Outline of “ Health Connector and Mixed Household Redeterminations, Renewals, and Release 9.0 ” conference call recording. Welcome to the “ Health Connector and Mixed Household Redeterminations, Renewals, and Release 9.0 ” conference call. . (Slide 1 Title Slide) - Health Connector and Mixed Household Redeterminations, Renewals, and Release 9.0. August 2016 (Slide 2) - Agenda Health Connector and Mixed Household Redeterminations and Renewals Release 9.0 Functionality (Slide 3 Title Slide) - Health Connector and Mixed Household Redeterminations and Renewals (Slide 4) - Redeterminations & Renewals: Overview Open Enrollment is the time of year when individuals and families may enroll in non-group coverage or switch existing Health Connector coverage for any reason, without needing a qualifying event Open Enrollment is November 1, 2016- January 31, 2017 − Health Connector members can begin shopping and make new plan selections on November 1, but any new plan selection will not be effective until January 1, 2017 − New applicants can submit applications and enroll for coverage starting January 1, 2017 without experiencing a qualifying event. If new members would like coverage in 2016, they must have a qualifying event − Any Health Connector members enrolled in 2016 will be redetermined and renewed into a plan for 2017 − As a reminder – people can apply for and become eligible for MassHealth, the Health Safety Net, or Children’s Medical Security Plan at any time during the year (Slide 5) - Redeterminations & Renewals: Overview The federal government requires that each year, individuals in Marketplaces have their eligibility redetermined and have their QHPs/QDPs renewed Redetermination: Eligibility Annual process for a Marketplace to reassess an individual’s el igibility for enrollment in or financial assistance paying for a Qualified Health Plan (QHP)/Qualified Dental Plan (QDP) by proactively reviewing federal data and requesting new information from a customer whose prior eligibility information does not reasonably match any new information obtained. Renewal: Enrollment Process outlined by federal regulations that guarantees that eligible QHP/QDP enrollees be renewed into coverage for the following coverage year if they are still eligible. Includes guidelines on how to
provide a like-plan for members in a mapping scheme in the event their same plan is not available or if their eligibility has changed. Given unique features of our market – most notably the ConnectorCare program – we use a state-specific approach to redeterminations and renewals that has been approved by Centers for Medicare & Medicaid Services (CMS) (Slide 6) - Redeterminations & Renewals 2017 There are three key updates for the 2017 annual redeterminations and renewals process: 1. Verified FPL – Using Internal Revenue Service (IRS) income data for renewals if an individual has not manually verified during 2016 and current income is not compatible with IRS data. 2. Failure to Reconcile – Use a system process to find out if individuals have not properly filed or reconciled their premium tax credits. 3. New process for Mixed Households (both Health Connector and MassHealth eligible individuals). (Slide 7) - Redeterminations & Renewals: Overview OE 2016 Checked federal data sources for: • Public minimum essential coverage (MEC), • Death, • Disability, and • Failure to reconcile (FTR) o Only a limited number of individuals received tax credits in 2014, so the impact during Open Enrollment was small Did not use Federal data sources for income (because every member updated income within the past year) OE 2017 Checking federal data sources for: • Public minimum essential coverage (MEC), • Death, • Disability, • FTR, and • Income • This is the first time the Health Connector is using income as part of the redeterminations and renewals process New Process Mixed Households (Slide 8) - Redeterminations & Renewals 2017 Mixed Household Process • Mixed households are households with any individuals with a Health Connector determination (regardless of enrollment) and a MassHealth determination (other than a Health Safety Net wrap) • MassHealth members in mixed households will be processed as part of Health Connector redeterminations
• A new joint notice for mixed households with Health Connector members who are sent a pre-populated form will provide one central location for members to find information about renewals (Slide 9) - Redeterminations & Renewals 2017 Mixed Household Process • If there are MassHealth members in the household, that household may have to take action to maintain MassHealth benefits o Households with enrolled Health Connector members who cannot be renewed into the same benefits using federal or state data sources will receive a prepopulated renewal form and special joint cover letter • Households without enrolled Health Connector members will receive a regular MassHealth renewal cover letter and prepopulated form cover letter for their household, just as they do today (Slide 10) - Redeterminations & Renewals 2017 Using State and Federal Data Sources for Income • The Health Connector and MassHealth (for members in mixed Households) will be checking members’ income against available state and federal data sources unless income was manually verified within the year (August 2015-August 2016) • If a member’s income was not manually verified during the current year, the member’s self-attested income will be checked against the income available from federal data sources • If MassHealth members in mixed HH’s do not respond to their renewal within 45 -days, MassHealth will use federal and state data sources in order to determine what benefit the member will qualify for. This is the same process that MassHealth does for MassHealth- only members who are renewed through the HIX (Slide 11) - Redeterminations & Renewals 2017 Using State and Federal Data Sources for Income • When using state and federal data sources: o If the Health Connector member’s self -attested income is higher, the self-attested income is used for 2017 eligibility o If the self-attested income is lower, the Health Connector determines if it is reasonably compatible. If reasonably compatible, the Health Connector uses the self-attested income for 2017 eligibility. If not reasonably compatible, the Health Connector uses the data available from federal data sources o If no income is available with state or federal sources the member will be determined eligible for an unsubsidized QHP (Slide 12) - Self-Attested Income vs. Federal/State Income Use Self- Attested Income If… • Income for everyone in the household was manually verified between August 2015-August 2016 OR • Income wasn’t manually verified, BUT… o Attested FPL is reasonably compatible with Verified FPL Use Federal/State Income Data If…
• Income wasn’t manually verified, AND… o Attested FPL is NOT reasonably compatible with Verified FPL If no IRS data is available, household gets unsubsidized coverage (Slide 13) - Redeterminations & Renewals 2017 (cont’d) Failure to Reconcile • If a Health Connector member does not properly file or reconcile their taxes after receiving tax credits in 2015, the member will be blocked from receiving subsidies in 2017. This is known as failure to reconcile (FTR) • In 2015, a substantial number of members received premium tax credits for the first time in Massachusetts. Filing and reconciling taxes was a new process for many Health Connector members this year • The Health Connector is not allowed to reveal federal tax information to members. Therefore, if a member is blocked from subsidies because of FTR, the Health Connector cannot directly tell the member that this is why subsidies are not available for 2017 • Individuals who did not file in 2015 will likely see their eligibility change online at the end of September when IRS updates their records. Members will see their resulting changes in their October Notice (Slide 14) - Redeterminations & Renewals 2017 Health Connector members without social security numbers (SSNs) will become eligible for an unsubsidized QHP • The Health Connector and MassHealth are unable to check federal data sources for members without SSNs • Members can update their SSN or 2017 application information if they are seeking subsidies Picture of Online Eligibility Results and 2017 Application Summary This picture displays the 2017 eligibility results for a member without a social security number. The pictures shows a member with ConnectorCare in 2016 and Health Connector Plans (no financial assistance) in 2017. The application summary shows that the member does not have a social security number. (Slide 15 Title Slide) - Health Connector and Mixed Households Redeterminations and Renewals Noticing and Communications (Slide 16) - Redeterminations & Renewals: Communications and Notice The Health Connector will only be noticing and renewing individuals who are actively enrolled in a 2016 Qualified Health Plan (QHP) or Qualified Dental Plan (QDP) leading up to or during Open Enrollment o Note – Mixed Households will receive a unique cover letter (with instructions) and a prepopulated renewal form. This is similar to the letters that MassHealth currently sends to members who are having their benefits redetermined in the HIX today Preliminary Eligibility Notice • Late August-early September • Sent to enrollees who submitted a subsidized application • Informs them of estimated 2017 FPL and program eligibility
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