Pennsylvania Association of

Community Health Centers

Supporting Pennsylvania's health centers in increasing access to quality primary health care for all


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Monday, July 09, 2018

July 6, 2018 Outreach and Enrollment News

Health Insurance Marketplace 2018 Report

Newly released data from the Centers for Medicare and Medicaid Services (CMS) shows more consumers who do not qualify for premium assistance through Advanced Premium Tax Credits (APTCs) on the health insurance Marketplace are not enrolling in Marketplace health insurance. Some are choosing to shop off of the Marketplace or go without coverage. While the number of consumers who qualify for tax credits has increased significantly, consumers are still concerned about the cost of premiums. According to a CMS report, marketplaces remain relatively stable and the numbers show an increase of 4% of consumers relying on APTCs. More consumers paid their first premium in 2018 than in 2017. For more information, click here to read the full report.

 

Community HealthChoices Disenrollment

The PA Department of Human Services (DHS)released a statement earlier this week notifying Community HealthChoices (CHC) providers that a systemic issue was identified for some CHC enrolled participants not showing as enrolled in the PROMISe™ Eligibility Verification System (EVS) for processing dates July 1, 2018 and forward. Claims with dates of service July 1, 2018 forward were also impacted by this issue. DHS has identified a resolution and anticipated the records would be corrected no later than Wednesday, July 4. For services going forward, DHS advises to continue services based upon CHC eligibility as of June 30, 2018. In order to avoid claims processing denials, hold submission of your impacted claims until July 5. For questions, contact the Office of Long-Term Living (OLTL) Provider Inquiry Unit at RA-ProviderOperation@pa.gov or 1-800-932-0939.

 

Tips from CMS for Enrollment Assisters on Working with Outside Organizations

Navigators and certified application counselors (CACs) may be required under Centers for Medicare and Medicaid Services (CMS) regulations to provide certain kinds of referrals or may find it helpful to collaborate or partner with outside organizations as part of outreach and enrollment assistance efforts.

Assisters might find it helpful to work with or refer consumers to:

  • Federal or state programs that offer health care, health coverage, or payment assistance or discounts related to health services, such as your state Medicaid or Children's Health Insurance Program agency, the VA Health Benefits Program, Medicare and State Health Insurance Assistance Program (SHIP) counselors, federally qualified health centers (FQHCs), Ryan White HIV/AIDS programs, or AIDS drug assistance programs
  • Organizations that specialize in disease-specific issues or represent local patient groups such as the American Cancer Society or the American Diabetes Association
  • Other local or community organizations, such as homeless shelters, food banks, lesbian, gay, bisexual, and transgender (LGBT) community centers, churches, legal aid organizations and local colleges and universities
  • Local businesses, such as coffee shops, malls, farmer's markets, and grocery stores

Marketplace Enrollment Assister Numbers Drop, Increasing Importance of Health Center-Based Services

The number of registered brokers and agents who help people sign up for coverage through the federal Marketplace continued to decline in 2018, despite efforts by the Centers for Medicare and Medicaid Services (CMS) to encourage their participation by making it easier for them to sign up customers during open enrollment. The number of agents and brokers participating in the Affordable Care Act open enrollment for 2018 dropped 24.8% to 49,100 from more than 65,300 during open enrollment for 2017 coverage, according to a CMS report released this week. Since open enrollment for 2016 coverage, the number of registered agents and brokers has fallen by 38.3%. These drops in individuals offering enrollment assistance mean health center-based enrollment assisters (certified application counselors and Navigators) become an even more important part of access to enrollment assistance.

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