ACA Playbook - Montana Department of Public Health and Human Services

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1 ACA CLIENT FREQUENTLY ASKED QUESTIONS SCRIPT Please refer to this document for answers to common questions clients may have about the Affordable Care Act, eligibility, and the Federally Facilitated Marketplace. COMPLETING THE APPLICATION 1. What is the FFM? Does it have hours? The Federally Facilitated Marketplace is a website where you can go to review health insurance options, apply for health insurance under the Affordable Care Act, review policies and pricing. You may apply online at Healthcare.gov or by calling The Marketplace is available 24 hours a day, 7 days a week. 2. Where can I apply for Medicaid? You can apply online at app.mt.gov/mtc for coverage prior to January 1, 2014, or Healthcare.gov for coverage under the Affordable Care Act beginning January 1, You can also apply in- person at your local Office of Public Assistance. Or we can mail you an application. 3. If I complete this FFM application, when do my benefits start? Why don t my benefits start right now? Health coverage assistance under the Affordable Care Act begins January 1, This is a new, federal program. To see if you re eligible for Montana Medicaid now, you will need to apply through the Office of Public Assistance or online at app.mt.gov/mtc. 4. What application do I need to complete if I want health coverage right now? You can apply online at app.mt.gov/mtc, apply in- person at your local Office of Public Assistance, or we can mail you an application. 5. Did Montana expand Medicaid? Why did Montana not expand Medicaid? No. The 2013 Legislature voted not to expand Medicaid in Montana. You may still apply for health coverage assistance at Healthcare.gov to explore your options for private health insurance. 6. What s the different between applying for health coverage using the Marketplace and using a state application? If you are only applying for health coverage assistance, visit Healthcare.gov. To apply for additional programs, including SNAP and TANF, complete a Montana application in- person or at app.mt.gov/mtc to have eligibility reviewed for all programs. 7. What does open enrollment mean? Open enrollment means that anyone can apply for health coverage assistance. The open enrollment period is October 1, 2013 to March 31, Can I apply after March 31, 2014 for Medicaid? You can apply online at Healthcare.gov at any time. Individuals may also apply through the Marketplace during special enrollment periods if they have a Qualifying Life Event. Go to Healthcare.gov for more information.

2 9. What is a Qualifying Life Event? Examples off qualifying life events are moving to a new state, certain change in income, and changes in family size (for example, marriage, divorce, or having a baby). Go to Healthcare.gov for more information. 10. Who can I go to for assistance in completing my application? (Montana and FFM) For assistance in completing an application through Healthcare.gov, please call You may also chat with a representative live at Healthcare.gov. There are also certified application counselors and navigators in Montana to help you apply. For contact information, go to Healthcare.gov. If you are applying for health coverage assistance now in Montana, please call or contact your local Office of Public Assistance. (Please refer to the field office contact information in your ACA PLAYBOOK!) 11. Which is the recommended means of applying? Go to Healthcare.gov to complete your application. If you are also applying for TANF and/or SNAP, go to apply.mt.gov/mtc, or we can mail you an application. 12. Can I apply via the telephone? Yes. Call to complete an application for health coverage assistance beginning Jan. 1, 2014, or contact your local Office of Public Assistance for help filling out an application. 13. Is there only one FFM for all the states? Yes. The Marketplace is the one place for residents in all states to apply for health coverage assistance under the Affordable Care Act. 14. How long will it take me to complete a Single Streamlined Application online? The online application may take up to 60 minutes if you are applying for all programs, including SNAP, TANF and health coverage assistance. 15. What are navigators and certified application counselors? These people assist consumers in submitting eligibility applications. For information on contacting a navigator or a certified application counselor, see the ACA Playbook. 16. How do I contact a navigator or certified application counselor? Find contact information at Healthcare.gov. 17. Do I have to bring my tax forms? No. You will need basic information about your household s income. This could be found on tax returns, W- 2s, or current pay stubs. You do not need to send in copy of your income verification. 18. What year of taxes are you looking at for my application? Will you be filing taxes for the current calendar year? If yes, that is the information that will be requested. EXAMPLE: If you are applying on , we want to know the tax information for the current calendar year, which you will be filing in the next year (2015). 19. What if I don t file taxes can I still apply? Yes. 20. The Marketplace is down. What do I do? Please call

3 21. I m stuck on this screen on the Marketplace, what do I do now? Please call Can I apply for Medicaid for previous months via the Marketplace? Yes, an applicant can apply for retroactive coverage through the Marketplace. However, the retro coverage processing will be handled by your local Field Office of Public Assistance instead of the Marketplace. 23. If I am out of compliance between the months of October 2013 December 2013, can I reapply for Medicaid in January and still receive benefits? If your Medicaid case has not been closed, but are just in non- cooperation status, then a new application for Medicaid will not remedy this situation. The application will be looked at as a change report. If the Medicaid case has been closed, then a person may reapply for Medicaid and be eligible for Medicaid at initial determination and then need to regain compliance within six months of application date. 24. What happens if there are children in my application that are being cited as tax dependents by someone other than me? The children will be considered non- tax filers and we will follow the non- filer tax rules to determine the household composition. If the child is under age 19, the household will include the child s natural, adopted and step parents and natural, adoptive, step siblings. 25. Does applying through the Marketplace affect my existing (SNAP/TANF/etc.) case? It depends. You may receive notification from your worker requesting new verification if any information provided through the Marketplace application is different from what is currently in your SNAP/TANF case. Information included in your Marketplace application may affect your SNAP/TANF case. 26. I only have my children part of the year, but claim them as dependents on my taxes. Can I apply for health coverage for them? Yes. Apply online at Healthcare.gov or call My children live with me part of the year and in another state with an absent parent the remainder of the year. Will their coverage be accepted in another state? Which parent should apply for coverage for the kids? Medicaid does not transfer from state to state. Each parent must apply in their state when the children are living with them. They also need to notify their respective case workers when the children move out of state. 28. My grandchildren live with me, but I do not claim them as dependents on my taxes. How do I apply for coverage for the children? Submit an application online at Healthcare.gov or call

4 AFTER THE APPLICATION IS SUBMITTED 1. I received a notice from the Marketplace. What does this mean? Please go online to Healthcare.gov or call to speak with a customer service representative about your Marketplace application. 2. I completed a single streamlined application via the Marketplace or Self Service Portal, what else do I need to do? Nothing. Wait until your application is processed. You will be notified by mail if anything further is needed to process your application. You will be notified of your approval or denial by mail. 3. How long will it take to process my application? It may take up to 45 days to process an application. 4. I applied via the Marketplace last night. Is my application for Medicaid processed yet? Please call or go to Healthcare.gov to check on the status of your application. 5. Where do I get my Medicaid card? If you are approved for Medicaid, your card will be automatically mailed to you, as well as an approval notice with contact information for your local Office of Public Assistance. It could take up to two weeks for your card to arrive in the mail. If you do not receive your card, please contact your local Office of Public Assistance. 6. What if I am enrolled in a tribe and get services through Indian Health Services? Members of a federally recognized tribe can apply for health coverage assistance through the Marketplace at Healthcare.gov. Tribal members do not have to pay the penalty fee if they do not have coverage, and may qualify for special enrollment periods and lower out- of- pocket costs for deductibles, copayments and coinsurance. 7. If I apply in person and am determined ineligible for ACA Medicaid beginning January 1, 2014, what happens to my application? Do I need to reapply on the Marketplace? Your application will automatically be referred to the Marketplace. You do not need to submit another application. You will be notified by the Marketplace when your application is processed. 8. On the Marketplace, how will I know if I am actually determined eligible or not where do I find that information? You will receive a notice from the Marketplace regarding your approval, denial or changes. If the Marketplace determines that you may be eligible for a Medicaid program, HMK or HMK Plus, your application will be forwarded to the local Office of Public Assistance for a determination. You will receive notification from the Marketplace if your application is transferred to your local Office of Public Assistance. 9. What happens if I don t qualify for Medicaid or health coverage assistance through the Marketplace? If you do not qualify for any program, you will be given options for purchasing private health insurance at the Marketplace. People without health coverage in 2014 may have to pay a fee. For more information, go to Healthcare.gov.

5 10. I applied via the Marketplace in another state, but now moved to Montana. Does my health coverage still apply here? Health coverage through Healthcare.gov is specific to each state. Please re- apply for health coverage assistance in Montana by going online to Healthcare.gov. 11. Why did I get denied for Medicaid? A notice with the reason for your denial was mailed to you. This letter will indicate who to contact with further questions. Also, your application will be forwarded to the Marketplace to review other health coverage options. 12. If I am already receiving state benefits, will the Marketplace know? No. This feature is not yet functional. 13. I received a denial notice from the Marketplace. How do I appeal this? Contact the Marketplace at Healthcare.gov or I was denied by the Marketplace, but I think I should be eligible. Can you help me dispute the denial? No. Contact the Marketplace at Healthcare.gov or The Marketplace is responsible for handling disputes or fair hearings that they make for health care benefits.

6 COVERAGE UNDER THE AFFORDABLE CARE ACT 1. Is moving from state to state a qualifying event (for a new determination) when I apply through the FFM? Yes. If you have coverage through the Marketplace and you move to a new state, you must report the change to your case worker and re- apply for coverage in Montana. You can re- apply at Healthcare.gov, or through your local Office of Public Assistance. 2. What is the Advanced Premium Tax Credit? A new tax credit available to consumers who purchase health insurance through the Federally Facilitated Marketplace. 3. I received Foster Care in another state - will Montana still accept me for the Former Foster Care program? Yes. Any person who was in foster care and receiving Foster Care Medicaid at age 18, regardless of which state issued the benefit, will be eligible for the Former Foster Care program through the month they turn Do I have to provide proof that I was in foster care at age 18? No. 5. I need to get a hold of my case manager. How do I do that? If you are on Medicaid, please call your local Office of Public Assistance. For help with your health coverage assistance through the Marketplace, please call (Please refer to the Playbook for field office contact information.) 6. Who do I report changes to? Report changes to your case worker if you are covered by a Medicaid program, HMK or HMK Plus. For health coverage through the Marketplace, be sure to update your information at Healthcare.gov. If you have an open SNAP or TANF case with the Office of Public Assistance, report changes to your case worker according to your reporting requirements. 7. What changes do I report and by what time? Report changes to the Office of Public Assistance regarding your Medicaid, HMK, HMK Plus, SNAP or TANF changes according to your reporting requirements. For coverage through the Marketplace, report changes at Healthcare.gov. 8. I m on Medicaid. Will my benefits change or stop starting October 1, 2013? Do I have to do anything or call my case worker? Do nothing. Your benefits will not change. When your case is up for renewal, you will receive more information from your case worker. 9. What happens if I don t enroll in health insurance? You may be forced to pay a fee if you do not enroll in health insurance. For more information, please call or go to Healthcare.gov. 10. What is a Qualified Health Plan? An insurance plan certified by the Marketplace that provides essential health benefits, follows established limits on cost sharing (such as deductibles, copayments and out- of- pocket maximum amounts) and meets other requirements. Go to Healthcare.gov for more information.

7 11. What are essential health benefits? Minimum requirements all health coverage plans must offer. These include: 1. Outpatient care 2. Trips to the emergency room 3. Treatment in the hospital for inpatient care 4. Care before and after a baby is born 5. Mental health and substance use disorder services 6. Prescription drugs 7. Services and devices to help you recover if you are injured, or have a disability or chronic condition. 8. Lab tests 9. Preventive services including counseling, screenings, vaccines, and care for managing a chronic disease. 10. Pediatric services, including dental and vision for kids Specific health care benefits may vary by state. Even within the same state, there can be small differences between health insurance plans. When you fill out your application and compare plans, you ll see the specific health care benefits each plan offers Go to Healthcare.gov for more information. 12. How can I lower the price I pay for health coverage? Certain households may be eligible for cost sharing reductions, discounts that lower out- of- pocket costs for deductibles, coinsurance and copayments. If you are a member of a tribe or your income is below a certain level, and you purchase health insurance through the Marketplace, you may be eligible for a cost sharing reduction. 13. How do I get the hardship exemption? For more information, go to Healthcare.gov. 14. Will I receive notices about ACA and non- ACA programs? Read notices closely. A denial notice may be sent to certain household members, and other household members, if approved, will receive a separate approval notice. 15. Will my Medicaid card still look the same? Yes. 16. What happens to my SNAP/TANF eligibility if there is a discovered change when verifying my information for ACA? Reporting requirements haven t changed for SNAP or TANF. Discovered changes will be acted on according to your reporting requirements. 17. I am already on Medicaid. Will my coverage end December 31? No. There will be no change to your current Medicaid, HMK or HMK Plus coverage. 18. I am currently aging out of Foster Care Medicaid, will there be a seamless transition to Former Foster Care, or will I need to submit a separate application? At this time there is no transition from Foster Care Medicaid to Former Foster Care, so a client will need to submit a new application.

8 19. My child is currently on HMK, how will new ACA limits affect this enrollment? Will my child be changed to Medicaid rather than HMK? The new ACA limits will not affect current HMK eligibility until a change is reported or the annual redetermination. If your child becomes eligible for HMK Plus, they will be enrolled in this program instead of HMK. 20. Who do I contact about fair hearings? If the eligibility notice was sent by the State then contact the local Field Office of Public Assistance. The contact information is on the front of your eligibility notice. If the eligibility notice was sent by the Marketplace, contact the Marketplace at Healthcare.gov or RESOURCES Federally Facilitated Marketplace: Healthcare.gov or Montana Medicaid Hotline: Montana Field Offices of Public Assistance: See the contact list in the ACA Playbook Montana Connections: app.mt.gov/mtc

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