Webinar Transcript October 22, Open Enrollment & Health Insurance Plan Renewals: What you need to know

Webinar Transcript October 22, 2015 2016 Open Enrollment & Health Insurance Plan Renewals: What you need to know Tajan: Good afternoon, everybody, and welcome to today's ACE TA Center webinar. I'm Tajan Braithwaite-Renderos, and I'm the Project Manager for the ACE TA Center. Our goal at the ACE TA Center is to help Ryan White program grantees and providers enroll diverse clients, especially people of color, in health coverage. Today, our webinar is all about 2016 open enrollment and health insurance plan renewals, and we'll explaining what you need to know to best prepare for this. Our presenters will be explaining why it's important for enrolled clients to log in to the marketplace, and for many of these clients to make sure that they file their 2014 taxes. This webinar will also introduce new AT Center tools for consumers, and an updated tool to help with plan renewal. I'm really excited to introduce our presenters for today. Rachelle Brill is a Policy Analyst for Community Catalyst's Outreach and Enrollment Team. She does policy analysis work, tracks these on best practices and trends in outreach and enrollment, as well as provide technical assistance on outreach, education, and enrollment strategies. First, Rachelle is going to discuss the 2016 open enrollment period, important special enrollment period, and new 2016 renewal and redetermination information. Lori Nichols is an ACE Activity Manager who brings over eight years of experience developing and providing capacity-building assistance to HIV service providers. Lori will be discussing the ACE Center's Plan Renewals Flowchart and other really helpful ACE Center tools. Before we get started, I'll go over a few technical details. All attendees are in a listen-only mode, but we do really want to hear from you. If you have a question at any time, please use the chat box at the lower left of your screen to chat with the presenter. You can send us content questions or any technical issue concerns that you might have. We will be stopping at a few different points to go over the questions that have come in, and we'll have time for Q&A at the end of the call. If you think of any questions that you want to ask after the webinar, we want to hear those questions, too. Please just send us an email at acetacenter@jsi.com. The easiest way for you to listen to us today is through your computer. If you can't hear, please make sure your computer's sound is turned on. If you still can't hear us or if you experience any sound delays, try refreshing your screen, or you can mute your computer audio and use the following call-in number, that is: 855-550-2900. Again, if the presenter and the slides are out of sync with each other at any time during the call, www.targethiv.org/ace

you can just mute your computer speakers and use this telephone number instead. The objectives of today's call are to understand how to make sure clients are still enrolled in the best plan, learn how to asses if clients qualify for financial assistance, and finally to use ACE TA Center resources to talk with clients about enrollment using language that is accurate and, of course, easy to understand. This is an interactive webinar, so we'll be doing a number of audience polls throughout the webinar. I want to get you guys used to and accustomed to this system, so we're going to do two polls right now. The first poll that we're going to do is a simple question, which is, what is your role in your RWHAP-funded agency? Are you a program manager or staff? Are you a case manager? Are you a clinical director? Are you a benefits and enrollment staff person? Director? Administrator? Are you a QA person? Or, if you are some other role, you can just chat that role out to our chairperson. Of course, if none of these are applicable, if you're not a grantee or provider, please just check "not applicable." Go ahead and choose whatever applies to you. I'm going to give you a few more seconds before we close the poll. All right, so we'll go ahead and close that poll, and we will look at the poll results together. You should be seeing them on your screen at this point. I can see that we have a wide range of staff participating. That's great, because of course it means that we'll have a lot of different perspectives on the call, and our tools are really beneficial for a wide range of people. It looks as if we have about I want to say 33% of folks on the call are program managers or staff people, more than 31% are case managers, about 10% benefits and enrollment staff, and the rest of you filling the other categories. We'll go ahead and do another quick poll. This poll's question is, have you ever been on an ACE TA Center webinar before? Now your options are "yes" or "no." Let's go ahead and look at the poll results together. It looks like most of you have been on an ACE Center webinar before, with about 77% of you having been on one of our webinars before. That's great to hear. For those of you who haven't, I'm sure you have a lot to learn from this webinar. For those of you who have, there's a lot of new and helpful resources, as well as updated resources that we have to share for you today that will be really helpful. With that, I'm going to go ahead and transition to Rachelle Brill, who's going to be talking about open enrollment in the marketplace. Rachelle Brill: Thanks, Tajan. Once again, my name is Rachelle Brill. I work for an organization called Community Catalyst, which is a national health care advocacy organization that strives to give all consumers a voice in health care policy decisions, and seeks to be a catalyst for collaboration, innovation, and action in health care reform. We achieve these goals by advocating for pro-consumer policy changes at the national level, and we ACE TA Center webinar transcript 2016 Open Enrollment & Health Insurance Plan Renewals Page 2

also provide support for the state-based Consumer Health Advocacy Organization, working to guarantee access to quality, affordable health care for all. As a Policy Analyst specializing in outreach and enrollment, I research and analyze enrollment issues and trends for a project called In the Loop. It aims to serve enrollment assisters, or individuals who help consumers enroll in marketplace plans and Medicaid. As an organization advocating to improve health care access for all, Community Catalyst is proud to partner on the ACE TA Center to promote the enrollment of clients living with HIV in new insurance options. Let's begin with the overview of the Affordable Care Act Marketplace open enrollment period. This year, open enrollment is a three-month period running from November 1 of this year to January 31 of next year, and so uninsured clients can enroll in Marketplace health coverage beginning on November 1. All Marketplace plans are based on a calendar year and begin on January 1, and the last day the clients can enroll in January 1 coverage is December 15 of this year. After January 1, clients who enroll between the 1st and 15th of the month will begin coverage on the 1st of the following month, while those who enroll between the 16th and last day of any month will begin coverage on the second month following the month of enrollment. Clients who enroll by January 15 will begin coverage on February 1, while those who enroll by January 31 will begin coverage on March 1. If clients don't enroll in the plan by January 31, they can't enroll in a Marketplace plan for 2016 unless they qualify for a special enrollment period. Special enrollment periods are 60-day periods that are granted to eligible consumers in certain circumstances. These circumstances typically fall into two categories: a life-changing event such as marriage or birth, or a loss of coverage event such as loss of employment-sponsored coverage or a loss of Medicaid. If any of these types of events occur, a consumer is granted a 60-day enrollment period to enroll in coverage. For loss of coverage events, these periods can happen 60 days before or after the event, and for life changing events these periods are typically granted for 60 days after the vent occurs. Special enrollment periods can vary, though, in state-based marketplaces, and so if you're in a state with its own marketplace, it's important to check their special enrollment period rules. This year, the federally facilitated Marketplace offered limited circumstance special enrollment periods that were granted for either a small period of time or for just a certain group of individuals, such as those who first became aware of the fee for not having health coverage when they filed their taxes. It's not certain, though, that these types of special enrollment periods will be available again in 2016. A client who thinks they might be eligible for a special enrollment period should be encouraged to contact the marketplace and see if they're eligible. ACE TA Center webinar transcript 2016 Open Enrollment & Health Insurance Plan Renewals Page 3

For more details on special enrollment periods, I'm going to chat out the ACE SEP fact sheet for all of you now. What happens if an uninsured client doesn't enroll in health coverage by January 1 and isn't eligible for a special enrollment period? If a client is uninsured in 2016, they will have to pay a fee for not being covered, or they can apply and qualify for an exemption from paying the fee. Clients who don't have health coverage in 2016 will pay the higher of either 2.5% of their yearly household income up to a maximum of the national average premium cost of a bronze plan, or $695 per person in a household up to a maximum of $2,085 for a family. Clients will pay this fee when they file their federal income tax return. Clients can avoid paying the fee, however, if they qualify for an exemption, and healthcare.gov has a tool that helps determine whether an individual is eligible for an exemption. We won't go over each exemption in this webinar in detail, but I'll provide a quick overview of the different types now. Clients can qualify for an exemption based on income-related reasons, such as their income is so low that they're exempt from the requirement to file taxes, or the lowest priced plan available to them is still unaffordable to them, but also health coverage related exemptions, such as if a client was uninsured for no more than two consecutive months of the year or if they live in a state that didn't expand Medicaid but they would've qualified if it had. There are also group membership exemptions for groups that the federal government recognizes as exempt from the requirement to have health insurance, such as members of a federally recognized tribe. There are also exemptions for individuals who experience hardship, such as becoming homeless, getting evicted, facing a foreclosure, or becoming a victim of domestic violence or a natural disaster. Lastly, there are other exemptions such as for individuals who become incarcerated. Clients can apply for these exemptions in one of two ways: either when they file their federal tax return, or by applying through the Marketplace or on a paper application. The tool on healthcare.gov includes information on how clients can apply for the exemptions they're eligible for. If granted, clients will receive an exemption certificate number which they need to include on their federal tax returns. It's important that clients hang onto this number at tax time. Of course, working with clients to educate them on their plan options and the application process will not always guarantee the clients enroll or enroll right away. However, it's important to document your enrollment activities to document vigorous pursuit. The ACE TA Center has tools to help, such as an Enrollment Tracking Worksheet, an Organizational Self-Assessment, and a Data Tool Kit. The Organizational Self-Assessment links users to resources from 19 best practices for engaging, enrolling, and retaining racially and ethnically diverse clients in Affordable Care Act health coverage options. The Self- Assessment is divided into three sections: preparing your organization to best meet the enrollment needs of clients; engaging clients to enroll in health coverage, use their coverage, and stay enrolled; and documenting and monitoring your organization's engagement and enrollment effort. ACE TA Center webinar transcript 2016 Open Enrollment & Health Insurance Plan Renewals Page 4

This tool is designed to help Ryan White HIV program recipients and subrecipients use data to document, monitor, and improve the enrollment of people living with HIV in health insurance coverage options. They also help organizations identify populations that experience the greatest barriers to accessing coverage and care, and ultimately help impact health outcomes by improving access to care for people living with HIV. This Tool Kit provides organizations with sample engagement and enrollment process and outcome measures, and guides them in selecting a few measures to track and identify data sources. We're chatting out the link to these resources now. Let's try a poll question. On this slide I'm going to read the poll question and answers, but then you'll actually enter your answer on the next slide. Which client would be eligible for an exemption from health coverage? 1, Mark is not required to pay taxes because of his low income. 2, Maria has health coverage outside the Marketplace that qualified as "minimum essential coverage." 3, Jason is eligible for Medicaid through his state's Medicaid program. 4, all of the above. Or 5, none of the above. In this slide, let's go ahead and enter your answers of either Mark, Maria, Jason, all of the above, or none of the above. I'll give everyone a few moments to respond. All right. I can see the answers coming in now. I m going to give everyone a few more seconds. Let's go ahead and close the poll. A little over half of you answered 4, all of the above. The correct answer is actually 1, Mark, who is exempt from the requirement to have health coverage because his income is so low that he's no longer required to pay federal taxes. I mentioned that very briefly in the overview of exemptions. What's difficult with exemptions is the great variety of categories individuals can be eligible for. About 30% of you answered Mark, so congratulations on getting the right answer. Again, exemptions can be really tricky, and that's why it can be helpful to check out the healthcare.gov exemption tool to see if your client can qualify for an exemption next year. Now that we've discussed how uninsured clients can enroll in health coverage for 2016, let's turn to how currently enrolled clients can stay enrolled in meaningful coverage by discussing the plan renewal and redeterminations process for 2016. First, let's start with what we mean when we say "renewal" or "redetermination." Renewal, also called reenrollment, is the process through which an insurer re-enrolls a client in coverage, or the process through which a client updates their application and then either re-enrolls or switches their coverage, which is often referred to as an active renewal. Redeterminations are the process through which the Marketplace will review a client's eligibility to continue having Marketplace coverage and to receive financial assistance to help pay for that coverage. It's also the process through which the financial assistance amounts are re-calculated. To promote clients having continuous coverage and avoiding gaps in coverage, the Marketplace renewal process allows for clients to be ACE TA Center webinar transcript 2016 Open Enrollment & Health Insurance Plan Renewals Page 5

automatically renewed by their insurer even if they take no action so long as that plan's still available in 2016. However, it's very important to encourage enrolled clients to log back into the Marketplace and update their information and compare the plans available to them. Why is this important? Because a plan might be available now that better meets their health needs or budget, and they may be eligible for higher amounts of financial assistance. It's really beneficial to log back into the Marketplace, update the application, and review plan options. Active renewal is really recommended. What can you do to help clients actively renew this year? There are four key steps. Assess your client's needs, look at qualified health plan options, assist with the eligibility redetermination process, and remind clients who received financial assistance last year to file and reconcile their 2014 taxes. Let's go through each of these steps one by one. The first step is to assess your client's health needs to see if they've changed since their last enrollment. For example, perhaps they need a new prescription or medical device this year, or perhaps they're seeing a new provider. It's important to help ensure they're covered by a plan in 2016 that meets their current needs, and so a great first step is to evaluate whether their health needs have changed before looking for a plan that best meets those needs. After assessing your client's needs, a second important step is to encourage them to review both their current plan benefits to see if they've changed, as well as features of new plans available to them to see if one is more affordable to them or covers their needed services, benefits, or providers in a more comprehensive way. In addition, depending on the AIDS Drug Assistance Program, or ADAP, in your area, some programs review and recommend certain health plans that only provide assistance for certain plans. It's important to check with your state ADAP first to see which plans are recommended, to make sure your client is enrolled in the plan that best meets their needs. If you're wondering how to contact your state's ADAP program, we have a listing on our webpage, and we're also going to chat a link to you all right now so you can get there easily. The third step you can take is to assist your clients with the eligibility redetermination process, which, again, is the process through which their financial assistance will be re-calculated. What do we mean when we say "financial assistance"? We're really referring to three different things: a premium tax credit, which is a credit clients will receive at tax time to help reimburse them for the premium payments they made throughout the year; an advanced premium tax credit, which is a credit that gets paid directly to a client's insurer each month and then the client pays the premium balance; and cost-sharing reduction, which are discounts the clients receive to help lower out-of-pocket costs such as deductibles and copayments. In addition, ADAPs provide different kinds of additional financial help, and more details will be provided in our December webinar. ACE TA Center webinar transcript 2016 Open Enrollment & Health Insurance Plan Renewals Page 6

Clients are encouraged to take advanced premium tax credit, because doing so helps the Ryan White program provide their assistance in a more efficient way and so clients can receive assistance as premium payments each month. How do different types of financial assistance redetermine? Similar to the renewal process, clients receiving financial assistance this year will have their current amount automatically redetermined based on the most recent income information on file, updated benchmark premium data, and federal poverty levels, regardless of whether they update their application during open enrollment. In contrast to last year when consumers needed to actively re-enroll in order to receive an updated eligibility determination, this year the redetermination process will be automatic, and depending on whether and when a client updated their application the most recent income information will be either 2014 tax data or 2015 application information. Even though the redetermination process is automatic, it's still important for clients to log back in and update their application so they can be sure the Marketplace will be using the most up-to-date information and so that the re-calculation of their financial assistance is accurate. In addition, because new premium data and federal poverty levels will be used, it could be the case that your client will qualify for more financial assistance even if their income or other eligibility information hasn't changed. Lastly, your clients will receive notices from the Marketplace providing explanations of how the amount of assistance will be redetermined for 2016 if a client does not contact the Marketplace, as well as notices from their insurer informing them whether their plan is still available and what their new premium amount is. It's important for them to read any notices from the Marketplace and their insurer. If your client is currently receiving financial assistance from the Marketplace, the last step you can take to ensure a successful renewal is to make sure they file their 2014 taxes and reconcile 2014 advanced premium tax credits, as well as authorize the Marketplace to review their tax data so they can continue being able to receive APTCs in 2016. If not, these clients will lose their financial assistance on December 31 of this year. Reconciling 2014 tax credits means filing Form 8962 with their federal income tax return. On this form, the amount of advanced premium tax credits your client received throughout the year will be compared to the amount they were actually eligible for based on their income, and if they were eligible for more or less than they received, they'll either receive a refund or owe money back to the IRS. If the Marketplace does not have 2014 tax information on file currently, clients will receive a notice from the Marketplace informing them that if they do no file their 2014 taxes, including Form 8962, their APTCs will discontinue on December 31. ACE TA Center webinar transcript 2016 Open Enrollment & Health Insurance Plan Renewals Page 7

To help consumers who filed taxes late with notifying the Marketplace that they've filed, healthcare.gov will contain a question this year on the application asking whether an applicant has filed 2014 taxes. This will serve as a nice way to catch folks who filed taxes late and make sure they can continue to receive financial assistance. The Marketplace will be accepting this self-attestation as sufficient proof that a consumer filed taxes, and they'll also be doing one final check of IRS data at the end of December to make sure they can see everyone who filed taxes. Let's try another poll question. Your client has been enrolled in a Marketplace plan and receiving APTCs. Again: advanced premium tax credits. What will happen if the client has not filed for the 2014 taxes? 1, the client will not be eligible for health coverage. 2, the client must change plans. 3, the client won't be eligible to continue receiving tax credits. 4, all of the above. Or 5, none of the above. I'll give everyone a few moments to respond. We've got some good results coming in. I'll close the poll in just a few moments. Let's go ahead and close it and see what everyone answered. Almost 70% responded that the client won't be eligible for tax credits next year, and that's the correct answer, so congratulations. As mentioned in the previous slides, clients receiving financial assistance now have to file and reconcile their taxes and those financial credits they received last year to be eligible to continue receiving financial assistance next year. Thanks so much for listening to my portion of the presentation. Now I'm going to turn it over to Lori. Lori Nichols: Thanks Rachelle. Hi, everyone. I'd like to walk you through a new tool. It was actually jointly developed by both JFI and Community Catalyst, which is where Rachelle is from. It's called the Plan Renewals Flowchart. As I talk about this and as we show some of the screenshots, if this tool looks or sounds familiar to anyone on the call, it's because we actually developed it last year, but we've just recently updated it, so it does reflect the information for the upcoming calendar year and some of those new changes that Rachelle already mentioned. We're hoping that this revised tool is just a nice visual. It's going to cover a lot or everything that Rachelle just went over, but it's a nice little tool for you to have handy to help you and your client walk through that redetermination and renewal process just to ensure that the client does remain enrolled in a plan that meets both their health needs as well as their budget. If we look at the first screenshot, this is a screenshot of what the entire flowchart looks like. I should also mention that there's a page that precedes the flowchart. If you go to the ACE TA Center site and download the tool, you'll see that on page 1 there's a page that outlines the key dates during the open enrollment time period. I don't expect that you can actually read all the main points on this flowchart, it's very small. We're actually going to go over them individually with some larger screenshots. I just wanted to let you know that the 5 key areas that we're ACE TA Center webinar transcript 2016 Open Enrollment & Health Insurance Plan Renewals Page 8

going to talk about and the questions that are posed in this tool are whether or not your client was enrolled in a plan in 2015, whether that client's plan is actually available in 2016. Did your client receive financial assistance such as those tax credits and cost sharing reductions that Rachelle was talking about, whether or not the client filed their taxes? Then the last point on the flowchart is going to be around whether or not the client has authorized the collection of that tax data from the IRS. The first step in the flowchart is to determine whether or not your client was enrolled in a qualified health plan in 2015. This makes sense when you think about the tool, because this is a tool for renewals. If your client was not enrolled in 2015, they can still look at enrolling in the Marketplace, obviously, during open enrollment, and in that case there's a tool, it's called the ACE Health Care Plan Selection Worksheet. It's a different tool. It's probably going to be better to help with that process if the person was not enrolled before. In a few minutes I'm going to refer to a few other tools on the ACE TA Center website that might be helpful as well. What's really important to know for this year is that for your clients that were enrolled in a plan last year, as Rachelle said, most clients will automatically be enrolled in coverage, with the exception of those that may have their plans discontinued. Last year, clients had to log back into the Marketplace to renew, and in many cases this year they do not. Either way, as we're going to be emphasizing throughout this entire presentation, whether or not that renewal is automated or not it's a good idea for the clients to still log back into the Marketplace application to compare their plan options and also update their income and household information. If for any reason your client wants to change plans based on what they see on what the options that are available this year, they can obviously do that during open enrollment. The next question on our flowchart asks about whether or not your client's plan is available again in 2016. If the plan is discontinued at the end of 2015, the client may be auto-enrolled in a similar plan, only if one is available, obviously. That's going to depend on how the insurer is defining a similar plan. What's similar? This is another time where it's really good to encourage your clients to examine the new plan carefully, really make sure it meets all their needs. They're going to want to make sure that they're not losing any critical benefits if they're being automatically renewed into a plan that might be similar but it might be slightly different in some way. If the insurer decides that a similar plan is actually not available, then it's important to know that auto-renewal will not happen and the client is going to have to actively choose a new plan. In these cases, Rachelle mentioned it earlier and I'll just say it again, clients should receive some kind of written notification that their plan is not being renewed. It shouldn't be a big surprise. That letter that they get is going to prompt them to pick a new plan so that they don't find themselves uninsured in the new year. ACE TA Center webinar transcript 2016 Open Enrollment & Health Insurance Plan Renewals Page 9

Even if your client's same plan is offered in 2016, encourage him or her to review the new plan options. That way they can compare price and coverage options and see if they might qualify for some financial help to help lower the price of a new plan. The next step in our flowchart is step 3, and that's going to ask whether the client received those tax credits, the PTCs is the acronym that you may see. Those are the tax credits that are applied to the premiums that help pay for those costs. The other form of financial assistance is a costsharing reduction or a CSR, and those are additional discounts that are applied to help lower the out-of-pocket costs. If they didn't get those in the past, the client can apply for that kind of assistance in the new year to potentially get help paying for the premiums and out-of-pocket costs in 2016. It's on the flowchart, but I'll give you the income limits. Clients with incomes up to 400% of the federal poverty level might be eligible for those tax credits. That's a little different when you're talking about the CSRs. Clients with incomes up to 250% FPL may also be eligible for those CSRs. If you think about that, up to that 250% level someone may be eligible for both. When you're talking above 250 but lower than 400, they would only be eligible for the premium tax credit. As Rachelle mentioned earlier, if they did receive the tax credit or cost reductions this year, the redetermination process is automatic for 2016. Again, clients should still log in to the Marketplace to update their information. Updating the information is really important because it's going to make sure that the calculation is as accurate as possible. That may result in giving the same amount of tax credits and cost-sharing reductions, or in some cases it could be more, as Rachelle mentioned, based on new criteria. The reason that a client wants to know that ahead of time, it's going to help them at tax time. An example is, if they are actually eligible for less, it's good to know that ahead of time so they don't get hit with some unexpected amount of money that's owed at tax time. The fourth step in the flowchart is to find out if the client filed their taxes this year. If they did, that's great. They're in good shape, because the clients who have filed in the previous years can be considered for tax credits and cost-sharing reductions in the new year. If they didn't, they'll want to, because the clients have to file a tax return for every year that they receive a tax credit or cost-sharing reduction if they want to continue to be eligible for future financial assistance. Because there's some lag time between the end of the year and tax time, I'm going to give you an example of how this works. Clients who are covered in 2014 and received tax credits that year were required to file their 2014 taxes in 2015. I believe that Rachelle alluded to this as well. If they didn't, they wouldn't have been eligible for any tax credits in 2015, and they're going to continue to be ineligible in 2016. Clients who were enrolled for the first time, however, in 2015 and ACE TA Center webinar transcript 2016 Open Enrollment & Health Insurance Plan Renewals Page 10

received a tax credit or a cost-sharing reduction, they have not filed their taxes yet because that time hasn't come yet so they can still receive an estimated tax credit for 2016, and then they'll just need to file their 2015 taxes later on. That's going to be based on information that's in the Marketplace. The final step in the flowchart is step 5, and that's to ask whether or not the client has authorized the collection of the tax data from the IRS for 2015. If they haven't, you'll want to tell your clients that, without the updated tax data, the current financial help, whether it be the tax credits or cost-sharing reductions, is going to end on December 31 of 2015. While you don't have to authorize the collection of the tax data upfront when you're initially applying for the financial assistance, you do need to authorize it for the process to automatically be renewed, so it's important to communicate that to your clients. If the client has given authorization for the IRS to provide that updated tax data, then the Marketplace is going to use that information to calculate the amount of the tax credit or the cost-sharing reduction that they're going to be eligible for in 2016. Something that's not shown on this slide but that we do mention in the flowchart, and I just want to mention it before we go on to talking about some of the other ACE tools, is that we do mention that the Ryan White program remains available to ensure that coverage completion. They might be able to help cover the remaining premium and out-of-pocket expenses in some cases. This is particularly good to know in the case of where your client may not be eligible for as much financial help in 2016 as they may have received before. The flowchart that I just showed you is a great tool to help your client get through this plan renewal process. Obviously, you may still have additional questions about the basics of tax credits and cost-sharing reductions and what those tax filing requirements are. We have it's a frequently asked question or a FAQ resource on the ACE TA Center site and it's on this topic. It answers some of those common questions about the federal financial help. We tried to use as clear and simple explanation as possible, and we've just updated it. People have looked at it before. We've actually just updated it for this year's open enrollment period, so it's got some of this new information on there. I believe that we are chatting out a link to it now. In a few minutes I'm going to tell you about a webinar that we're going to be conducting on December 10, so mark your calendar for that, where we're going to talk about premium tax credits and cost-sharing reductions and tax filing and all kinds of fun stuff in much more detail than we are today. I'm going to pause here for a second so that we can hear from all of you for a moment. We'd like to ask another polling question, and the question that we have is why do you think you should help clients log into the Marketplace during open enrollment? Our choices are to look at the 2016 ACE TA Center webinar transcript 2016 Open Enrollment & Health Insurance Plan Renewals Page 11

plans and prices, to authorize tax data collection, to confirm or update eligibility information, to confirm tax filing and reconciliation, or to begin the plan selection process, or all of the above. I'll give folks a minute to pick your choices. All right. It looks like we've gotten a lot of responses, and a couple in all the categories it looks like. A lot of people have been responding with "all of the above," and I'm happy to say that that actually is the correct answer. If folks have questions about some of the things on this polling slide, feel free to reach out to us and we'd be happy to elaborate further. Now I'd like to do another poll, if that's okay. The next polling question we have is, where do your clients seem to get the most lost during the enrollment process? We've got a bunch of different options here, whether it's getting started, addressing their concerns, filling in an application. It might be submitting the application, following up on their submission, using their benefits, or staying enrolled. We do have an option here for "not applicable" if you're not a grantee provider or don't feel you can answer this polling question. Great. We've got a lot of responses across the board. It seems like "getting started" is slightly in the lead there. Inching up is "staying enrolled." The reason that we ask you this is because the ACE TA Center has some other tools and resources that you may find helpful. I'm going to touch on those in the next few slides. Thank you for letting us know where you are encountering some challenges with your clients. Moving on. In addition to the renewal flowchart that we just went through, there are a handful of other tools that are available through the ACE TA Center that I've been referring to. We wanted to share those with you. I'm going to cover new tools that we've developed for the clients themselves. We have some new tools that will support navigators and enrollment assisters. Then we have some revised tools that are going to support staff as they work with their clients. First let's take a look at 3 new resources for clients. All of our client resources do include a blank space at the end of them where you can insert your contact information, so that your clients know who to talk to about enrollment, so they can be a little bit customized for you. The first tool I'm going to talk about is a resource that we've called Get Covered for a Healthy Life. It's designed as a tool that you can print out for clients or you can leave it in your waiting room. Get Covered, it's for eligible clients that have not enrolled yet in health coverage, and it's written in a question and answer format, as you can see here on this slide. It provides answers to what we've heard as being some of the most common questions that clients may have about enrolling for coverage. As we go to the next slide you'll see an example of some of the questions that we've had. I'm going to run through a few of them just because some of them may resonate with what you're hearing from your own clients. ACE TA Center webinar transcript 2016 Open Enrollment & Health Insurance Plan Renewals Page 12

We included things like, "Why do I need health insurance? I already get care through my Ryan White program." Another question may be, "Health insurance can be expensive. How will I pay for it?" Some of the other questions are, "Will I still be able to see my current HIV provider?" or, "Will insurance pay for my HIV medication?" or, "Can I still get services from the Ryan White program and ADAP?" We have a question and answer for "What if I don't enroll in health insurance?" Hopefully, we've provided some answers in this tool to each of these questions that your client will find useful. Another tool that I want to talk about is called Making the Most of Your Coverage. This is a relatively new tool. We just launched it on the TARGET site a few months ago. Similar to that Get Covered tool that I just talked about, this one is also designed so that you can print it out for clients if they're sitting across the desk from you, or you can leave it in your waiting room. There are different pages that cover different topics. You can either use all the pages together, or you can use each page on its own. Some of the topics that we cover there are listed on the slide. It doesn't look like this in the tool, but they're listed on the slide in that black box, such as "Check your mail." That's talking about things that they want to look for, whether it be their insurance card or their first bill for their premium and things like that. "Know your costs," so really just understanding what exactly is covered, and if they don't understand it how to ask questions about that. "Knowing where to go for care." That's a page that distinguishes between primary care or the HIV specialist or urgent care and emergency care. In what situations would you seek out different kinds of care? Then we have a page that's titled Making the Most of your Visit. That talks about things that you can do to prepare for the visit, things that you can bring with you, what you can do during the visit in terms of asking questions and getting exactly what you need, and then after the visit, how do you follow up on instructions or how do you ask questions, how do you advocate for yourself, and things like that. I think the next screen is just another screenshot of the tool just to give you a sense of what it looks like. This one is on the "Know where to go for care" page. I just want to point out here that we've used some call-out boxes and different images on every page. We're hoping that that's helping to break up all the information. It makes it a little easier and hopefully a little bit more interesting for clients to read it and to be able to distinguish one page from the next, so that if you do have it out in your waiting room and it's multiple pages, they understand that one page has information that's different from another page. Moving on. In addition to the two handouts that I just talked about, there's also a resource that we've developed. It's a set of 5 open enrollment posters. We have a couple screenshots of a few of them. Each one has a different image on it, and then a different quotation to help motivate consumers to consider getting enrolled. The posters are designed for you ACE TA Center webinar transcript 2016 Open Enrollment & Health Insurance Plan Renewals Page 13

to either print yourself... They can be just printed as a 8 1/2 x 11 size. You can either hang them up one at a time or you can hang them up as a group. They were designed as a series, but they can be used individually. All the posters are available for download from our website. I believe that we're going to chat out the link to the posters now as well. If you would like the posters in a larger size, just send us an e-mail. We can send you a different file that's actually a little bit better for the large format printing. Now that we've covered some of the consumer facing tools, I just want to talk for a moment about the importance of the partnerships with enrollment assisters and helping these folks really understand the need of Ryan White clients living with HIV. Because the clients need to work with someone who understands your need for things like medication coverage and provider continuity and affordability, one of the best practices that we strongly encourage is the one-on-one enrollment assistance for your clients. This is really crucial to help your clients compare plans and maybe complete the enrollment process, hopefully getting the most affordable plan for their needs. When I say "enrollment assisters," I do want to just say that that does include navigators and certified application counselors as well as the in-person assisters. These folks, they might be working directly in your program, they might be co-located in your program, or they might be somebody that you're referring to externally. In the next couple of weeks we plan to release a 1-page handout for enrollment assisters. The handout is going to summarize 8 key points that they need to understand about things like the importance of the affordability, the medication coverage, things that I just mentioned, provider continuity, and the role of the Ryan White program. Also, in early November we're going to be releasing a short animated video. We're really excited about this. It covers a lot of the same points. We hope that you'll help us distribute both of these resources, both the handout as well as the little video, to help the navigators and enrollment assisters across the country support people living with HIV and choosing the best plan and getting the financial support that they need. Last but not least, there's a whole list of resources that you may or may not have heard of or seen before. I just wanted to call attention to them here. We've recently improved on them. At least we think they're improved upon. They're all available on the ACE TA Center site. They include our eligibility decision tree. We have a common questions and suggested responses document. That one is also available in Spanish. We have a plain language glossary that has a lot of health insurance terms, and some of them are HIV-specific. That one is also available in Spanish. We have a health care plan selection worksheet. This is that worksheet that I mentioned at the very beginning. If someone wasn't enrolled before but are enrolling for the first time and want to work through the selection process, that's a nice resource. We also have a renewal tracking checklist. That is different than the flowchart that I walked you through. It's ACE TA Center webinar transcript 2016 Open Enrollment & Health Insurance Plan Renewals Page 14

actually a checklist. Then, last but not least, we have a special enrollment period worksheet to help folks walk through that process. Last but not least, I have one last polling question. We'd like to ask which new ACE TA Center tools do you plan to use of the ones that I just went through... I know I went through some of them quickly... Making the Most of Your Coverage; Get Covered for a Healthy Life, that was that Q&A one that I talked about right after the flowchart; the My Health Insurance Works for Me, that's the series of the posters that I just talked about; or the navigator training material, that summary of the 8 points as well as the video that I mentioned? If you take a moment and maybe check any that apply of tools that you might plan to use, that would be really helpful for us. I see a lot of responses coming in. Great. It looks like we've got folks that can use all of the tools, maybe slightly more planning to use the Making the Most of Your Coverage and the Get Covered one, but really a nice set of responses across all tools. We're excited about that. If you have any questions about the tools, like I said earlier, don't hesitate to reach out to us. With that, I think I'll hand things back over to Tajan. Tajan: Thank you so much, Lori. As a reminder, this is where you can find us on the web. All the tools that we've presented today can be found here. This webinar is going to be recorded and archived, and also all participants will receive an e-mail when it's posted so you can share it with your colleagues. I encourage you to do so. I want to quickly talk to you about our upcoming webinar. I hope you can join us for our next webinar in November, which is on Engagement and Enrollment in Diverse Communities. We're going to offer some really concrete strategies that you can use to address common challenges that can create barriers to enrollment among your African American and Latino clients specifically that are relevant in both expansion and non-expansion states. If you're on our mailing list, then we'll let you know whenever we have a webinar or a new resource comes out. We don't really send too many e- mails, only when there's something new to share, so I strongly encourage you to sign up for our mailing list. As soon as the webinar ends, an evaluation form will pop up on your screen. Please fill this out and let us know what you learned today and you think we could improve next time. That's really important to us. Now let's take a look at some of the questions that have come in through the chat feature. The first question that we have is, "Are state ADAP plans recommended or mandatory? In other words, do you have to sign up with these ADAP plans in order to receive assistance? This question is particularly referring to the state of Florida." I'm going to ask Mira to take a stab at answering that question. Mira Levinson: Hi, everyone. This is Mira Levinson. I'm the ACE TA Center Project Director. Let me take a quick crack at this question. The quickest answer ACE TA Center webinar transcript 2016 Open Enrollment & Health Insurance Plan Renewals Page 15

is it depends on your ADAP whether these plans are recommended or mandatory, or whether there isn't even an evaluation by the ADAP plan at all. In some cases, the ADAP or another entity does an analysis of plans and provides information about which ones are most suitable for people living with HIV, while in other cases the ADAP chooses a subset of available plans and only provides premiums and/or cost-sharing support for those plans. Both of these approaches may also apply in some Part A jurisdictions, so at the regional level. In Florida specifically, the ADAP program as I understand it will be reviewing plans as soon as they are available. However, in Florida the plans become available quite a bit later than in many other states, so it may take a little more time after November 1 for the ADAP to be able to look at the plans, analyze them, and then release them. We chatted out a little bit earlier a list of ADAP contact information, and if you're not sure what the situation is in your state, then we would encourage you to check in both with your ADAP program as well as with your Part A program if you're in a Part A jurisdiction. Tajan: Rachelle Brill: Mira Levinson: Tajan: Rachelle Brill: Thank you, Mira. The next question that came in is, "When will the new plans and premium amounts for 2016 be posted to healthcare.gov?" I'm going to ask Rachelle to take that question. That's a great question. Healthcare.gov currently states the plans and prices will be available in late October, but as we all know it's October 22, so it should really be any day now. We have one full week left in October before open enrollment begins, and we're pretty hopeful that it will be posted before the first day of open enrollment. I'll just encourage everyone to keep checking the site until they go live. I'm just going to jump in again. This is Mira again with a little follow-up about the Florida situation. Normally we don't take a lot of locationspecific questions, but I know that there have been a lot of questions about this particular situation and we have a lot of participants from Florida, so I'll just take one more moment of your time and let you know that the Florida ADAP has urged people not to automatically re-enroll and to wait that extra time until the ADAP program has had the opportunity to evaluate and announce its approved plans, because they won't cover those non-approved plans. Thank you, Mira. The next question is, "Is the October notice regarding the reconciliation of tax credits IRS Letter 5591?" I'm going to ask Rachelle to take that question. That's a great question, and the person who asked it is correct. The IRS Letter 5591 did contain information about whether clients need to file taxes and reconcile so they continue receiving financial assistance. My understanding though is that this letter went out earlier than October, and so what we were referring to in the webinar by "October notice" was the notices from the Marketplace and insurers: again, the Marketplace ACE TA Center webinar transcript 2016 Open Enrollment & Health Insurance Plan Renewals Page 16