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November Edition: Transitions in Coverage Assister Monthly Digest

Your monthly compilation of upcoming events, resources, state highlights and more!





Health Insurance Marketplace




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*Welcome to the Final Transitions in Coverage Assister Monthly Digest!*

Assister communities are vital in helping consumers who might recently have found out they’re no longer eligible for Medicaid or CHIP coverage navigate their health coverage options. This digest is intended to equip assisters with resources and tools to connect with consumers in need of assistance. CMS will continue to share guidance and resources supporting assisters’ work with consumers on REGTAP and CMS.gov.

*"Have questions?"*" Certified Application Counselors (CACs) should contact the CAC mailbox at ""CACQuestions@cms.hhs.gov" <CACQuestions@cms.hhs>", Enrollment Assistance Personnel (EAPs) should contact ""EAPQuestions@cms.hhs.gov" <EAPQuestions@cms.hhs.gov>", and"" Navigators should reach out to their Project Officer."

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*Reminder:* Use communication and engagement methods tailored to the specific needs of your consumers, which include (but aren’t limited to) phone calls, emails, and texts. Additionally, ensure that consumers _enter your assister ID_ when they complete the Marketplace application, and make sure that consumers are aware of your role as a CAC by identifying you as a CAC on the application. Your assister ID, whether CAC, Navigator or EAP, is a 13-digit alphanumeric ID assigned to you by your organization leadership. Including your assister ID will help CMS better understand the support that the assister community provides and continue to improve the consumer experience.



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"Important transitions in coverage resources on REGTAP and CMS.gov are located at the "bottom of this resource. [ #Resources ] "You can also view past editions of this digest ""here" [ https://regtap.cms.gov/reg_library.php?libfilter_keyword=transitions%20in%20coverage&libfilter_resource=11 ]"."

*"In Case You Missed It: "*"The Complex Case Web Form allows Navigators, CACs, EAPs, and Advocates (using the “Other” category) to submit a complex case for investigation by the Complex Case Help Center (CCHC) team. A complex case is an issue involving a single consumer or tax household where the assister has not been able to resolve a specific issue on the consumer or tax household’s application for Marketplace coverage. Complex cases are not policy questions or general questions about the Marketplace application. Assisters must first report the complex case issues to the Marketplace Call Center, unless they are reporting cases of unauthorized enrollments or unauthorized plan switches, which do not require contacting the Marketplace Call Center. "

"Click ""here" [ https://mats-cms-ccrms.my.salesforce-sites.com/complexcase ]" to access the Complex Case Web Form, and ""here" [ https://www.cms.gov/marketplace/technical-assistance-resources/training-materials/complex-case-user-guide.pdf ]" to access Complex Case Web Form navigation instructions."



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Health Insurance Marketplace® Enrollment Is Open!

The Marketplace Open Enrollment Period kicked off on *November 1* for the 12th year! Consumers who need to sign up for health insurance coverage should visit HealthCare.gov or CuidadoDeSalud.gov to enroll in health coverage. Consumers who enroll by midnight on December 15 can get full-year coverage that starts January 1, 2025. Otherwise, their coverage will begin on February 1. Consumers can enroll until January 15, 2025.

Consumers May Still be Eligible for a Special Enrollment Period Through November 30!

The Unwinding Special Enrollment Period (SEP) extends through November 30, 2024. This SEP is in place to help consumers maintain coverage as they transition from Medicaid or Children’s Health Insurance Program (CHIP) coverage into a Marketplace plan. Assisters like you are key to helping these consumers transition smoothly. 

*The Unwinding SEP may be available to consumers who:*


* Live in states with Marketplaces served by the HealthCare.gov platform.
* Submit a new application or update an existing HealthCare.gov application between March 31, 2023, and November 30, 2024, and attest that they have lost Medicaid or CHIP coverage between the same time period.

Click here [ https://www.medicaid.gov/resources-for-states/downloads/extn-sep-cnsmrs-lsg-chip-cvrg-adndm-faq.pdf ] for more information on the Unwinding SEP. This document is an addendum to the original FAQ, which is available for reference here [ https://www.cms.gov/technical-assistance-resources/temp-sep-unwinding-faq.pdf ]. After November 30, consumers who have lost Medicaid/CHIP that qualifies as Minimum Essential Coverage may be able to use the Loss of MEC SEP to apply for coverage outside of Open Enrollment. For more information on the Loss of MEC SEP, check out the Fact and Myth section of this digest below.

*Theme Weeks of Action*

During the Open Enrollment Period, “Theme Weeks of Action” are available each week for partners to focus on specific audiences. We encourage partners to use the resources available, develop an outreach plan, and share with your networks. Check out this resource [ https://www.cms.gov/marketplace/outreach-and-education/theme-weeks.pdf ] to see the theme weeks schedule!

*2024 Open Enrollment Period HealthCare.gov Scheduled Maintenance Windows*

Every year, CMS establishes scheduled maintenance windows for HealthCare.gov. Similar to operations for other IT systems, these scheduled maintenance windows are how we update and improve our systems to run optimally and are the normal course of business. Consumer access to HealthCare.gov will be limited while systems are updated. Maintenance will only occur when deemed necessary to provide consumers with a better shopping experience. The purpose in scheduling these times is to minimize any consumer disruption.

Like the last several years, we are sharing the maximum potential windows of scheduled maintenance on HealthCare.gov for the Open Enrollment period to allow agents, brokers, assisters, and states to plan in advance.

It is important to note that these times are the maximum windows for scheduled maintenance activities that require limiting or restricting consumer access to HealthCare.gov. Consistent with past years, the actual maintenance periods may be shorter. As with all IT systems, there is a possibility that unscheduled work will be needed, in which case CMS will use existing channels to notify stakeholders.

Potential maximum scheduled HealthCare.gov maintenance windows for this upcoming Open Enrollment period are [ https://www.cms.gov/files/document/healthcaregov-scheduled-maintenance-windows.pdf ]:


* Sundays December 8 and December 22 – midnight to 7 a.m.

*Assister Support Resources*

The resources below are available to help answer complex questions or issues assisters and consumers may encounter.


* The Marketplace Call Center: 1(800) 318-2596 (TTY: 1(855) 889-4325)
* The Marketplace Call Center helps consumers enroll in health coverage and provides frontline support for consumers experiencing Marketplace eligibility or plan selection issues.

* Assister-Specific Mailboxes [ #questions ]
* Complex Case Webform [ #WebForm ]

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Marketplace Assister Webinars and More

The Marketplace Assister 2024 Webinar Series has ended, but the 2025 Webinar Series is coming soon to REGTAP; stay tuned for updates. Once the series becomes available, you can log into your REGTAP account and register for the series under "Training Events." If you do not already have a REGTAP account, visit this link [ https://regtap.cms.gov/register.php ] and select “Create an Account” before registering for the series. Webinars provide a unique opportunity for you to learn about unwinding topics that can help you support consumers who might have recently lost or will lose Medicaid or CHIP coverage.

For complete instructions for how to register for webinars, click here [ https://content.govdelivery.com/landing_pages/46044/315d75855de61a4dd08982899adf603b ]. Resources from past webinars can be found here [ https://www.cms.gov/marketplace/in-person-assisters/training-webinars/webinars ].

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CAC Designated Organization (CDO) Office Hours

The CMS CDO Program Office is hosting CDO Office Hours, which are monthly technical support calls for CDO leadership contacts (Organization Senior Official, CAC Project Director, and Secondary Contact) who may need assistance with technical aspects of the CDO Program.

These calls will give CDOs the opportunity to raise questions with CMS subject matter experts on issues they may be experiencing with the CDO Program such as, but not limited to:


* Using the Organization Maintenance Web Form (OMWF),
* Updating your CAC Roster,
* Renewing your CMS-CDO agreement or signing your agreement with DocuSign, or
* Annual assister certification training issues.

CMS hosts these CDO Office Hours calls the *second Thursday of the month from 2 p.m.-3 p.m. E.T.*

If your organization is interested in attending these office hours, CDO leadership should keep an eye out for reminder emails which will be sent the Monday before each call, and will include the Zoom link, meeting ID, and passcode. For questions, please send an email to cacquestions@cms.hhs.gov.

Additionally, please be on the lookout for new engagement opportunities that will give you an opportunity to discuss transitions in coverage topics in more detail with CMS and other assisters.

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Truth and Myth: Loss of MEC SEP

Each month, we’ll feature a new key fact or question we’ve identified using your feedback to help you assist consumers securing coverage.

This month, we’re focusing on the Loss of Minimum Essential Coverage Special Enrollment Period (MEC SEP). To view November's fact and myth, visit this page [ https://content.govdelivery.com/landing_pages/46163/6a084f265e23138f287d911a28d47b20 ].

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Key Resources

*"REGTAP Resources"*


* This webinar [ https://regtap.cms.gov/reg_library_openfile.php?id=4758&type=l ] provides an overview of assister “Do’s and Don’ts” when supporting consumers applying for Marketplace coverage. It addresses a range of topics, including consumer outreach, application and enrollment assistance, conflicts and interest, and assisting underserved communities.
* This job aid [ https://regtap.cms.gov/reg_library_openfile.php?id=5596&type=l ] provides detailed guidance related to Medicaid and CHIP. Check it out to understand eligibility, application, expansion, cost sharing, and much more!
* This resource [ https://regtap.cms.gov/reg_library_openfile.php?id=5589&type=l ] contains requirements and best practice for assisters on handing personally identifiable information. Check it out to understand requirements as they apply to you.
* This presentation [ https://regtap.cms.gov/reg_library_openfile.php?id=4067&type=l ] provides tips for working with outside organizations, such as other assisters, agents and brokers, and tax support organizations.

*"CMS.gov Resources"*


* This webpage [ https://www.cms.gov/marketplace/in-person-assisters/outreach-education/materials-multiple-languages ] provides outreach and education materials in multiple languages for use by assisters.
* This infographic [ https://www.cms.gov/files/document/2025-open-enrollment-infographic.pdf ] provides detailed breakdowns of Enhanced Tax Credits and their impact on Marketplace Enrollment and affordability.
* These resources [ https://www.cms.gov/marketplace/in-person-assisters/outreach-education/materials-special-populations ] can help you reach out to people included in special groups, such as American Indians, Medicare beneficiaries, and young adults. The fact sheets, partner publications, and associated web sites explain the programs and services available to them.
* The Marketplace Application Checklist [ https://www.cms.gov/marketplace/outreach-and-education/marketplace-application-checklist.pdf ] provides an easy to understand list of everything consumers need to have in order to apply for or re-enroll in Marketplace coverage.
* Check out these recently updated videos for a step-by-step walkthrough of how to help consumers fill out the latest version of the HealthCare.gov application.
* Households seeking financial assistance [ https://youtu.be/mVkBSP9HKO0?si=U0R6Y7V2m1zYeIZ- ]
* Households not seeking financial assistance [ https://youtu.be/Dvd36cQWUgM?si=L2n7D95avKfR2ZXR ]
* How to answer optional demographic questions [ https://www.youtube.com/watch?v=8BvEtcdXDY4&list=PLaV7m2-zFKpgUK9AqdbnOdW69-WwodvRj&index=27 ]

*"Medicaid.gov Resources"*


* For more resources about transitions in coverage, visit the Medicaid Renewals and Outreach Education page [ https://www.medicaid.gov/resources-for-states/coronavirus-disease-2019-covid-19/unwinding-and-returning-regular-operations-after-covid-19/index.html#Marketplace ]. On this page you’ll find resources that can help you reach and communicate with healthcare professionals, children and families, and members of special populations, as well as general FAQs and best practices for transitions in coverage.



















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