3

• WEBINAR TOPIC: CoveredCA.com Tips

• Auto-Generated Forms for New CECs in

IPAS

• Announcements and Updates

• Upcoming Webinars

• Questions

5

• Always select “Yes”

if consumer wants

financial help from

Covered California

or Medi-Cal.

• Only check “No” if

the consumer

definitely does not

want to receive

premium assistance

or Medi-Cal (if

eligible).

6

• “Source of application”

& “Document ID” fields

are required fields.

• “In-person” option will

be available soon in

“Source of Application”

drop down list, for now,

please select “Phone.”

• Document ID is for

SCRs to handle faxed

applications. CECs

should to enter “0”.

7

• The primary

contact

should

always be

the same

individual as

Household

Member 1 to

avoid any

confusion.

8

• When submitting an application

that includes children, always

select ‘Yes’ to the question:

“Does this person want health

insurance? Even if you have

insurance now, you might find

better coverage or lower

costs.”

• The system will not evaluate

the parents’ eligibility for Medi-

Cal if “No” is selected for the

children.

• Even If the children already

have Medi-Cal the consumer

should still select “Yes”

• For previously submitted

applications, only the Service

Center can adjust these

changes in order for new

eligibility to be established.

9

• Naturalized

Citizens should

answer “No” to

the question of

whether or not

they are a

naturalized

citizen.

• Note: This

question will be

removed from

the online

application.

10

• To be eligible, only one individual on

the application is designated as the

Primary Tax Filer.

• In order to be eligible for tax credits,

the primary must check “Yes” to

“Does this person plan to file taxes

this year?”

• Married couples must choose

“Married Filing Jointly” to get the

expected tax benefit from Covered

California if they are on the same

application.

• The spouse should not be marked

that they are claimed as a dependent.

• Head of household will fail if spouse

is marked married filing jointly, so

both must be marked married filing

jointly to be evaluated in the system

for APTC

11

• For children, the

primary tax filer must

be selected as the

primary caretaker of

the child from this

drop down, in order to

qualify the child

through Covered

California or Medi-Cal.

• An error occurs if

there is no phone

number entered in for

the primary caretaker

of a child. If the

primary caretaker

does not have a

phone number, please

enter (999) 999-9999.

12

• Select “None of the

above” in “Health Care

Information” page to

qualify for affordable,

minimum standard value

health insurance through

Covered California.

• If the consumer receives

Medicare benefits, they

will not qualify through

this application; they

must go to the county

office to apply.

13

• The CEC must enter the

same electronic

signature and electronic

PIN # here that they

used in creating their

CEC account in

CoveredCA.com.

• E-signature & PIN #

must belong to the

person logged in and

accessing the consumer

application.

• CECs are instructed to

use PIN 3742, if the

CEC pin is not accepted.

• After you submit, you

will not be able to go

back and edit any

information on the

application.

14

• Note: Once the

application is

submitted, you

cannot currently

go back and

edit the

“Maintain My

Consent”

timeframe that

is selected.

15

• After submitting the

attestation page, the

Access Code will be

generated for the

consumer.

• The CEC should give

this code to the

consumer so that they

may be able to access

their information at

another time.

• The access code is only

generated when a CEC

uses the “Add an

Individual” feature, not

when the consumer

delegates to the CEC.

16

• The required documents are based on

the information entered in the application.

• Ensure any stated required documents

are uploaded for the primary contact

household.

• Documentation will be asked for each

member of the household, only upload

the documents that are relevant.

• Disregard proof of residency and income

for infants/children, unless related to

citizenship.

• The Covered California Eligibility team

will only process the application if

sufficient details related to primary

household are furnished.

• Consumers have 90 days to submit their

documents. Consumers may mail in

documents and should clearly write their

Application ID on each document.

17

• The CEC or the consumer can upload the required documents that are indicated in the

table after clicking ‘Submit Verification’.

• CEC should upload only the required document in the respective section; Do not upload all

documents at once in a single section. This will show the other section as still pending.

• For example – for ‘Proof of California Residency’ – CA Driver License should be uploaded

as a single document in the first section.

18

• Consumers have 90 days to upload the required documents after the application is

submitted.

• The consumer will be ‘Contingent Eligible’ based on the information provided in the

application (this is only available during the open enrollment period).

• CECs can always come back to the consumer application and upload the

documents when available, or the consumer may do it on their own.

• To upload required documents click ‘Manage Verifications’ option on the right hand

menu.

19

• If you come across a

“Sorry Error” – you

can try to resume your

application from your

CEC Consumer

Dashboard, by clicking

the “Return” button on

the top left hand

corner, and reload the

application.

• If the error persists,

the CEC can try

withdrawing the

application and

starting over using the

“Add New Individual”

link.

20

• Consumers requesting delegation to a CEC are not informed if the CEC

declines the request. All CECs intending to decline delegation requests must

contact the consumer directly and inform them to select another CEC.

• Password Reset: a minimum of (8) characters are required for a new

password. The system incorrectly instructs the user that a minimum of (6)

characters are required.

• The Household Members page must be completed and saved before the

progress of the application is saved.

• When in the process of reporting a change, clicking “Cancel All Changes”

does not navigate away from the page. CECs should return to the Home

Page and withdraw all changes by clicking the “Cancel Change” button.

• The “Appeal” button is currently disabled and will be available in a future

release of CalHEERS.

22

• New Live Scan and Criminal Disclosure forms can now be auto-generated from IPAS for prospective CECs.

• These new forms are customized for each CEC: they

contain pre-populated fields and other tracking codes for

improved tracking and processing.

• Please be sure to only use these forms for each CEC

they are generated for. Do not share forms between

other CECs.

• Reminder: Only add CECs in IPAS NOT on

CoveredCA.com

23

• When all information for a CEC has been completed, a “Download Forms” link will

appear for that CEC on the list of all CECs for your entity.

• The link will not appear unless all information for that CEC has been completed.

24

• Click on the links for each form to download the auto-generated forms that

are specific to this CEC.

25

• The Live Scan form will

generate with certain

fields already pre-

populated, and barcode

for improved tracking

purposes.

• Be sure to complete the

remaining blank fields

before taking to Live Scan

for fingerprinting.

26

• The disclosure form will also

generate with certain fields

already pre-populated.

• Give this form to the CEC to

complete on their own. They

should then mail to the address

stated on the form.

• DO NOT complete, handle, or

mail a completed form for a

CEC. This information is

confidential.

28

• Consumers have until February 25th to make their first premium payment for

coverage beginning March 1st.

29

Refer consumers to the

CoveredCA.com site for

information about paying.

Information for each plan is

provided at:

https://www.coveredca.com/

getting-covered/how-to-

pay.html

31

Local Resource Guides

• CEEs can request copies of the

resource guides through the Print

Shop

• Resource guides will be available

next week

• New CEEs will receive Print Shop

login and password within 2 weeks of

application approval

• Email Print Shop questions to:

Mattie.Gleason@covered.ca.gov

32

33

•»

»

»

•»

»

•»

»

34

•

•

•

•

35

• Covered California has partnered with 27 libraries in the Los Angeles area

to help consumers. o Every Saturday, from now through March 29, 2014, ten (10) libraries branches will host

representatives from Covered California to provide enrollment assistance and education and

explain health insurance options available to consumers and their families through Covered

California health plans.

• Help get the word out.

o Distribute the event flyer - available for download at: http://chilp.it/0b57d2

o Use social media - post event information for the library branch in your neighborhood

o Post on your blog/website – post event information about the enrollment events to help get

the word out

• Covered California’s Executive Director, Peter V. Lee, will be in attendance

at the Panorama City Library this Saturday, February 8 at 10:00 a.m.

36

Tell us if you have changes

It is important that consumers let Covered California know of any changes that may affect whether they qualify for health insurance, qualify for another program or qualify to get premium assistance to help pay for health insurance.

What changes should consumers report?

You should let us know within 30 days of the change. Tell us, if:

• You move

• Your citizenship status changes

• You qualify or other health insurance

• Your household size changes because of marriage, divorce, pregnancy, new child

• Your household income changes

37

To see how your changes to your income and household size might affect your household’s health insurance coverage, refer to the chart below:

Family

Size Annual Household Income

1 $0- $15,970 $15,971- $17,235 $17,235-$22,980 $22980-$28,725 $28,725 - $45,960

2 $0 - $21,558 $21,559- $23,265 $23,265-$31,020 $31,020-$38,775 $38,775 - $62,040

3 $0 - $27,146 $27,147 - $29,295 $29,295-$39,060 $39,060-$48,825 $48,825 - $78,120

4 $0 - $32,499 $32,500 - $35,325 $35,325-$47,100 $47,100-$58,875 $58,875 - $94,200

5 $0 - $38,047 $38,323 - $41,355 $41,355-$55,140 $55,140-$68,925 $68,925 - $110,280

6 $0 - $43,910 $43,911 - $47,385 $47,385-$63,180 $63,180-$78,975 $78,975 - $126,360

7 $0 - $49,498 $49,499 - $53,415 $53, 415-$71,220 $71,220-$89,025 $87,025 - $142,440

8 $0 - $55,086 $55,087 - $59,445 $59,445-$79,260 $79,260-$99,075 $99,075 - $158,520

To use this chart to decide if you should report changes, follow these instructions:

1. Find the household size that you put on your application.

2. Find the household income range that is closest to the income that you put on your application in that same row.

3. Circle the box.

4. Find your current household size and your current household income in that row.

If the change in your income or household size causes your income to move from one box to another box on this chart, your eligibility may have changed. This means that you should report the changes to Covered California.

38

Understanding Covered California Premium Assistance Premium Assistance (Advanced Premium Tax Credits or APTC)

• Individuals and families may be eligible to receive a federal tax credit which can be

paid in advance to lower the cost of monthly plan premiums or claimed during tax

filing process. This includes consumers who:

o do not have affordable or adequate coverage through an employer;

o are not eligible for or enrolled in any other minimum essential coverage; and

o with household incomes between 100% - 400% of the federal poverty level (FPL).

• The APTC is calculated according to income, family size, and rating region, based

on the cost of the second-lowest silver plan available to a consumer.

• Consumers are not obligated to enroll in the second-lowest silver plan; they may

apply premium assistance to any plan available to them and thereby lower the cost

of the premium.

• Generally, consumers that are eligible for or enrolled in minimum essential coverage

are ineligible for premium assistance

39

Modified Adjusted Gross Income (MAGI) What is MAGI?

• Modified adjusted gross income (MAGI) is used to calculate eligibility for Covered California financial assistance and for Medi-Cal and CHIP eligibility.

• Eligibility under the Affordable Care Act is calculated by the household MAGI which is governed by IRS, Medicaid and Treasury regulations.

• For most consumers that apply for coverage, MAGI will be equal to their AGI. (Adjusted Gross Income)

40

Employer-Sponsored Affordability Test (9.5%)

Affordable Plans and the 9.5% Standard

• A job-based health plan is considered “affordable” if the employee’s share of

premiums for the lowest cost self-only coverage that meets the minimum

value standard is less than 9.5% of their family’s income.

• If your share of your premiums for a plan that covers only you (the

employee)--not your family--is less than 9.5% of your family’s income, the

plan is considered affordable.

• You may pay more than 9.5% of your income on premiums for spouse or

family coverage from your employer.

Affordability is determined only by the amount you’d pay for self-only coverage from your employer.

41

Access to Consumer Information After Payment

• CECs are not authorized to have access to case

information once premium payment has been made.

• The payment transaction severs the link between the

CEC and the consumer and applications become

“inactive” on the dashboard until all automated

transactions have taken place and the case is no longer

displayed to CEC at all.

o This is to protect the consumer’s personal information

42

Access to Consumer Information After Payment

• If the consumer wants a CEC to have access to their

case information, they must grant access to the CEC by

designating the CEC as an authorized representative.

• If a consumer needs to report a change and wants the

CEC to assist with reporting the change, the consumer

must re-delegate the CEC via the “Find Help Near You”

feature.

43

New Fax Line for CEC Disclosure Forms

• CEC candidates may fax disclosure forms to:

(916) 323-3729

• Forms may be mailed to:

Covered CA

ATTN: Disclosure Unit

PO Box 1199

Sacramento, CA 95812

44

New Resource • CEE/CEC Assistance Line: 855-324-3147

Monday through Friday, 8am to 5pm.

• You can call the help line for direct assistance with the following:

o Eligibility questions

o Status update on paper applications submitted

o General CoveredCA.com errors

DO NOT SHARE THIS PHONE NUMBER WITH CONSUMERS.

• Consumers should be referred to the Service Center 800-300-1506

45 https://assisters.ccgrantsandassisters.org/

46

47

RESOURCES

49

51

• All Webinars are scheduled for Thursdays 10:00-11:30 am

o February 13, 2014

o February 20, 2014

o February 27, 2014

o March 6, 2014

o March 13, 2014

o March 20, 2014

o March 27, 2014

52

QUESTIONS?

All questions for next week’s webinar

should be submitted by COB today.

trodriguez@rhainc.com

53

Questions Answers Application

When editing an application from your dashboard there is no way

to edit the birth dates, Social Security Numbers, or whether the

person wants subsidies. How does a CEC change this

information on an application?

If the application has not been submitted, you can go back and

remove the page with incorrect information and click the add

member button to re-enter the correct information. If the

application has already been submitted, it will need to be

withdrawn so corrections can be made.

When will it be possible to add or remove a family member

through the Report a Change function? Currently, there is no

radio button for either in the website and the only way to do so

was to call the Service Center.

This feature has always been available. Once you Report a

Change, the buttons are at the bottom of the household member’s

page.

CECs Are CECs supposed to call to follow up on a client's case status?

Clients call us about their case status, about changes in their

income etc. Is that the role of the CEC or do we refer them to the

Service Center?

CEC should be able to look up case information for their clients

up until the time clients pay their premium. After that, the client

would need to re-delegate the CEC for the CEC to assist them

with the reported change. CECs/CEEs may contact the new

CEE/CEC Help Line for assistance with these types of issues at

1-855-324-3147.

What if a CEC who helped a consumer enroll quit their job? How

do consumers follow up with their applications?

They can use the “Manage Delegates” link from their home page

and remove the current CEC and then designate a new one. The

process for this was included on the Webinar presented on

1/30/2013.

Consumers can also call 800-300-1506 to get the current status

of their applications or to request an Access Code so they can

create an account linked to their case

54

Questions Answers

Eligibility

A consumer has 2 dependents (nephews not living in US) on

his income tax and makes less than 133% FLP. He doesn’t

qualify because of the 3 people on the household, for Medi-

Cal he does not qualify because dependents are not his

children. Should he only include himself on his Covered

California application?

A consumer that claims dependents, that are qualifying

relatives, may still be eligible for Medi-Cal. This may be

related to a “glitch” in the online application. When submitting

an application with children, always select ‘Yes’ to this

question: “Does this person want health insurance? Even if

you have insurance now, you might find better coverage or

lower costs.” This will enable the system to process the

parents’ eligibility for Medi-Cal too. For previously submitted

applications, only the Service Center can adjust these

changes in order for new eligibility to be established.

What would a Dream Act recipient making less than 100%

FLP qualify for?

Individuals with certain types of DACA status or PRUCOL

status may be eligible for full-scope Medi-Cal. If the

consumer was incorrectly determined ineligible for full-scope

Medi-Cal and instead granted restricted Medi-Cal they

should contact their county eligibility worker and request a

reevaluation and override of their eligibility determination.

For children who claim their parents as their dependents

include the parents in the family size or should parents

continue to file as a separate household?

The parents and their income should be included in the

family size and income. Make sure to clearly indicate the

individual who is the primary tax filer.

If someone is a dependent from a tax return, who should

apply for Covered California? Example: An unemployed

dependent aged 24, should the parent be the primary

applicant or the child?

It depends how they file their taxes. Whoever is the primary

tax filer would be considered “the primary applicant”.

However, the application clearly asks which individual is the

primary tax filer, as there can only be one. Consumers

should indicate that the primary tax filer is the primary

caretaker for the children on the application.

55

Questions Answers

Plans

Can a consumer put his girlfriend on their insurance as a

dependent? Is this an "offer of affordable health insurance?"

No, consumers must apply with their tax household. If they

are not married then they must apply separately.

After a consumer enrolls in Covered CA and chooses a plan,

can they change the plan or metal tier? If so, how do they

change the plan? What are the rules for changing your plan?

Consumers may terminate their participation in a plan by

contacting the plan and requesting a termination code. The

consumer must then contact the Covered California Service

Center to provide them with that termination code and date.

There is a discrepancy between the premium quoted during

enrollment and the bill sent to the consumer by the Health

Plan. The consumer called the Health Plan and was told

that they did not qualify for subsidies. Where should the

customers go to appeal or get an explanation? One of them

did get a bill for the lower premium from the Health Plan and

she paid it on time. Then a few day later she got a letter

from Covered California requesting her to send in her proof

of income. On the same day, she also got another bill from

the Health Plan for a much higher bill, which she cannot

afford.

Without having more details about this specific case we

cannot comment on if the bill she received was in error or

not. She should contact the Service Center or the CEC may

contact the CEE/CEC Help Line for a possible explanation of

why she received that bill. If you believe the eligibility

determination to have been made in error in CalHEERS

please direct the consumer to the Covered California

Request for a State Hearing to Appeal an Eligibility

Determination Form located on IPAS.

How to you change your health plan? Consumers may terminate their participation in a plan by

contacting the plan and requesting a termination code. The

consumer must then contact the Covered California Service

Center to provide them with that termination code and date.

Medi-Cal Managed Care members may contact Health Care

Options (see resource guide).

56

Questions Answers

Plans

How do you change your metal level? See above.

How often and when can you change your health plan? Covered California Health Plan Consumers may change their

plan only during Open Enrollment. Medi-Cal Managed Care

Members may change their plan throughout the year.

How often and when can you change your metal level? See above.

Immigration

For “Certificate of Citizenship”, what number/id should we use

since is not letting us use the same one as for “Certificate of

Naturalization”.

This question will be removed from the online application. Even

if the consumer is a naturalized citizen please select ‘No’.

When a consumer is a Resident, when asking to upload

verification, there is no option for “Resident Card” or “Green

Card”. Where can we enter this?

You do not need to select the type of document in order to

upload. We are aware that the Green Card is not listed as an

acceptable document. Consumers should still upload this

document for verification or mail it in. This will be added to the

list of acceptable documents in the future. Make sure to upload

one document per section only.

57

Questions Answers

Immigration

We have several consumers that are "lawfully present" with

income below poverty level; the system sometimes automatically

assumes Medi-Cal coverage, but these patients are not

Citizens/US Residents. Example: we assisted a 40 y/o woman

with TPS (work permit) making $16,000/year. We processed the

application through Coveredca.com, but now the system shows

her as ineligible. Profile indicates that we need to show "proof of

residency". We verified with our DPSS worker and a person with

just a Work Permit will not qualify for Medi-Cal. What can we do?

We were also told that restricted/emergency Medi-Cal is not

insurance, therefore these consumers might be penalized for not

having qualified coverage.

Lawfully present individuals are eligible for full-scope Medi-Cal

and APTC/CSR with Covered California. If the county determined

eligibility for limited-scope or restricted Medi-Cal because the

consumer has Temporary Protected Status (TPS) or holds only

an Employment Authorization Card (EAD or work visa), the

consumer should contact the County Eligibility Worker and

request a reevaluation of their eligibility and an override. For

Covered California or APTC/CSR determinations, all lawfully

present individuals (including TPS and EAD) need to reside or

intend to reside in California for the entire benefit year and file

taxes for the benefit year (they must select ‘yes’ they will file taxes

for the benefit year). If you are seeing cases where the consumer

is unable to receive full-scope Medi-Cal or APTC/CSR due to

their lawfully present status please email

Gil.Duran@covered.ca.gov with the case number.

Visa holders' children - these children are lawfully present, as

derivatives of visa parents. However, these children do not have

social security number because obviously they don't work.

CALHEERS doesn't allow people to enroll in health care unless

they do not have social security number, so is there a way to

enroll them and verify their identity through other means?

They may apply for an I-TIN number with the IRS. They may use

this number in lieu of a Social Security Number.

58

Questions Answers

Immigration

Employment visa holders (lawfully present) but in Medi-Cal

income bracket: We have encountered a few families that

have work permit and pay taxes, but in Medi-Cal income

range. They are NOT eligible for Medi-Cal because they are

not green card holders. This means they need to purchase

qualified health plans through Covered CA, BUT CALHEERS

system automatically states them as ineligible for qualified

health plan based on their income and sends their application

to Medi-Cal even though they are NOT Medi-Cal eligible. Is

there any way to override these cases so these families can

apply for qualified health plans (QHP)? Rejecting them from

QHP based on their income when they cannot even apply for

Medi-Cal (at most, they can only get restricted-scope that will

only cover emergency services, they cannot receive regular

care) seems quite flawed.

Lawfully present individuals are eligible for full-scope Medi-

Cal and APTC/CSR with Covered California. If the county

determined eligibility for limited-scope or restricted Medi-Cal

because the consumer has Temporary Protected Status

(TPS) or holds only an Employment Authorization Card (EAD

or work visa), the consumer should contact the County

Eligibility Worker and request a reevaluation of their eligibility

and an override. For Covered California or APTC/CSR

determinations, all lawfully present individuals (including TPS

and EAD) need to reside or intend to reside in California for

the entire benefit year and file taxes for the benefit year (they

must select ‘yes’ they will file taxes for the benefit year). If you

are seeing cases where the consumer is unable to receive

full-scope Medi-Cal or APTC/CSR due to their lawfully present

status please email Gil.Duran@covered.ca.gov with the case

number.

CoveredCA

How does a consumer create an account using the "access

code"?

A consumer does not need an access code to create an

account. If the CEC created the account for the consumer, a

consumer access code is generated at submission of the

application that the consumer will need in order to access

their application on their own. You must give this to the

consumer. If a consumer delegates the application to the CEC

then they will not need an access code.

59

Questions Answers

Other

Is a pregnant women counted as 2 people or 1 person? IRS rules do not allow unborn children to be claimed as tax

dependents. Therefore, for purposes of calculating the

Covered California APTC/CSR household size, a pregnant

woman is counted as one person. However, Medi-Cal has

special rules for counting pregnant women that include the

number of babies expected. Thus, a pregnant women

expecting twins could be counted as one person under the

Covered California APTC/CSR rules and as three people

under Medi-Cal rules.

Would you please review the minimum essential coverage? Please refer to the section in this Webinar for a review of

MEC.

Are there going to be Webinars for CECs after March,

2014?

Yes, there will continue to be webinars. The frequency of

the webinars is subject to change.