Commonwealth Health Insurance Connector Authority 100 City ...

Massachusetts Navigator Program

Notice of Grant Opportunity

Commonwealth Health Insurance Connector Authority

100 City Hall Plaza

Boston, Massachusetts 02108


Navigator Program

May 18, 2015



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TABLE OF CONTENTS

SECTION 1: GENERAL INFORMATION ............................................................................................................ 3

SECTION 2: PROGRAM DESCRIPTION.................................................................................................. ............ 9

SECTION 3: APPLICATION REQUIREMENTS.................................................................................................. 18

SECTION 4: GENERAL APPROACH OF GRANT PERIOD………………....................................................... 21

SECTION 5: APPLICATION SELECTION AND EVALUATION PROCESS……............................................ 22

SECTION 6: TIMELINE AND GENERAL INFORMATION...................…………............................................ 23

APPENDIX A: GLOSSARY............................................................................ ....................................................... 26

APPENDIX B: OUTREACH AND ENROLLMENT WORKPLAN TEMPLATE................................................ 29

APPENDIX C: BUDGET WORKSHEETS ……………………………………………………………..……... 32

APPENDIX D: APPLICATION CHECKLIST ……………………………………………………………..…… 36

http://www.mahealthconnector.org/



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1.0 General Information

1.1 Introduction

The Navigator program is an outreach, education and enrollment assistance program required by

the federal Patient Protection and Affordable Care Act (“ACA”) for every Health Insurance

Marketplace. The Commonwealth Health Insurance Connector Authority (the “Health

Connector”), the designated Marketplace for Massachusetts, is issuing this Notice of Grant

Opportunity to obtain applications from eligible organizations (see Section 2.2.1.) to become

Navigators for Massachusetts residents.

In Massachusetts, more than 96% of the population has health insurance, but more needs to be

done to reach the remaining uninsured. In 2014-2015, the primary objective of the Navigator

program was to assist members in transitioning from their existing coverage to new ACA-

compliant coverage. This required all affected populations to re-apply for benefits in a new

system governed by new rules. Overall, the Navigator program and the Commonwealth’s

member transition efforts more broadly were a tremendous success. Nevertheless, there are still

people in Massachusetts who have yet to complete the transition, and there are still more people

who remain uninsured.

As such, for the 2015-2016 Navigator program, the primary objectives for Navigators are (1)

outreach the remaining uninsured and those that did not successfully transition last year and

enroll all of them into new ACA coverage; (2) assist those in coverage through the Health

Connector with updating their applications and renewing their coverage for 2016; and (3)

generate awareness of the Health Connector and access to coverage through the Commonwealth

in the hardest-to-reach communities. Special attention should be paid to those communities,

cultures, and languages that disproportionately represent the populations that did not transition to

ACA coverage or are chronically uninsured.

Specifically, for 2015-2016, Navigators must:

1) Target the Uninsured

Outreach and assist those consumers who are known to the Navigator organizations,

who have not started an application, or were determined but did not yet enroll

Conduct targeted outreach to those consumers within their communities who remain

uninsured due to cultural, linguistic or other barriers

2) Mitigate Gaps in Coverage

Assist those currently enrolled in a Health Connector Qualified Health Plan (“QHP”)

with their renewal leading up to and during Open Enrollment (“OE”; this year from

November 1, 2015 to January 31, 2016)




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Support shopping for members who would like to make changes to plans or who are

eligible for new programs in 2016

Assist those consumers who experience any life changes with reporting that

information to the Commonwealth

3) Increase Awareness

Using culturally and linguistically appropriate methods, continue to generate

awareness about the available health insurance programs and options through

MAhealthconnector.org

1.1.1. The Health Connector

The Health Connector was established by the landmark Massachusetts health reform law of 2006

(Chapter 58 of the Acts of 2006, or “Chapter 58”). The mission of the Health Connector is to

connect Massachusetts residents and small businesses with affordable health insurance.

The Health Connector is an independent public authority governed by an eleven-member board,

comprising government officials and members of the public. The Health Connector board

represents a range of interests and expertise, including organized labor, employee health benefits,

consumers, small business, health insurance brokers, actuarial science, and health economics.

The Health Connector currently serves as a Marketplace, facilitating enrollment in health

insurance plans for Massachusetts individuals and small businesses. The Health Connector offers

individuals subsidized and unsubsidized health insurance options, and facilitates federal tax

credits and Wellness Track rebates to small businesses.

The Health Connector’s subsidized program, known as ConnectorCare, offers subsidized health

insurance to eligible adults with incomes up to 300% of the Federal Poverty Level (“FPL”) who

are not eligible for MassHealth and generally do not have access to Employer-Sponsored

Insurance (“ESI”). ConnectorCare enrollees include Aliens with Special Status who are lawfully-

present immigrants not eligible for federally-funded coverage through MassHealth. In addition

to ConnectorCare, eligible individuals with incomes up to 400% of the FPL meeting similar

eligibility requirements as outlined above may be eligible for Advance Premium Tax Credits

(APTC) to help them pay for a portion of the costs of an otherwise unsubsidized commercial

health plan.

The Health Connector’s unsubsidized program serves as a Marketplace for eligible individuals

and small employers to shop for unsubsidized commercial health plans. Initially launched on

July 1, 2007, for individuals, the program expanded in February 2009 to offer coverage for small

employers with up to 50 benefits-eligible employees. The Health Connector’s unsubsidized

program offers a broad range of plans for purchase by individuals, families and small businesses,

subject to geographic availability and Open Enrollment Period rules.




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In addition to administering these subsidized and unsubsidized programs, the Health Connector

is charged under Chapter 58 with several policy and regulatory functions. These include, but are

not limited to, the implementation and administration of the Commonwealth’s adult health care

coverage mandate, development of regulations defining what constitutes Minimum Creditable

Coverage, and adoption of an Annual Affordability Schedule defining who is subject to the

Commonwealth’s adult health coverage mandate. The Health Connector is also responsible for

policy development associated with the administration of Certificates of Exemption and appeals

of the Commonwealth’s individual mandate for those tax filers who have chosen to appeal

potential tax liabilities for not having coverage.

1.1.2. MassHealth

MassHealth is the Massachusetts Medicaid program administered by the Executive Office of

Health and Human Services (“EOHHS”). Medicaid is a means-tested entitlement program,

jointly funded by state and federal governments, that pays for health care for eligible

Massachusetts residents. MassHealth provides or supplements health care coverage for nearly

one of every four residents of Massachusetts. Its members include low-income children and

families, parents and caretakers, pregnant women, adults, women with breast or cervical cancer,

people with HIV/AIDS, seniors, and people with disabilities. Eligibility for coverage is different

for each of these categories and determined based upon a variety of factors, including income

relative to the FPL, age, immigrant status and, for some categories of eligibility, assets.

1.1.3. Moving Beyond The Health Connector’s ACA Transition Planning

The Health Connector has been designated, in accordance with Chapter 96, §7 of the Acts of

2012, to serve as the ACA-compliant Marketplace for the Commonwealth. The Health

Connector has implemented significant programmatic and operational changes to align with

ACA-required rules, which include, but are not limited to, eligibility determinations for

Marketplace participation and insurance affordability programs, certification of Qualified Health

Plans (“QHPs”), and enrollment of Marketplace populations in QHPs.

In addition to implementing market and product reforms, the Health Connector continues to

augment its operational and technological infrastructure to better serve individuals and small

employers purchasing coverage through the Marketplace.

A key required function of an ACA-compliant Marketplace is real-time eligibility determination

that facilitates enrollment in the Marketplace as well as other subsidized coverage options.

Specifically, the Marketplace must have the capability to assess individuals’ Modified Adjusted

Gross Income (“MAGI”), as required by the ACA, which will be used to determine eligibility for

APTCs and Cost-Sharing Reductions (“CSRs”) afforded by federal law. In Massachusetts, the

Health Connector is able to support these determinations as well as determinations of eligibility

for MassHealth, and as such, serves as the single front-door from an online perspective for

application, eligibility determination and enrollment into MassHealth and Health Connector

programs.




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Individuals with income up to 400% FPL may be eligible to obtain federal APTCs when they

purchase QHPs through the Marketplace. Eligible individuals with income up to 250% FPL are

also able to access federal CSRs. To further enhance coverage affordability, the Health

Connector provides additional subsidies in the form of a state wrap, (also known as

ConnectorCare plans) which includes both a premium component and a cost-sharing component,

to eligible individuals with income up to 300% FPL through the Marketplace.

The 2015-2016 Open Enrollment period will run from November 1, 2015 through January 31,

2016. This year, users can expect new system functionality to better support consumers in

application and shopping and new communications and notices related to eligibility

redetermination and plan renewals. In late summer/early fall, Health Connector members will

begin to receive communications regarding their 2016 coverage and Open Enrollment

information. The Open Enrollment period will be a critical time for those consumers who are

already enrolled in coverage to take a closer look at their health insurance options to ensure that

they are enrolled in the plan that best meets their needs. Open Enrollment is also an opportunity

for those consumers who were unable to enroll this past year or for consumers looking for health

or dental coverage anew. More details about this process will be shared during the summer

months through the Health Connector’s Board of Directors meetings and in other venues.

1.1.4. The Role of the Massachusetts Navigator

The approved grantee(s) will assist individuals, families and small businesses across the

Commonwealth in a fair and impartial manner with finding or maintaining ACA-compliant

health and dental insurance programs offered through the Health Connector and will provide

ACA-related education and outreach on topics that will facilitate such enrollment in a culturally

and linguistically appropriate manner.

1.2 Defined Terms

Capitalized terms not defined herein shall have the meanings assigned in the Glossary attached

as Appendix A hereto unless the context clearly indicates otherwise.

1.3 Issuing Officer

The Health Connector is issuing this Notice of Grant Opportunity. The Issuing Officer for this

Notice of Grant Opportunity is:

Paul Landesman


100 City Hall Plaza

Boston, MA 02108

617-933-3148

Email: [email protected]


mailto:[email protected]



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Interested parties may submit questions only in accordance with Section 6.3 below. No other

contact with a Health Connector employee and/or Board member with respect to this Notice of

Grant Opportunity is permitted from the date of release of this Notice of Grant Opportunity until

a final agreement is executed, unless otherwise directed by the Issuing Officer.

1.4 Terms of this Notice of Grant Opportunity

The required services are set forth in Section 2.0 below. Any organization that submits an

Application (“Grant Applicant”) must be ready to provide services in accordance with those

requirements.

This Notice of Grant Opportunity is not an offer or promise to award a grant to a particular

applicant or applicants. The Health Connector may select none, one, or more than one grantee.

Grants may be awarded in full, awarded in part, or not awarded at all. The Health Connector will

decide how many grants to award, and the amount of each grant based on a number of factors,

including the availability of grant funding, the number, scope and quality of the grant

applications, and the need to use grant funding to serve diverse populations across the

Commonwealth.

Successful Grant Applicants will be awarded grant funding subject to terms and conditions,

including the requirements set forth in Section 2 of this Notice of Grant Opportunity, which the

grantee must agree to. Grantees will be required to complete the training necessary and pass a

certification exam to become certified navigators in order to receive grant funds. Grantees will

be required to obtain criminal offender record information (CORI) checks on all staff/volunteers

in accordance with the Health Connector’s Navigator Criminal Offender Record Information

Policy for Navigators Designated by the Massachusetts Health Connector.

The Health Connector reserves the right to modify the terms of this Notice of Grant Opportunity

at any time prior to the issuance of final awards. Any such modifications will be posted on

COMMBUYS and interested parties are encouraged to check COMMBUYS regularly for

information regarding this Grant Opportunity.

1.5 Term of Grants

The grants awarded under this Notice of Grant Opportunity shall be for the period commencing

on August 1, 2015, and ending on July 31, 2016, with the grant monies being disbursed on a

monthly basis. The first payment will be released in mid-September 2015 after successful

completion of training including achieving a passing score on the certification exam. Subsequent

installments will be released upon successfully submitting the required monthly report which is

due to the Health Connector by the second Friday of every month. Each report must be

accompanied by a monthly budget. More detail on this can be found in Sections 2.5 and 2.6. The

Health Connector reserves the right to withhold funds from Navigator organizations that do not

meet expectations as defined in the Outreach and Enrollment Workplan.




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1.6 Funding

The award of any grants for the Navigator program is subject to sufficient state appropriation.

2.0 Program Description

2.1 General Scope

The Massachusetts Navigator program shall fulfill federally-specified standards and comply with

all federally-mandated regulations under the ACA, including the minimum qualifications as

outlined in 45 C.F.R. §155.210 as well as state law and other requirements outlined below. The

Navigator program is designed to support the Health Connector’s mission of facilitating access

to affordable, quality coverage options using culturally and linguistically appropriate methods for

eligible individuals and small businesses in Massachusetts.

The Navigator program is designed to maintain and improve upon the current near-universal

health insurance coverage in Massachusetts by actively targeting identified geographic and

demographic communities of need through outreach activities. The Health Connector envisions

that Navigators will develop their own multifaceted campaigns that include a mix of

complementary activities that will be used to meet the objectives of the program. Navigators

should develop strategies that focus on assisting those individuals, families and small businesses

that may need assistance with their redeterminations plan renewals or who are applying for

insurance for the first time.

The Navigator program is a component of the Health Connector’s broader outreach and

education efforts to maintain and expand coverage and minimize unnecessary gaps. The

objectives of the Navigator Program for 2015-2016, as described in Section 1, focus on three

areas: Targeting the Uninsured, Mitigating Gaps in Coverage, and Increasing Awareness.

Navigators must also provide general outreach and education to individuals, families and small

businesses that are eligible for health insurance offered through the Health Connector. They

should support the Health Connector and MassHealth by providing information related to health

insurance options and facilitating application and enrollment for individuals, families and small

businesses.

When responding to the grant application, applicants should review the findings from two (2)

sources as the information and data analysis contained in these reports can inform applicants as

they prepare their outreach and enrollment workplans for the Navigator grant application:

1. The recent Blue Cross Blue Shield of Massachusetts Foundation resource, The

Geography of Uninsurance in Massachusetts, 2009-2013

(http://bluecrossfoundation.org/publication/geography-uninsurance-massachusetts-2009-

2013), This brief and set of detailed tables, prepared by the Urban Institute, provide


http://bluecrossfoundation.org/publication/geography-uninsurance-massachusetts-2009-2013

http://bluecrossfoundation.org/publication/geography-uninsurance-massachusetts-2009-2013



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estimates of the number and rate of uninsurance in Massachusetts by various geographic

units ranging from congressional districts to counties to neighborhoods. The resource is

based on the 2009 to 2013 five-year file of the American Community Survey (ACS),

which included a sample of 140,001 people in Massachusetts.

2. The Findings From The 2014 Massachusetts Health Insurance Survey from the

Massachusetts Center for Health Information and Analysis (CHIA,

http://chiamass.gov/assets/docs/r/pubs/15/MHIS-Report.pdf) This survey provides

information on health insurance coverage and health care access and use by

Massachusetts residents, and provides information on the remaining uninsured in

Massachusetts. Furthermore, it is a tool that is used to track and monitor the experiences

of Massachusetts residents in obtaining timely and affordable health care.

The Health Connector is looking for Navigators that are uniquely situated to target these

populations as they disproportionately comprise the remaining uninsured and former members of

the Health Connector that did not complete re-enrollment activities last year. In their response,

applicants should outline how they are uniquely capable of reaching some or all of the

populations outlined below and in the referenced reports, along with their unique and innovative

strategies for reaching these hard-to-reach populations.


http://chiamass.gov/assets/docs/r/pubs/15/MHIS-Report.pdf



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Areas of High Need for Outreach in Massachusetts

City Languages of Interest

Dorchester English

Vietnamese

Spanish

Cape Verdean Creole

Worcester English

Spanish

Vietnamese

Albanian

Lawrence Spanish

English

Brockton English

Cape Verdean Creole

Haitian Creole

Lowell English

Cambodian

Spanish

Lynn Spanish

English

Springfield English

Spanish

New Bedford English

Portuguese

Spanish

Fall River English

Portuguese

Quincy Chinese

English

Vietnamese




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2.2 Minimum Qualifications

In order to be considered for a Navigator grant, an applicant must meet the minimum

qualifications set forth in this Section 2.2.

2.2.1. Eligible Organizations

The ACA defines eligible organizations in 45 C.F.R. § 155.210(c) as any of the following:

Zip Code Languages of Interest

01841 - Lawrence • Spanish

• English

02301 – Brockton • English

• Cape Verdean

• Haitian Creole

02128 – East Boston • English

• Spanish

• Arabic

02148 – Malden • English

• Chinese

• Haitian Creole

02124 – Dorchester • English

• Vietnamese

• Spanish

02150 – Chelsea • Spanish

• English

01902 - Lynn • Spanish

• English

02151 – Revere • English

• Spanish

02124 – Everett • English

• Spanish

• Haitian Creole

• Portuguese

02125 - Dorchester • English

• Vietnamese

• Spanish




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A community or consumer-focused non-profit;

Trade, industry, or professional association;

Commercial fishing industry, ranching or farming organization;

Chamber of commerce;

Union;

Resource partners of the Small Business Administration;

Licensed agents and brokers; and

Other public or private entities or individuals that meet Navigator requirements,

including, but not limited to, Indian tribes, tribal organizations, urban Indian

organizations and state or local human service agencies.

2.2.2. Ineligible Organizations

As prohibited by the ACA in 45 C.F.R. §155.210(d), a Massachusetts Navigator must not:

Be a health insurance issuer or stop loss insurance issuer;

Be a subsidiary of a health insurance or stop loss insurance issuer;

Be an association that includes members of, or lobbies on behalf of, the insurance or stop

loss insurance industry; or

Receive any consideration directly or indirectly from any health insurance or stop loss

insurance issuer in connection with the enrollment of any individuals or employees in a

QHP or a non-QHP.

2.3 Navigator Program

The purpose of this Notice of Grant Opportunity is to solicit applications from qualified and

interested organizations to participate in the Massachusetts Navigator program.

This year, the Health Connector will be seeking applicants to target specific geographic and

demographic communities that data suggests additional outreach and enrollment assistance is

needed. In addition, we are seeking Navigators that will also be able to support existing

populations that may need to update their application or shop for a new plan during the

upcoming Open Enrollment. The Health Connector’s organizational focus for the upcoming

grant year centers around the 2016 Open Enrollment period. This year the Health Connector will

be focused on redetermining eligibility of its existing members, and renewing those members




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into their 2015 plans (or similar plans, as needed), which will be a new experience for both

subsidized and unsubsidized QHP members who enrolled through hCentive in the last year. As

such, for this year, we are re-focusing the Navigator program’s overall activities to provide more

targeted, culturally appropriate outreach and education activities to attract the remaining

uninsured while still maintaining staff to provide application and enrollment assistance for both

new and renewing members. To that end, for this year’s grant period, Navigators, among other

requirements, must:

Develop their own multifaceted outreach campaign, which includes a mix of

complementary activities that will be used to meet the objectives of the program

(attracting the remaining uninsured, assisting renewing members, and generating broad

awareness of health care reform and the Health Connector)

Create, organize and run their own community events

Be available to support ad hoc outreach and/or enrollment events that may be conducted

by the Health Connector and MassHealth during weekdays, evenings and weekends

Hold at least one larger enrollment event with other community partners such as Certified

Application Counselors (CACs) from local hospitals and health centers during the Open

Enrollment period at which Health Connector and MassHealth staff may offer needed

back-office support (but not direct application assistance)

2.4 Navigator Program Requirements

As a Navigator grant recipient and in accordance with 45 C.F.R. § 155.210(e), an organization

will be required during the grant year to:

Maintain expertise in eligibility, enrollment, redetermination and renewals, and program

specifications for Health Connector programs as well as MassHealth

Provide information and services in a fair, accurate and impartial manner, acknowledging

other health programs as appropriate or connecting consumers with other assisters or

brokers, as needed

Generate knowledge of and interest in the Health Connector programs, particularly

through public education activities

Facilitate the selection of QHPs

Provide referrals to any applicable federal or Massachusetts agency for any enrollee with

a grievance, complaint, or question regarding their health plan, coverage, or a

determination under such plan or coverage




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Provide information in a manner that is culturally and linguistically appropriate to the

needs of the population being served by the Health Connector, including individuals with

limited English proficiency

Ensure accessibility and usability of Navigator tools and functions for individuals with

disabilities in accordance with the Americans with Disabilities Act and Rehabilitation

Act

Ensure that applicants are informed of the functions and responsibilities of Navigators

Require applicants to provide authorization prior to the Navigator obtaining access to an

applicant’s personally identifiable information in a form prescribed by the Health

Connector and maintain records of these forms

Maintain a physical presence in the Commonwealth of Massachusetts so that face-to-face

assistance can be provided to applicants and enrollees

2.5 Specific Deliverables

During the grant period, Navigator Organization(s) will be required to:

Achieve the projected outreach activity goal per phase as expressed in the Outreach and

Enrollment Work Plan in Appendix B

Achieve the projected consumer outreach goal per phase as expressed in the Outreach

and Enrollment Work Plan in Appendix B

Achieve the completed application goal per phase as expressed in the Outreach and

Enrollment Work Plan in Appendix B

Achieve the enrollment goal per phase as expressed in the Outreach and Enrollment

Work Plan in Appendix B

Achieve the projected consumer redetermination assistance goal per phase as expressed

in the Outreach and Enrollment Work Plan in Appendix B

Achieve the projected consumer renewals assistance goal as expressed in the Outreach

and Enrollment Work Plan in Appendix B

2.6 Performance Management

Navigator organizations will be required to report on performance metrics on a regular basis, to

be defined in the terms of the agreement. Performance metrics have been established and are




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designed to measure the progress towards achievement of Specific Deliverables as outlined in

Section 2.5.

The Health Connector will establish an electronic performance management report to collect

regular updates on performance metrics. Navigator organizations may suggest additional metrics

that they will collect and report. The Health Connector reserves the right to modify reporting

metrics and frequency during the course of the grant award. Navigators will be given sufficient

notice prior to the collection of new measures.

The following measures are examples of what may be collected and submitted to the Health

Connector on a regular basis (e.g. monthly or even daily during open enrollment):

Age/demographic/income data of applicants assisted, and status of applicants at the time

of application (uninsured vs. active or recent insurance coverage)

Number and type of interactions (e.g., community events, one-on-one assistance, etc.)

Total hours dedicated to Navigator activities

Changes to monthly budget report

As part of the regular evaluation of each Navigator organization, grantees will be required to

participate in scheduled on-site visits.

2.7 Additional Obligations

Navigator organizations must meet all certification or other standards prescribed by the ACA, the

Commonwealth of Massachusetts or the Health Connector, if applicable. These certification

standards could include, but are not limited to the following:

Complete training and pass the certification exam to be a Certified Navigator as well as

any other additional training during the grant period

Obtain criminal offender record information (CORI) checks of any and all staff or

volunteers in accordance with the Health Connector’s Navigator Criminal Offender

Record Information Policy for Navigators Designated by the Massachusetts Health

Connector

Participate in follow-up and on-going evaluation on a periodic basis as described in

Section 2.6

Adhere to policies and procedures of the Health Connector during the grant period (e.g.

policies and procedures related to eligibility, enrollment, payment policies, etc.)




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Comply with privacy and security standards as required by applicable federal regulations

(See 45 C.F.R. §155.260), state laws, and any security requirements and administrative

safeguards that are established for access to any related state systems that Grantees may

gain access to during the grant period; comply with conflict of interest standards as

required by applicable federal regulations (See 45 C.F.R. §155.210) and set forth in any

subsequent agreement entered into between the selected grantee(s) and the Health

Connector

Participate in regular feedback sessions with Health Connector Navigator program staff

Attend four quarterly (one per quarter) Massachusetts Health Care Training Forum

(MTF) meetings during the grant period to receive policy and operational updates

2.8 Training

As noted above, entities seeking certification as Navigators must complete initial certification

training and pass the certification exam to become a Certified Navigator and must complete

additional training throughout the Grant Period, as needed. The goal of the training will be to

educate Navigators on the Health Connector’s eligibility application, shopping and enrollment

processes. In addition, Navigators must be thoroughly trained on other consumer-assistance

channels, such as those identified in Section 2.1, to know when and how to refer consumers to

other resources available in the market.

The Health Connector will develop the training modules and certification exam to be used to

certify Navigators in collaboration with other partners and based upon feedback received from

various stakeholders, including, but not limited to, other state agencies, the Health Connector

Board of Directors, Massachusetts health insurance carriers, providers and consumer advocacy

groups. Training topics will include, but may not be limited to:

• Navigator Policies and Procedures

• Legal Requirements

• Conflict of Interest

• Privacy and Security Standards

• Ethics

• Program administration, including reporting,

evaluations, and reviews

• Consumers

• Individuals and Families

• Employers, Employees

• Shopping Experience

• Web capabilities for Eligibility, Application

and Enrollment

• Decision-support tools

• Access to Medicaid and/or QHPs, including

mixed households

• Eligibility and Enrollment

• Eligibility criteria

• MAGI calculations

• Open enrollment period and restrictions

• Renewals and Redeterminations

• Member Costs

• Premium rates

• Advanced Premium Tax Credits (inc. Tax

reconciliation)

• Cost-sharing reductions

• Additional state subsidies

• Small Business federal tax credits

• Wellness Track rebate

• Individual Mandate

• MCC Requirements

• Individual and Small Business penalties

• Additional Consumer Support

• Brokers

• Customer Service




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• Products

• Qualified Health Plans (metallic tiers)

• Dental plans (inc. pediatric)

• Catastrophic plans

• Options for Small Business (SHOP)

Training courses will use a blended learning approach, inclusive of online modules, in-person

sessions and printed materials, and will be followed by a final certification exam. Initial training

must be completed in advance of the Open Enrollment Period, commencing November 1, 2015,

in order to obtain final certification as a Navigator.

3.0 Application Requirements

3.1 Applicant Letter of Intent (Limited to one page)

Each applicant must submit a letter of intent by Friday, May 29, 2015, stating the entity’s intent

to submit an application. The Letter of Intent can be submitted electronically in PDF format to

[email protected]. The purpose of the Letter of Intent is to estimate the number of

applications. The Letter of Intent is non-binding on the submitter.

3.2 Application Submission Process and Deadline

Two original, unbound applications (signed in ink) and eight (8) copies must reach the Health

Connector offices no later than 5:00 p.m. EDT on Friday, June 5, 2015 at the address below:


100 City Hall Plaza, 6th floor

Boston, Massachusetts 02108

Attn: Paul Landesman

An electronic submission is also requested by the above date and time. Electronic submissions in

a commonly acceptable format may be delivered to [email protected].

Applications should be prepared in as concise a manner as possible, delineating the capabilities

of the Grant Applicant to satisfy the requirements of this Notice of Grant Opportunity.

Applications should include each of the components outlined in the Application Check-List

(Appendix D). Total length of the application, excluding sample deliverables, resumes and

audited financial statements, must not exceed 30 pages.

3.3 Transmittal Letter (Limited to one page)

A signed transmittal letter, no longer than one page, shall accompany each application. The

transmittal letter shall be executed by an individual authorized to bind the Grant Applicant

contractually. The transmittal letter shall, at a minimum:






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Confirm the Grant Applicant’s willingness to be bound by, and ability to perform fully in

accordance with, the requirements set forth in Section 2.0 of this Notice of Grant

Opportunity

State that the Grant Applicant has not colluded with anyone in the preparation of the

application

Outline your organization’s eligibility to be a Navigator as specified in Section 2.2

Include the federal tax identification number and legal name of the Grant Applicant. The

application should provide the name, title, and contact information for the individual

responsible for the application, who will be available to respond to Health Connector

requests for additional information, if necessary

Disclose any potential or potentially perceived conflicts of interest as described in

Section 2.2.2

3.4 Project Abstract (limited to one page)

A project abstract shall accompany each application and include the following information:

Describe the population and geographic region that the applicant currently serves

Include a brief description of the target market(s) or population(s) that will be served,

including the extensiveness of geographic reach and its relation to the geographic areas

outlined in Section 2.1

Provide a brief description of the proposed approach to meet the goals of the 2015-2016

Navigator Program

The outreach, application and enrollment goals for the entire grant period

A brief description of the proposed approach to meet the projected outreach and

application, enrollment, redetermination and renewal goals

Indicate amount of funding requested

3.5 Qualifications and Program Proposal

In a brief narrative, Applicants must also address the following:




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Knowledge of the implementation of the Affordable Care Act in Massachusetts and the

role of the Health Connector

How the applicant researched, investigated and analyzed the remaining uninsured and

what conclusions the applicant has drawn about how the applicant is uniquely qualified to

outreach and assist those consumers

Experience in managing a program of this scope, both programmatically and financially

Experience in assisting individuals and families with applying for and/or enrolling in

health coverage

Competencies with health insurance, usability, accessibility and ADA compliance

Experience working with state or federal government agencies

Ability to identify and eliminate barriers in order to achieve the projected outreach and

application and enrollment goals

Existing relationships or strategies to create such relationships with employers,

employees, consumers (including uninsured and underinsured consumers), or self-

employed individuals likely to be eligible for health and dental coverage through the

Health Connector

How the applicant arrived at the projected outreach and application and enrollment goals

identified in the Project Abstract

Staffing capacity (and the hiring plan for additional staff, if necessary) including cultural

and linguistic capabilities required to perform the activities necessary to meet the

projected outreach and application and enrollment goals and the needs of targeted

communities

Plans and strategies for local and regional outreach and enrollment events

Strategy for actively assisting the Health Connector and MassHealth with outreach and

enrollment events in targeted areas of need

How the applicant will structure the Navigators’ time to focus on group enrollment

activities and outreach in hard to reach communities

Unique outreach and enrollment approach using grant monies in order to execute

successful multifaceted campaigns. This should include a mix of complementary




20

activities such as: local and ethnic media, mailings, brochures, flyers, space rental, and

door knocking or other activities that are appropriate for the community being

outreached.

3.6 Outreach and Enrollment Work Plan

Each applicant must submit a detailed Outreach and Enrollment Work Plan that addresses how

they will achieve the projected outreach, application, enrollment, redetermination and renewal

goals – using their own multifaceted campaigns that include a mix of complementary activities.

See Sections2.3 for details.

When developing their workplan, applicants should reference Section 2.1 and also consider the

following:

The three grant phases: Pre-Open Enrollment, Open Enrollment, Post-Open Enrollment

and the efforts and communications that the Health Connector and MassHealth will be

implementing during that time

Other Assister organizations near them that they may be able to partner with for activities

and events during the three grant phases

Continue to work optimally when assisting the hard to reach communities

An Outreach and Enrollment Work Plan Template with additional instructions is located in

Appendix B.

3.7 Budget Narrative and Proposal

Each applicant must provide a budget narrative that describes how each line item will support the

execution of proposed objectives and achievement of projected outreach, application and

enrollment, redetermination and renewal goals. Each applicant should prepare a proposed

budget that includes only those costs that are integral to carrying out Navigator program

activities which will facilitate the achievement of the outreach and application/enrollment goals.

A Budget Worksheet with additional instructions is located in Appendix C. Note that Full-Time

Equivalent (“FTE”) hours devoted to Navigator activities have a set grant award rate, as further

detailed in Appendix C.

3.8 Approach to Program Oversight

As part of the grant application, applicants are required to include the following information:

Strategy for monitoring its progress toward achieving the outreach and

application/enrollment goals and meeting the needs of the targeted market(s) and

population(s)

Approach to addressing challenges or barriers once identified




21

Policies and procedures for ensuring the privacy and security of any personally

identifiable information and other secure data

3.9 References

Applicants should provide three (3) current references. The references should be previous

clients/members for whom the Grant Applicant served for engagements which have provided the

experience requested under Section 3.6. Please provide telephone numbers and the names of

contact persons.

4.0 General Approach of Grant Period

The selected grantee(s) will be responsible for meeting the requirements and producing the

specific deliverables outlined in Section 3.6 during the term of the grant period. The grantee(s) is

expected to work closely with the Health Connector throughout the grant period, with frequent

communication on progress.

The approved grantee(s) would take part in at least the following activities by the specified

timeframes:

Certified Navigator training and certification exam

(individuals from selected grantee organizations)

August/September 2015

Navigator certification Upon successful completion of

training and certification exam

Conduct Navigator outreach, education and enrollment

activities to individuals, families and small businesses to

facilitate eligibility and enrollment

August 1, 2015 – July 31, 2016

Submit regular reports on quantitative and qualitative data

and monthly Navigator staff numbers

Monthly

End of Grant Period Report (final report due 30 days after

the end date of the Grant Period)

September 1, 2016

The Health Connector must review and approve any change in scope, deliverables or due dates.

5.0 Application Selection and Evaluation Process

Once a Grant Applicant has been deemed compliant with the application submission instructions

stated in this Notice of Grant Opportunity and to have met the minimum qualifications set forth

in Section 2.2 above, the Grant Applicant will be evaluated based on its written application,

reference checks, and any other information available to or known by the Health Connector.

The Health Connector will convene a Grant Awarding Committee (“GAC”) comprised of staff

members from the Health Connector and MassHealth to evaluate submissions.




22

5.1 Navigator Grant Application Selection Criteria

The Health Connector will review applications for their reasonableness and value. Additionally,

the Health Connector will determine the size of a grant award based on the availability of funds,

the need to serve diverse populations across the state or in targeted areas of need, the number and

quality of grant applications, and the cost-effectiveness of a particular application. The Health

Connector is not required to select an applicant, nor required to select the lowest priced

applicant. In addition, the Health Connector may, in its discretion, decide not to issue any

Navigator grants.

The Health Connector will thoroughly review responses from applicants giving significant

consideration to the following:

Applicant’s alignment with Navigator program requirements

Applicant’s strategy to maximize outreach and enrollments and achieve projected

outreach, application, enrollment, and redetermination and renewal outcomes

Strength of the applicant’s proposed staffing plan that demonstrates the applicant’s ability

to meet the projected outreach, application and enrollment outcomes

Degree of innovation in outreach and enrollment work plan

Distinction from the applicant’s other funded activities

The GAC will recommend awards to Grant Applicant(s) whose applications provide the best

value to the Commonwealth.

6.0 Timeline and General Information

6.1 Relevant Deadlines

It is the Health Connector’s intent to select grantee(s) on or before Friday, July 3, 2015, with the

requirement that the accepted Grantee(s) be prepared to execute an agreement by August 1,

2015. The Health Connector reserves the right to modify such dates in its discretion.

The following estimated timetable, although subject to change, indicates the Health Connector’s

intentions regarding the Notice of Grant Opportunity:

Deadline Date

Notice of Grant Opportunity Issued Monday, May 18, 2015

Grant Applicant Questions Due Wednesday, May 20, 2015




23

CCA Responses to Applicant Questions Due Friday, May 22, 2015

Applicant Letter of Intent Due Friday, May 29, 2015

Grant Application Due Friday, June 5, 2015

Oral Presentations from Finalists (if necessary) Week of June 29, 2015

Notice of Award (NoA) Friday, July 3, 2015

Navigators Return Signed NoA and Agreement to CCA Wednesday, July 8, 2015

Commencement of Work Saturday, August 1, 2015

6.2 Additional Information

It may be necessary for the Health Connector to request additional information from one or more

Grant Applicants and the Health Connector reserves the right to do so. The Health Connector

may ask certain Grant Applicants to make oral presentations. The Health Connector, in its sole

discretion, will determine which Grant Applicants will do so.

The Health Connector reserves the right, in its sole discretion, to request, at any time following

submission of applications and prior to the final selection of Grant Applicants that all or some

Grant Applicants clarify any given aspect of their application.

6.3 Questions

Questions regarding this solicitation or requests for additional information should be directed to

[email protected]. All requests for additional general information should be

received by 5:00 p.m. EDT on May 20, 2015. Written responses to such questions will be

provided to all eligible Grant Applicants by 5:00 p.m. EDT on May 22, 2015. The Health

Connector will not respond to any requests for information from potential Grant Applicants

about this Notice of Grant Opportunity other than those submitted in writing in accordance with

this section. Potential Grant Applicants are expected not to contact Health Connector employees

or board members for information about this Notice of Grant Opportunity other than as set forth

in this section.

6.4 Reimbursement

The Health Connector will not reimburse Grant Applicants for any costs associated with the

preparation or submission of any Grant Application or for any travel and/or per diem expenses

incurred in any presentations of such Grant Application.

6.5 Health Connector Rights

The Health Connector reserves the right to reject any and all applications, to waive any minor

irregularities in an application, to request clarification of information from any Grant Applicant,





24

and to effect any agreement deemed by it to be in its best interest with any of the Grant

Applicants.

Issuance of this Notice of Grant Opportunity is not a guarantee that a grant will be awarded. The

Health Connector may at any time prior to the issuance of a final notice of award and acceptance

thereof by the successful applicant notify Grant Applicants of the cancellation of this grant

opportunity, for any reason and without penalty.

6.6 Applicable Laws

The Grant Applicant shall be responsible for compliance with provisions of federal, state and

local laws applicable to the development and submission of any application received in response

hereto. By submitting an application, the Grant Applicant agrees that Commonwealth laws shall

govern any and all claims and disputes that may arise between parties.

6.7 Public Records

All applications and related documents submitted or presented to the Health Connector as part of

this Notice of Grant Opportunity shall become its property. They may be subject to disclosure

upon request under M.G.L. c. 66, § 10, and c. 4, § 7, cl. 26. The Health Connector is under no

obligation to return any applications or materials submitted by a Grant Applicant in response to

this Notice of Grant Opportunity, including Grant Applicant “trade secrets” and financial

information (which are not exemptions in the public records laws). The foregoing applies even if

the Grant Applicant has submitted a non-disclosure or other statement asking the Health

Connector to retain the security or confidentiality of the trade secret and/or financial information.

6.8 Ownership of Materials and Data

All material and data produced for the Authority under an Agreement resulting from this Notice

of Grant Opportunity are the exclusive property of the Authority. Any information provided by

the Authority cannot be used for any purpose other than the functions described in an Agreement

without the express written consent of the Authority.

6.9 Health Connector Liability

The Health Connector shall have no liability whatsoever to any Grant Applicant for any financial

losses or expenses incurred by such entity or entities in response to this Notice of Grant

Opportunity or in connection with a contract or the services of such thereunder except as

expressly set forth in a contract.




25

APPENDIX A

GLOSSARY

For the purpose of this grant the following terms are defined as:

Advance Premium Tax Credit (“APTC”): The Affordable Care Act provides a tax

credit to help consumers with income up to 400% FPL afford health coverage purchased

through the Marketplace.

Affordable Care Act (“ACA”): The federal law that enacts comprehensive reforms for

health insurance and requires the establishment of Marketplaces.

Business Express: An offering within the Small Group segment in which small

employers select a single QHP for all their benefits-eligible employees.

Commonwealth Health Insurance Connector Authority (“Health Connector”):

Established pursuant to M.G.L. c. 176Q, §2, the Health Connector is the state’s

designated Marketplace whose primary responsibility is to facilitate access to affordable

health insurance coverage for eligible individuals and small employers. The Health

Connector is charged with fulfilling additional policy and regulatory responsibilities

under Chapter 58 of the Acts of 2006.

ConnectorCare Plan: A Massachusetts program that will supplement federal subsidies

with state-funded premium and cost-sharing assistance to further strengthen affordability

of coverage for individuals and families with incomes at or below 300% FPL. The State

Premium Wrap and State Cost-Sharing Wrap are offered under the State Wrap.

Cost-Sharing Reduction (“CSR”): A discount that lowers the amount paid out-of-

pocket for deductibles, coinsurance, and copayments for an Enrollee with a household

income at or below a specified percent of the FPL.

Eligibility Determination: An assessment to determine if someone meets requirements

and qualifies for a federal or state benefit.

Employer Sponsored Insurance (“ESI”): Health insurance offered by an employer to

an employee that is subsidized or paid for in part by the employer.

Enrollee: Eligible individuals, eligible employees and eligible dependents enrolled in a

QHP and entitled to coverage thereunder.

Essential Health Benefits (“EHB”): A set of health care service categories that must be

covered by plans offered in the Marketplace.

Federal Poverty Level (“FPL”): A measure of income level issued annually by the

Department of Health and Human Services. Federal poverty levels are used to determine




26

your eligibility for certain programs and benefits.

Grant Applicant: An organization that meets the minimum requirements set forth in

Section 2.0 of this Notice of Grant Opportunity that chooses to submit an Application in

response to this Notice of Grant Opportunity.

Marketplace (“Exchange”): A resource where individuals, families, and small

businesses can: learn about their health coverage options; compare health insurance plans

based on costs, benefits, and other important features; choose a plan; and enroll in

coverage. The Marketplace also provides information on programs that help people with

low to moderate income and resources pay for coverage. The Marketplace in

Massachusetts is the Health Connector.

MassHealth Program or MassHealth: The medical assistance and benefit programs

administered by the Commonwealth’s Executive Office of Health and Human Services

(“EOHHS”). MassHealth is the state-administered Medicaid health insurance program

for low-income families and children, pregnant women, the elderly, and people with

disabilities.

Minimum Creditable Coverage (MCC): A particular level of value or standard of

health insurance benefits that a resident of the Commonwealth must have in order to

satisfy the state’s individual mandate requirement. The Health Connector Board of

Directors is responsible for defining what constitutes MCC for the majority of people that

are covered by commercial insurance.

Minimum Essential Coverage (MEC): The type of coverage an individual needs to

have to meet the individual responsibility requirement under the Affordable Care Act.

This includes individual market policies, job-based coverage, Medicare, Medicaid, CHIP,

TRICARE and certain other coverage.

Modified Adjusted Gross Income (MAGI): The figure used to determine eligibility for

APTCs and CSRs in the Marketplace and for Medicaid and CHIP. Generally, modified

adjusted gross income is a consumer’s adjusted gross income plus any tax-exempt Social

Security, interest, or foreign income.

Non-Group: Individual health insurance.

Open Enrollment Period: The period during which an eligible individual may enroll in

health benefit coverage through the Health Connector. For the 2016 benefit year, the

Open Enrollment Period is November 1, 2015 – January 31, 2016.

Post-Open Enrollment Period: The period of time between the end of the Open

Enrollment period, February 16, 2016 and the end of the Navigator grant program, July

31, 2016.

Pre-Open Enrollment Period: The period of time between the start of the Navigator




27

grant program, August 1, 2015 and before November 1, 2015 when the Open Enrollment

period begins.

Premium: A monthly payment made by, or on behalf of, a covered person to purchase

and maintain a health benefit plan, regardless of whether the covered person uses health

care services or not.

Qualified Dental Plan (“QDP”): A dental plan that is certified by the Health Connector

as meeting certain standards regarding quality, value, and coverage and is offered


Qualified Health Plan (“QHP”): A health plan that is certified by the Health Connector

as meeting certain standards regarding quality, value, and coverage and is offered


Small Employee Health Options Program (“SHOP”): The Small Business Health

Options Program operated by a Marketplace through which a qualified small employer

can provide its benefits-eligible employees and their dependents with access to one or

more QHPs. The Health Connector will offer QHPs for purchase by small employers in

accordance with applicable SHOP rules.

Small Group: Group health and/or dental insurance coverage offered by eligible

employers in accordance with 45 C.F.R. §155.710 and 211 CMR 66.00.

Special Enrollment Period: A period during which a qualified individual or enrollee

who experiences certain triggering events may enroll in, or change enrollment in, a QHP

through the Health Connector outside of the Open Enrollment Period.

Target Market: A market segment that is based on factors such as, uninsured, culturally

diverse populations, certain employment sectors, populations with Limited English

Proficiency and individuals and families with incomes less than 400% of the FPL.




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APPENDIX B

OUTREACH AND ENROLLMENT WORKPLAN TEMPLATE Required Format: Microsoft Word

Grant Period: 8/01/2015 to 7/31/2016

Applicant Organization Name: _______________________________

Instructions

In Sections I – III, using the information provided in Sections 2.1, 2.3, and 3.6, describe the

applicant’s Outreach and Enrollment strategy for each phase of this grant: Pre-Open Enrollment,

Open Enrollment and Post-Open Enrollment. These and other metrics will be used when

evaluating the strength of the application.

Applicants should include a mix of complementary activities that will be used to meet the

objectives of the Navigator program (attracting the remaining uninsured, assisting renewing

members, and generating broad awareness of health care reform and the Health Connector).

Consider the following types of Outreach Activity categories when developing your multifaceted

strategy:

Media

Enrollment Events

Equipment/IT

Mailing

Collateral

Other (Please describe in detail)

Please note, when identifying application and enrollment goals, an application is considered

complete only when all relevant application materials have been submitted on behalf of a

consumer either online or through the appropriate processing center. With respect to identifying

an enrollment goal, an enrollment is deemed complete only when the consumer has selected a

plan and has submitted their first premium payment.

In Section IV, indicate the applicant’s projected outcomes (numbers) per category for the

duration of the Navigator grant award. These and other metrics will be used when evaluating the

ongoing performance of the selected Navigator organization(s).

I. Pre-Open Enrollment: August 1, 2015 - October 31, 2015

During the Pre-Open Enrollment weeks, the Health Connector will be sending

consumers various communications such as: redetermination notices, final eligibility

notices, and renewal or discontinuance notices. Keeping this in mind, please describe

what plan of action the applicant would take to also support the Health Connector’s




29

pre-Open Enrollment activities, including the types of activities that the applicant

plans to hold.

Given this framework, indicate the projected outcomes for the Pre-Open Enrollment

timeframe:

1. Total # of Outreach Activities Planned

2. Total # of Consumers Reached

3. Total # of Applications Submitted

4. Total # of Enrollments Completed

5. Total # of Consumers assisted with Redeterminations

Describe the outreach and education approach and strategy for the Pre-Open Enrollment

phase and explain why this approach is most effective toward reaching the applicant’s

projected outcomes.

II. Open Enrollment: November 1, 2015 - January 31, 2016

During Open Enrollment, the Health Connector will be focused on ensuring that those

consumers who need to renew their health care coverage or go through the program

redetermination process complete their objectives. The Health Connector will also be

working with Assisters on their enrollment events on weekdays, nights and weekends

by providing back office support.

Given this framework, indicate the projected outcomes for the Open Enrollment

timeframe:






6. Total # of Consumers assisted with Renewals

Describe the outreach and education approach and strategy for the Open Enrollment

phase and explain why this approach is most effective toward reaching the applicant’s

projected outcomes.

III. Post Open Enrollment: February 1, 2016 – July 31, 2016

During post-Open Enrollment, the Health Connector will continue to work with

Assisters on group enrollment and outreach activities in an effort to assist the hard to

reach communities and redeterminations.




30

Given this framework, indicate the projected outcomes for Post Open Enrollment

timeframe:






6. Total # of Consumers assisted with Renewals

Describe the outreach and education approach and strategy for the Post-Open

Enrollment phase and explain why this approach is most effective toward reaching

the applicant’s projected outcomes.




31

IV. Total Projected Outcomes for the Grant Period

In this section, indicate the applicant’s projected outcomes (numbers) per category for the

duration of the Navigator grant award. These and other metrics will be used when evaluating the

ongoing performance of the selected Navigator organization(s).

Outcome Category Total Projected Outcome

Outreach Activities Planned

Consumers Reached Through Grant

Activities

Applications Completed

Enrollments

Redeterminations

Renewals




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APPENDIX C - BUDGET WORKSHEET

Required Format: Microsoft Excel Worksheet


Instructions

Complete each section of the budget worksheet as described below. Insert additional rows as

needed. Please do not modify content or structure of worksheet.

Applicants should not allocate grant funds to cover expenses they would have funded in the

absence of grant funding.

I. Navigator Applicant Budget

Required Format: Microsoft Excel Worksheet (DO NOT PDF the spreadsheet upon

submission)

a. Personnel Costs: The budget requested for Personnel Costs must not exceed $15.00 per hour of

Navigator activities conducted. Organizations who are applying for the grant

should calculate the requested amount based on an annual basis. Holidays and

vacation time should not be included in the requested amount.

If a Navigator Organization is applying with a subcontracted organization, the

personnel expense should be calculated in the same way.

Using the excel spreadsheet provided, include detailed personnel information

below each section as indicated for current, proposed new hires and in-kind

personnel support.

b. Direct Costs: Organizations should use their discretion when requesting an amount for

Direct Costs. Grantees should categorize their requests for Direct Costs into

one of the following categories:

Media

Enrollment Events

Equipment/IT

Mailing

Collateral

Other

Examples of direct costs include but are not limited to Advertising in local

Newspaper, ethnic media, event space rental, rented equipment such as

laptops, printers and fax machine, letters, envelopes and postage, brochures,

postcards, flyers.




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c. Indirect Costs: The amount requested for Indirect Costs must not exceed 5% of total budget.

Indirect costs, or overhead, are those costs that are not exclusively part of the

grant project but are necessary to conduct the grant (e.g., rent).

II. Navigator Applicant Budget Narrative

Required Format: Microsoft Word

Prepare a budget narrative that describes how each line item will contribute to the

execution of the Outreach and Enrollment Work Plan and the achievement of the

projected outreach, application and enrollment goals.

Sample Budget Worksheet

a) Personnel

Costs

Lead

organization

staff

Position Title Staff Name

Number of

hours the

Navigator

will commit

during the

grant year

Total Dollar Amount

Lead Navigator First Name,

Last Name 2000 $30,000

Navigator First Name,

Last Name 1000 $15,000


Last Name 1000 $15,000


Last Name 500 $7,500





In-kind staff

Navigator (IN KIND) First Name,

Last Name 500

Navigator (IN KIND) First Name,

Last Name 500

Subtotal 6500 $82,500




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Subcontracted

organizations -

if applicable

Name of Organization Location

Number of

hours the

Navigator

will commit

during the

grant year

Total Dollar Amount

NA NA $0

$0

$0

$0

Subtotal

(Subcontracted) 0 $0

Subtotal (Lead

+

Subcontracted)

6500 $82,500

b) Outreach &

Enrollment

Activities

Describe Costs $ Amount Requested

Media

advertising in local newspapers $2,500

advertising in local radio stations $2,000

advertising on television $2,500

Enrollment

Events

space rental Senior Center each Saturday during Open

Enrollment $10,000

Equipment/IT

2 laptops for outreach events $1,800

1 portable printer for outreach events $500

Mailing Letters, envelopes and postage $5,000

Collateral Spanish brochure and Haitian Creole brochure $5,000

Other Flyering campaign 2 PT staff (20 hrs.) per week for 26

weeks $5,200

Subtotal Total Grant Funded Outreach and Enrollment

Activities Requested $34,500




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c) Indirect

Costs (limited

to 5% of overall

request)

Describe Costs $ Amount Requested

Detail 5% of indirect program support costs $6,413

Subtotal $6,413

Personnel Total $82,500

Total Request $123,413




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APPENDIX D - NOTICE OF GRANT OPPORTUNITY APPLICATION CHECKLIST

Required Format: Microsoft Word


A complete application to be considered for review consists of the following materials in two

original, unbound applications and eight (8) copies organized in the sequence below. Please

ensure that the materials are page-numbered. The sequence is:

� Applicant Letter of Intent

(Required by May 29, 2015)

� Transmittal Letter

� Project Abstract

(Limited to one page)

� Qualifications and Program Proposal

� Outreach and Enrollment Work Plan

(Appendix B)

� Budget Worksheet, Narrative and Proposal

(Appendix C)

� Approach to Program Oversight

� References


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