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Webinar Q&A: Basics of health coverage enrollment for Ryan White HIV/AIDS Program clients

July 22, 2015

ACE TA Center

Questions and answers from the July 22, 2015 ACE TA Center webinar, Basics of Health Coverage Enrollment for Ryan White HIV/AIDS Program Clients.

Questions

  1. Is “coverage completion" the same as wrap-around services or support services?

  2. Is there is a system or website which provides a listing of all Patient Navigators, Certified Application Counselors, etc. who assist to enroll RWHAP clients in each State if it is not done in house?

  3. How do we document the requirement that case managers and HIV programs vigorously pursue insurance options for their clients?

  4. Is it possible for HIV positive veterans to benefit from the ACA if they are already receiving care through Veterans Affairs?

  5. Will the "Make the Most of your Coverage" tool be translated into Spanish?

  6. Do you have any information or materials specifically for young adults (i.e. clients who are dependent on Medicaid, not employed, not familiar with health systems, etc.)

  7. Most of the clients I work with have Medicare and/or Medicaid. Does the website provide information for additional health coverage for patients who have Medicare?

  8. Do you have to be a Navigator to sign a client up for insurance?

  9. We have clients on ADAP that are comfortable with just having ADAP and no other comprehensive insurance. How can we get these clients to enroll into other insurance?

  10. Sometimes clients don’t fully comprehend verbal assistance from a case manager on why it is important to enroll and obtain health insurance.  Does the ACA have any available helpful videos around why it is very important to enroll?

  11. Some clients just barely make enough money to afford health insurance yet they don't meet Medicaid requirements. They essentially can't afford the Affordable Care Act. What can we do for them?

  12. We have run into challenges in confirming with the Marketplace that a plan does not meet the minimum value standards. What is the best way to complete this confirmation so that they can qualify for APTCs?

1. Is “coverage completion" the same as wrap-around services or support services?

Not exactly. Coverage completion is the process of examining the array of services covered by other payment sources (e.g., Marketplace, Medicaid) and coordinating the use of those resources with RWHAP funds to fill in gaps in affordability and address remaining barriers to care. 

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2. Is there is a system or website which provides a listing of all Patient Navigators, Certified Application Counselors, etc. who assist to enroll RWHAP clients in each State if it is not done in house?

There is a listing of who has received Federal funding for Certified Application Counselors, but that listing would not necessarily be HIV specific. A helpful website, HealthCare.Gov/Local Help, allows you to search by your zip code, and it will refer you to organizations that have Certified Application Counselors or a centralized health system for people seeking enrollment into coverage options.

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3. How do we document the requirement that case managers and HIV programs vigorously pursue insurance options for their clients?

We recommend that people listen to a webinar that HRSA hosted in November of 2014 on the issue of vigorous pursuit. The webcast and the slides are available. Each jurisdiction may be managing the requirements differently in terms of how they are asking organizations and HIV providers to document vigorous pursuit. You should also check in with your ADAP Part A or Part B program about what they are looking for to document vigorous pursuit.

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4. Is it possible for HIV positive veterans to benefit from the ACA if they are already receiving care through Veterans Affairs?

Yes, HAB Policy emphasizes and requires a collaborative role for Ryan White HIV/AIDS Program grantees with the Department of Veterans Affairs to ensure veterans living with HIV/AIDS receive optimal care and treatment. Even if HIV positive veterans are already receiving care through the veterans administration medical sites they may also be eligible for RWHAP services. This is stated in HAB policy. Veterans may also be eligible for Marketplace insurance, Medicaid, and Medicare. See the HRSA/HAB Policy on Services to Veterans.

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5. Will the "Make the Most of your Coverage" tool be translated into Spanish?

Yes, it will be translated into Spanish and also into Haitian Creole. These should be posted to www.targethiv.org/ACE in September.

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6. Do you have any information or materials specifically for young adults (i.e. clients who are dependent on Medicaid, not employed, not familiar with health systems, etc.)? 

Not at this time, but we are interested in learning more about what you might need. Please complete the needs assessment and also send us an email at [email protected].

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7. Most of the clients I work with have Medicare and/or Medicaid. Does the website provide information for additional health coverage for patients who have Medicare?

We don't have this information on the ACE TA Center website, but the information is certainly available. The Ryan White HIV/AIDS program can provide coverage completion (see first question of this Q&A) for many people with Medicaid and/or Medicare coverage. However, that coverage completion will be state specific. For details on what is available to your clients we recommend contacting your state's Part B and/or ADAP program to see what is available to your clients and which organizations are funded to deliver services. For information about your state’s Part B and/or ADAP program, go to the website for the National Association of State and Territorial AIDS Directors (NASTAD) at http://www.nastad.org/membership-directory

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8. Do you have to be a Navigator to sign a client up for insurance?

Certified Application Counselors and Navigators have defined roles (see below) and are governed by criteria set forth by the Centers for Medicare & Medicaid Services (CMS). But that doesn’t mean that case managers can't also help enroll people. Case managers can walk clients through the process, however, they might not be able to actually submit the application for the client based on CMS’s criteria. There are also limitations in terms of what the case manager can follow-up on and request information about the client’s application.

Navigator by definition is: an individual or organization that's trained and able to help consumers, small businesses, and their employees as they look for health coverage options through the Marketplace, including completing eligibility and enrollment forms. These individuals and organizations are required to be unbiased. Their services are free to consumers.

Certified Applicant Counselor, also known as a Certified Application Counselor, is an individual (affiliated with a designated organization) who is trained and able to help consumers, small businesses, and their employees as they look for health coverage options through the Marketplace, including helping them complete eligibility and enrollment forms. Their services are free to consumers. 

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9. We have clients on ADAP that are comfortable with just having ADAP and no other comprehensive insurance. How can we get these clients to enroll into other insurance?

NILC has a web page dedicated to questions related to DACA including how much it costs and what documents are needed to apply. Information about DAPA will also be posted here as it becomes available. See NILC.

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10. People who are in the visa waiver program, what are they eligible for?

These are the clients we had in mind when developing our most recent tools. Almost all of the new tools that the ACE TA Center is developing and releasing are designed to help you look at some of the different scenarios that your clients might be experiencing so you learn how to help them. There are two tools: 1) a consumer question and answer tool for pre-enrollment called Get Covered for a Healthy Life; and 2) the Discussion Guide. We will be posting an updated version of the Guide by early September and it will also be translated into Spanish. We've answered specific questions such as “I'm happy with my Ryan White coverage, so why would I want to get health insurance?” These tools will help you talk with your clients to help them consider some good reasons to get coverage, including coverage for unexpected expenses like hospitalizations and catastrophic events, and coverage for other family members.

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11. Some clients just barely make enough money to afford health insurance yet they don't meet Medicaid requirements. They essentially can't afford the Affordable Care Act. What can we do for them?

In states that have expanded Medicaid, if a person is not meeting Medicaid requirements, then they should be able to get a subsidized Affordable Care Act plan, also called a “qualified health plan.”  In many cases, the client should also be able to get help from your state’s Ryan White HIV/AIDS Program. If you are in a state that has not expanded Medicaid, speak with your HIV program manager, or if you are the HIV program manager, call your state ADAP program and ask them what other resources might be available in your area to help your clients afford the subsidized care. If you are in a major metropolitan area - an Eligible Metropolitan Area (EMA) or Transitional Grant Area (TGA) - you can also talk with your local health department or Part A program.

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12. We have run into challenges in confirming with the Marketplace that a plan does not meet the minimum value standards. What is the best way to complete this confirmation so that they can qualify for APTCs?

The minimal value standard refers to when a health plan is designed to pay at least 60% of the total cost of medical services for a standard population, as well as provide substantial coverage of inpatient hospital services. Individuals with employer-sponsored coverage that meet this standard aren’t eligible for a premium tax credit. 

Every health plan must explicitly state in their benefits summary whether or not they meet the minimum value standard. Therefore, the information should be easily confirmed by either contacting the employer or the health plan.

If your client does not have an employer-sponsored plan that meets the standard, they must select a Silver level Marketplace plan in order to potentially qualify for a premium tax credit.  

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