner Stop USF Cedar Circle, immediately in front of the Marshall Center.
                                                                    
-USF Health-
USF Health's mission is to envision and implement the future of health. It is the partnership of the USF Health Morsani College of Medicine, the College of Nursing, the College of Public Health, the College of Pharmacy, the School of Biomedical Sciences and the School of Physical Therapy and Rehabilitation Sciences; and the USF Physician’s Group. The University of South Florida is a Top 50 research university in total research expenditures among both public and private institutions nationwide, according to the National Science Foundation. For more information, visit www.health.usf.edu

​3 Weeks in and the #OpenEnrollment Numbers are Solid, but...
 
First, Happy Thanksgiving everybody, we hope you enjoy the annual feasting with family and friends today and that you have plenty to be thankful for.  We’re thankful to share this news with you that we just received:
 
Florida leads all states during this year’s Open Enrollment with nearly 500K signed up thru November 18th !! (since Nov. 1st)
 
From Business Insider: 

“An enrollment snapshot released Wednesday from the Department and Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) showed that enrollments in healthcare plans through the federally funded Healthcare.gov exchange has paced well ahead of last year.  Through November 18, 2,277,079 people enrolled in a Healthcare.gov plan. Of those, 566,042 are new customers, and 1,711,037 are returning enrollees.  That's a much faster pace than last year. Through the first full month of enrollment in 2016, just 2,137,717 people had enrolled in total, and 519,492 were new enrollees.
Sign ups are on pace for their fastest enrollment ever. But there's a catch...”
 
The catch of course, and the reason we are nervous, is simple.  Open Enrollment is going to be over soon, gone, kaput.  This year’s OE period ends on December 15th,  --six weeks sooner than last year’s time frame.  So our Navigator teams are going to join our family and friends at the table today, raise a glass to the success so far, but get right back to the business of enrolling consumers starting again tomorrow. Our phone line is open for appointments today.
 
We have a lot of organizations and individuals to thank for the big numbers so far in Florida, but we’ll save those for after, right now we are urging everybody to double down now on their outreach and marketing efforts, particularly to the traditional under-served and non-English speaking areas of Florida.  We’ve only got a couple of weeks left to make sure everybody who needs Marketplace insurance coverage in 2018 knows how and when to #GetCoveredNow!!
 
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Reprinted from Tampa Bay Times, by Justine Griffin.

​Despite the budget cuts, the attempts to repeal and replace, and reports of sharp rises in premiums, Floridians and other Americans are signing up for health insurance under the Affordable Care Act at record rates this year.

Enrollment has surged 47 percent over this point last year in the 39 states with federal health care exchanges, according to the Centers for Medicare and Medicaid Services. About 1.5 million people across the country have signed up through healthcare.gov in the first 11 days of the six-week enrollment period for 2018. That includes the 876,788 consumers who purchased insurance during the second week of the period, Nov. 5-11.
Compare that to the just over 1 million people who signed up for Obamacare during the first 12 days of enrollment last year.
In the Tampa Bay area, health care "navigators" say they are seeing more consumers than ever.
"We've been very, very busy," said Melanie Hall, executive director of the Family Health Care Foundation in Tampa, one of the government-funded nonprofits that helps people navigate the system and sign up for coverage on the Florida exchange, the nation's largest ACA marketplace. "What's great is the word is getting out and people aren't waiting until the last minute to sign up."
Navigators at the University of South Florida have been so busy, they've been adding more slots than anticipated for scheduled appointments this week, said Jodi Ray, the director of USF's navigator program, Florida Covering Kids & Families.
"Our phones have been ringing off the hook," she said. "I think people are nervous about losing their coverage."
During the first four days of enrollment, Ray's program saw a 50 percent spike in traffic compared to last year, she said.

And most people seem to be finding more affordable rates than they anticipated.
"I think people are seeing lower premiums in some cases because of the tax credits," Hall said, referring to a signature Obamacare feature that protects people with lower incomes from high insurance rates.
The plans fall into four categories: bronze, silver, gold and platinum. Consumers who choose bronze plans pay the lowest monthly premiums, but the most for care. Those with platinum plans have the highest monthly premiums, but the lowest cost of care.
Ray echoed Hall's assessment, adding: "Premiums jumped up this year, but what we're finding is that when we look at some of the plans side-by-side, even the gold plans, the premium costs actually went down. It depends on if you get the tax credits of course, but some people are finding better deals going up from a silver plan to a gold one to get that credit."
Not everyone is getting a great deal. Consumers with too much income to qualify for subsidies are bearing the brunt of premium hikes, a fact that many lawmakers are focusing on as they try to kill the law.
Those complaints, along with cuts to Obamacare's marketing budgets and the shorter sign-up window had navigators worried that fewer people would be shopping on the exchanges during this enrollment cycle.
"It's hard to know if we're enrolling more people or if more people are enrolling early, since we have half the time to reach them," Ray said. "But people are being responsive and that's making me happy."

Brittany Bianchi, a 28-year-old graduate student studying to be a physician's assistant at USF in Tampa, signed up for health insurance at a navigator event on campus this week. Bianchi is from California and is only in Florida for school, which made finding the right plan a little tricky.
"If I was back at home in California, I qualified for Medicaid because I'm a student and have no income," she said. "I was afraid if I tried to figure this out by myself it would have taken like, 4-5 hours, so I came here."
The uptick in overall enrollment was due mostly to consumers returning to the marketplace, as the number of new consumers is slightly down this year, according to the CMS report.
One of those newcomers is Spoorthy Prabhudeva, a graduate student in USF's college of medicine, who will no longer be on her parents' plan and was signing up for health insurance for the first time this month.
"A lot of what I've heard so far about the ACA has been exaggerated, like how high the premiums are," Prabhudeva said.
Bunni Lefebvre and her husband, Scott, in Tarpon Springs also signed up for the first time this week.
Both retired from their careers in IT earlier in the year when they were 50.
"We both had good jobs. We looked at our life and decided that we could live on what we'd saved so far, so we did it," Bunni Lefebvre said.
The couple married in 2016 and has no kids. They said not having the expense of children puts them a world apart from most other adults looking for insurance at their age.
"We don't have to pay for a college education or a wedding," Lefebvre said. "We don't have any family that we have to support or leave our house to. We budgeted and decided we could afford $1,000 a month for health insurance."
The couple decided on a bronze plan because they wanted only basic coverage.
"All we care about is coverage for the major stuff. We're not sickly people. We don't have major issues. But if one of us gets hit by a bus, we don't want to have a $700,000 bill," Bunni Lefebvre said.
After talking about their options with a broker, they said they were surprised at how easy it was to sign up on healthcare.gov — and how low their cost would be compared to what they had budgeted.
The plan they selected came with a premium of $70 a month for both of them, with a $7,000 deductible.
Contact Justine Griffin at jgriffin@tampabay.com or (727) 893-8467. Follow @SunBizGriffin.
http://sptimes.com/news/health/in-tampa-bay-and-elsewhere-early-numbers-show-record-sign-ups-for-obamacare/2344446

The test is expected to come near the end of a narrow window
Fans and foes of the Affordable Care Act expected that political confusion and budget cuts would splash cold water on the willingness of Americans to sign up for health care coverage in this year’s shortened open enrollment period.
But so far it appears that both sides underestimated the vital importance that access to health care holds for individuals who cannot obtain it any other way.
​
More than two weeks into an abbreviated enrollment period that ends Dec. 15, the daily average of people purchasing policies through the federal website HealthCare.gov is higher by 60 percent than in 2015 — at a rate of more than 134,000 a day, compared to about 77,000. Despite a lower number of insurance carriers, generally higher premium costs and slashed federal spending on promotion and assistance, the numbers of new and returning customers are both up sharply.
Data at the local and state levels are not yet available, said Jodi A. Ray, director of Florida Covering Kids & Families at the University of South Florida’s Chiles Center. Ray has led the coalition of organizations responsible for helping Floridians enroll in this part of the state since 2013, at the beginning of what has come to be known as Obamacare. But from what she is seeing so far, Ray is guardedly optimistic.

“I’m not going to tell you whether there’s a trend,” she said. “But the results that I’m getting from the field are really positive. We really put forth an aggressive effort to reach out to customers that we’ve worked with over the past four years. The appointments are filling up, which is great.”

This is happening despite a determined effort to reduce the amount of reliable information reaching consumers, observed Jennifer Tolbert, director of state health reform for the Kaiser Family Foundation, which researches health care issues.
“For the fifth open enrollment, the period was shortened to six weeks, with a 90 percent reduction in federal funding for advertising and a 41 percent reduction in navigator grants,” she said, referring to the hiring budget for the trained advisers who help people sign up online. The foundation’s research showed, she said, that going into the enrollment period, “Nearly 30 percent of the general public and 40 percent of the uninsured don’t know whether the health care law is still in effect.”

Funding for navigator funding in Florida is higher than the national average, with only a 30 percent reduction in spending from 2016, a drop from almost $9.5 million to about $6.6 million. Some states are responding by concentrating their outreach and education in urban areas, where it is most effective, and leaving rural consumers to find their own way.
But Ray’s group adopted a different strategy, hiring as many navigators as possible for the enrollment period and laying them off later.
“Regardless of the cuts that we took, we weren’t going to eliminate vulnerable populations that we were serving already,” she said. “We find that the people who need the assistance of navigators come in with more complex situations. We have been calling for months to let them know about the shortened enrollment period and encouraging them to come in.”
In Sarasota and Manatee counties, only about 7 percent of the population enrolled in Obamacare in 2017 — just over 54,000 residents. Several factors are in play here, including an unusually high number of Medicare beneficiaries, and the fact that Floridians do not have access to the Medicaid expansion program that makes more low-income Americans eligible for coverage. About 384,000 people in this state fell into that coverage gap last year, making too much money to qualify for traditional Medicaid coverage and too little to receive insurance subsidies under the federal plan.
But it is also likely that many young and healthy county residents, mostly holding jobs in the service economy, are opting to pay the tax penalty of $695 or more rather than seeking out health care coverage. This is the population that worries health care policy experts, because their participation is necessary to make the “risk pool” math work for insurance providers.
“It’s important to keep in mind that the impact of the Trump administration’s decision to significantly cut outreach will primarily be felt in the final weeks of open enrollment,” said Lori Lodes, co-founder of the nonprofit Get America Covered, and a former outreach staffer for HealthCare.gov. “The young and healthy tend to sign up when it’s close to the deadline, and need the extra reminders that advertising provides. That’s why we need to do even more during the final four weeks before the final Dec. 15 deadline to make sure people understand that coverage for most people is more affordable than they think.”
Ray emphasized that these younger consumers should at least find out what their options are, and whether they qualify for premium assistance.
“You want to make sure that people remember that there is a mandate, and they may get penalized financially,” she said. “You’re going to pay this huge penalty and not get anything for it. Most of the people who are applying, they’re getting the subsidy.”
She added that her navigators are encountering confusion about whether the Affordable Care Act is still in place.
“The early response is great and promising, but I’m not ready to call it a win,” she said. “We spent four years educating people, and we really made headway. I remember the first year, people didn’t know anything. And now we’re kind of almost starting over.”
On the other hand, she said, the pace of enrollments so far makes sense to her: “People need insurance. Florida every year has led the nation in enrollment. From my vantage point, we have seen the need, and we have witnessed the real desire to have coverage.”

Obamacare: what you need to know
• Deadlines: This year’s enrollment period runs until Dec. 15. Due to a special exception for states affected by hurricanes Harvey, Irma and Maria, Floridians can apply for an extension until Dec. 31. But this option is not recommended, because of uncertainty about how it would affect the start date of insurance coverage.
• How to enroll: Florida has no state exchange, so the federal website, HealthCare.gov, is the portal for enrollment. The site also has answers to most general questions.
• If you need help: Navigators are available in this area through the enrollment period, by appointment. You can find one by going to CoveringFlorida.org. Click on “enroll and renew coverage” and enter your ZIP code.

http://www.heraldtribune.com/news/20171120/so-far-heady-pace-for-obamacare-enrollment

Centers for Medicare & Medicaid Services
CMS News
FOR IMMEDIATE RELEASE
September 28, 2017

Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries
 
CMS Announces Special Enrollment Periods for Americans Impacted by Recent Hurricanes  
Agency provides special open enrollment periods for 2017 Medicare and Exchange coverage
 
As a result of Hurricanes Harvey, Irma, and Maria, the Centers for Medicare & Medicaid Services (CMS) will make available special enrollment periods for all Medicare beneficiaries and certain individuals seeking health plans offered through the Federal Health Insurance Exchange. This important step gives these individuals and families who have been impacted by the hurricanes the opportunity to change their Medicare health and prescription drug plans and gain access to health coverage on the Exchange immediately if eligible for a special enrollment period. 

“The lives of millions of Americans have been disrupted and impacted in some way by recent hurricanes,” said CMS Administrator Seema Verma. “Setting up special enrollment periods gives Medicare beneficiaries and individuals seeking coverage on the Federal Exchange the opportunity to access health coverage during this difficult time and when they need it the most. We remain committed to doing all we can to help support the areas and individuals affected by these historic and catastrophic hurricanes.”  

CMS established the following special enrollment periods to support individuals impacted by hurricanes Harvey, Irma, and Maria:   
Medicare special enrollment period:  This special enrollment period will allow individuals affected by these hurricanes to enroll, dis-enroll or switch Medicare health or prescription drug plans. It is available at the start of the incident period and runs through the end of the calendar year. Individuals may contact 1-800-MEDICARE to request enrollment using this special enrollment opportunity. 
 
Federal Health Insurance Exchange special enrollment period:  CMS created this special enrollment period for certain individuals impacted by these hurricanes who need to enroll in a 2017plan through the Exchange or make changes to their existing 2017 plan. This special enrollment period will apply to individuals who experienced a special enrollment period qualifying event between 60 days prior to the start date of the incident period and December 31, 2017, but were unable to complete the application, plan selection, and enrollment process due to a hurricane-related weather event in 2017. This special enrollment period will allow individuals impacted by the storms to select a new 2017 Exchange plan or make changes to their existing plan at any time through December, 31, 2017. Individuals affected by the storms may contact the Exchange Call Center at 1-800-318-2596 to enroll in a plan.

In addition to the special enrollment periods for the 2017, individuals who reside in or move from areas affected by a hurricane in 2017 will be eligible for a special enrollment period that extends the 2018 Annual Open Enrollment Period through December 31, 2017.  These individuals may contact the Marketplace Call Center at 1-800-318-2596 to request enrollment using this special enrollment period after December 15, 2017.  

These special enrollment opportunities are in addition to the Medicare and Exchange annual Open Enrollment Periods this fall and any other enrollment period for which the individual may be eligible.  CMS will continue to examine the circumstances in the areas affected by hurricanes and will consider taking action that reaches beyond December 31, 2017, if needed.  

Health and Human Services Secretary Tom Price, M.D., declared public health emergencies in Texas, Louisiana, Florida, Georgia, South Carolina, Puerto Rico and the U.S. Virgin Islands – areas all impacted by hurricanes Harvey, Irma and Maria. With the public health emergencies in effect, CMS has temporarily waived or modified certain Medicare, Medicaid, and Children’s Health Insurance Program requirements to provide healthcare providers, facilities, and suppliers the flexibility they need so they can focus on the health and safety of those impacted by the hurricanes. 

For more information on special enrollment periods for Medicare, visit:  
General guidance: https://www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/Disaster-Memo-Medicare-SEP.pdf 

Beneficiary Information: 
https://www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/MedicareBeneficiaryDisasterEnrollmentQsandAs.pdf 
Provider Access: https://www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/Disaster-Provider-Access.pdf 

For more information on special enrollment periods for the Health Insurance Exchange, visit:  https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/2017-Hurricane-Disasters-Guidance.pdf 

The agency continues to update its emergency page (www.cms.gov/emergency) with important information on its efforts to support hurricane response and recovery efforts. 
​
For information regarding HHS hurricane response activities, please visit https://www.hhs.gov/about/news.

Reprinted from Kaiser Health News, September 19, 2017

Health Plan Navigators: Feds Don’t Appreciate Scope Of The Job

The Trump administration says many of the organizations that help people enroll in health plans on the federal insurance marketplaces don’t provide enough bang for the buck, sometimes costing thousands of dollars to sign up each customer. So, it is cutting their funding, some by as much as 90 percent, the government told the groups last week.

But the navigators, as they’re called, say the government doesn’t understand the time involved in the effort or the complexity of the enrollment challenge. Nor do federal officials appreciate the variety of tasks that navigators are asked to handle, they say.

Some customers don’t know how to use a computer. Many don’t understand insurance lingo — what’s a deductible, anyway? — or how to pick the best plan for their needs. Consumers get confused about estimating income and determining household size to qualify for premium tax credits that are available for people with incomes up to 400 percent of the poverty level (about $98,000 for a family of four). What if you’re self-employed and have no idea how many hours of work you’ll get next year? If Grandma is a dependent, does she count as part of the household? What about mixed immigrant families, in which one member is undocumented and ineligible for health insurance? These are the types of vexing questions navigators routinely field, they say.

In addition to helping people sign up, navigators often assist them throughout the year as their income or job status changes and offer community outreach and education services. Marketplace coverage is complicated and so are people’s lives, they argue, and finding the right plan can be tough.
“You can decide on the best policy, but people come from so many different backgrounds and experiences that it’s impossible to have a policy that can be applied uniformly,” says Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. The center has run a technical assistance project for navigators in recent years and produced an online guide that addresses frequently asked questions.

Sandy Dimick is program director for Get Covered Tennessee, part of Family and Children’s Service, the state’s primary navigator grant recipient. She says one of the common issues that navigators there deal with is helping self-employed people estimate their income for the coming year to know if they can qualify for federal subsidies to help pay for their premiums.
“We’re in Nashville, Music City, and lots of musicians are contract workers,” she says. “They think they qualify for subsidized coverage, but by the time they deduct their expenses they may be in the Medicaid gap because we didn’t expand Medicaid here.” She was referring to people whose incomes are below 100 percent of the poverty level, the minimum amount to qualify for marketplace premium tax credits, but earn too much to qualify for Medicaid.

Navigators can also be instrumental in helping clients save money on out-of-pocket costs, she says, because the federal health law offers cost-sharing reduction subsidies for people earning up to 250 percent of the federal poverty level (about $30,000 for an individual in 2018). The subsidies may bring their deductibles down to zero, potentially saving them thousands of dollars in out-of-pocket costs, Dimick says. But many marketplace customers don’t know about the subsidy and don’t realize it’s available only if they buy a silver plan on the marketplace. Unless these people work with a navigator, they may miss out because those who are financially strapped lean toward purchasing the slightly cheaper bronze plan that doesn’t qualify for cost-sharing reductions.

Dimick says her group will lose 15 percent in federal funding on its $1.6 million grant, about the amount they had anticipated.
Helping people understand how the marketplace coverage works is an ongoing challenge, says Elisabeth Benjamin, vice president of health initiatives at the Community Service Society, New York’s largest navigator program. New York runs its own marketplace, and Benjamin says she doesn’t expect a funding cut.
“People are still struggling with the metal levels,” Benjamin says, referring to the bronze, silver, gold and platinum plan types offered on the marketplaces that pay from 60 to 90 percent of covered medical expenses. “They don’t understand that if they have premium tax credits and cost-sharing reductions they shouldn’t just lurch to the lowest-cost bronze plan.”

Erinn Garrison, a navigator in Ohio, sometimes travels to meet people at coffee shops or churches in the rural portions of the state.
“A lot of the people I work with have limited technological capability,” says Garrison, the health initiatives manager at the Ohio Association of Foodbanks in Columbus, which leads a statewide consortium of navigators. “They can’t work on a computer.”
The group’s navigator funding was cut by 71 percent for the coming year, to $485,967.

The Trump administration is taking a hard line, it says, because the navigator groups have not shown that they are providing good value. Last year, the groups received $62.5 million and enrolled 81,426 individuals. The administration says the new funding formula is based on how well each group did toward meeting its 2017 enrollment goal, but many navigator groups say there doesn’t appear to be a correlation.

The federal Centers for Medicare & Medicaid Services, which oversees the federal marketplaces, has a toll-free call center. When asked if it plans to increase staffing or undertake other enrollment activities this year, officials said, “CMS will continue to operate our year-round exchange call center to assist consumers with enrollment and as in past years we will ramp up staffing to support the higher call volume anticipated during open enrollment.”

If navigators are thin on the ground this fall, people can opt to sign up directly with insurers or brokers. The federal government plans to launch a “help on demand” tool on healthcare.gov that will connect consumers directly with agents and brokers, according to a blog post on the Health Affairs website by Timothy Jost, an emeritus professor at Washington and Lee University in Virginia and an expert on the health law. But advocates have expressed concerns that consumers may not get impartial advice from vendors who receive sales commissions for specific insurance products.

In addition to healthcare.gov, some groups have published detailed information aimed at navigators that may help intrepid consumers get answers to enrollment questions. The Georgetown navigator guide is available online, as is information from the Center on Budget and Policy Priorities.

The published CBPP information may be helpful to some individuals, but it’s not a substitute for navigators who help people one-on-one, says Judith Solomon, the center’s vice president for health policy. “It’s not boots on the ground,” she says.



http://health.wusf.usf.edu/post/health-plan-navigators-feds-don-t-appreciate-scope-job-0#stream/0

FOR IMMEDIATE RELEASE
September 14, 2017
 
Media Contact: Jody Young | 561-704-3912 | jody_r_young@att.net
 
 
TAMPA, FL-
 
Jodi Ray, Director of Florida Covering Kids & Families, ( FL-CKF) a community and consumer-focused nonprofit initiative of The Chiles Center, based in the College of Public Health at the University of South Florida , announced today that her organization has received a $4.9M award from the US Health and Human Service Centers for Medicare & Medicaid Services for Affordable Care Act enrollment and outreach programs for the current project year beginning September 13, 2017. Ray acknowledged that her program has received a 15% reduction in its expected award, requiring the organization to adjust the statewide program budget for the coming year's activities. Research shows that consumers are twice as likely to successfully enroll having in-person assistance as those who have attempted online without help. In addition, historically underserved communities rely more on in-person assistance.

Open Enrollment begins on November 1st this year and continues until December 15th for those needing coverage beginning January 1st , 2018.  The 2018 Open Enrollment window has been shortened this year to six-weeks, so consumers need to be made aware of the earlier deadline. 
 

Ray stated “ Our network of Navigators is recognized nationally for the service they provide to the communities across the state of Florida, for their high quality work and for the amazing number of consumers who have been helped in gaining coverage for the last several years. Our Navigators make an impactful difference in the lives of Floridians, and rest assured, we will continue our hard work and make best efforts on informing the public and helping them gain the coverage they deserve and access to the healthcare they need.” 


Ray continued, “Our Navigators not only do outreach and sign-ups, but we help consumers update their accounts, resolve data matching issues, understand their coverage options and how to use the coverage, file appeals and exemptions, inform them on the impact of unpaid premiums, and refer them to health care providers and community resources. Because of the decreased resources for outreach and marketing we will need more help from the communities and from the media to make sure the Open Enrollment window and deadlines are widely shared and publicized.”
 
 
FL-CKF and its consortium partners have been providing Navigator services throughout the state of Florida since the first Open Enrollment period in 2013. The following partners comprise the USF statewide consortium and are collectively known as "Covering Florida":

• 90 Works – Serving Escambia, Santa Rosa, Okaloosa, Walton, Holmes, Jackson, Washington, Calhoun, Gulf, and Bay counties
• Broward Regional Health Planning Council – Serving Broward County
• The Family Healthcare Foundation – Serving Hillsborough, Pinellas, Pasco, and Polk counties
• Florida Keys Area Health Education Center, Inc. – Serving Monroe County
• Suwannee River Area Health Education Center – Serving Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Levy, Marion, Putnam, Sumter, Suwannee and Union counties
• Health Council of Southeast Florida – Serving Palm Beach, Martin, Okeechobee, St. Lucie, and Indian River counties
• ​Health Council of South Florida – Serving Miami-Dade
• Health Planning Council of Northeast Florida – Serving Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia counties
• Health Planning Council of Southwest Florida – Serving Charlotte, Collier, DeSoto, Glades, Hendry, Lee, Sarasota, Highlands, Hardee, and Manatee counties
• Primary Care Access Network – Serving Orange, Osceola, Seminole, and Lake counties
• ​United Way of Brevard – Serving Brevard County
• University of South Florida Mobile Navigators – Serving Madison, Taylor, Jefferson, Gadsden, Wakulla, Liberty, Franklin, and Leon counties

Covering Florida is frequently called upon as an expert in health insurance coverage and health literacy for its ability to reach out to diverse audiences and educate consumers about health insurance coverage and utilization including options under the Affordable Care Act, Children’s Health Insurance Program (CHIP), and Medicaid.  Covering Florida reaches consumers through partner organizations and collaborates with hundreds of organizations, many of which provide direct service to thousands of health care consumers. The organization focuses largely on advocating for and increasing access to care and services via enrollment for individuals with limited English proficiency, individuals with disabilities, populations underserved in the current private health insurance market, and vulnerable populations by employing multi-lingual Navigators, producing brochures in multiple languages, conducting workshops, and providing interviews in various languages. 
 
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For free in-person Navigator assistance state-wide call (877) 813-9115 or visit http://www.coveringflorida.org/   

On January 13, Jodi Ray, director of Florida Covering Kids and Families (FL-CKF) , and members of her team visited the White House for a formal award ceremony honoring 50 of the campuses who took part in the White House Healthy Campus Challenge.
The USF College of Public Health’s FL-CKF program is the largest Navigator program in the nation, with USF receiving a total of $21 million over the past four years to operate the program.
Navigators provide outreach and enrollment services to anyone looking to enroll for health care coverage in the Federal Health Insurance Marketplace.
Ray enrolled USF in the challenge, a national effort to focus more engagement toward students and young people on getting enrolled in health coverage, at the beginning of this year’s open enrollment period.
According to Ray, the White House was hoping that at least 40 campuses would sign-up for the challenge, however a total of 350 other campuses across the nation took part in the effort.

Ray and her team of USF Navigators held various health care enrollment events on the USF campus, known as “Nav-Labs,” where the campus and community were free to speak with Navigators for enrollment assistance on the spot.
She said they also expanded their reach through strategic social media campaigns and messaging.
“The White House told me they designed the initiative [challenge] after our project,” Ray said. “I had no idea they were watching us this closely.”
Ray said she submitted a comprehensive summary of activities her team took part in to reach students, including details of enrollment engagement efforts at Hillsborough Community College, Eastern Florida State College, Miami-Dade College, and others across the state.
“We decided to capture not just what we were doing within the USF community, but how the USF grant was doing this with other campuses around the state,” she said. “We were so broad in terms of our campus challenge outreach. We wanted everyone engaged with this effort, so while we do a lot with the USF campus, we talked about all of the work we’ve been doing.”
The White House officially recognized a select group of the campuses that took part in the challenge with a certificate of honor.
While there, Ray was also asked to speak on a panel, which was live streamed via the web, to discuss millennial enrollment trends, a group that Ray said is typically the slowest to enroll in health care coverage.

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Former first lady, Michelle Obama, also met with the group for a photograph and an informal meet and greet with attendees.
Ray said that while there are talks of repealing the Affordable Care Act, she is proud to know that it has helped millions obtain coverage.
“I hope they [Congress] can get beyond the philosophical and political and work to make it even better,” Ray said. “We know 20 million have enrolled in health insurance that didn’t have it.”

Open enrollment ended on January 31, however, the special enrollment period is now open. For more information about obtaining coverage in 2017, visit www.CoveringFlorida.org or call a USF Navigator at 877-813-9115.
Story by Anna Mayor, USF College of Public Health

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