webinar topic: household incomehbexmail.blob.core.windows.net/eap/1.23.14 covered... · 1/23/2014...

3

• WEBINAR TOPIC: Household Income

• Using Social Media

• Announcements and Updates

o Enrollment Numbers

o Payment Dates

o How to Add a CEC

o Consumer Referrals

o CHCF Research Project

o CEC Dashboard

o Resources

• Upcoming Webinars

• Questions

4

HOUSEHOLD INCOME

Click to edit Master title style

1/23/2014 5


1/23/2014 5 5 of 18

• Current household income consists of

earnings for the current benefit year.

• If household income will vary during the

current benefit year, consumers will report

their projected household income for the

year.

SOURCES OF HOUSEHOLD INCOME


1/23/2014 6


1/23/2014 6 6 of 18

HOUSEHOLD INCOME AND ITS SOURCES • Household members, who may also have sources of household income, include:

o You (head of household)

o Your spouse (if you and your spouse are filing a joint tax return)

o Children living with you.

o Note: You can claim an exemption for a dependent even if the dependent files a

separate tax return. (IRS Publication 501). However, in this case, the dependent

would not be able to claim an exemption for her/himself if s/he files a separate tax

return

o Anyone you include on your tax return as a dependent, even if they don’t live with you.

o According to the IRS, a dependent is defined as qualifying child or qualifying relative

and must be a U.S. citizen, U.S. resident alien, U.S. national, or resident of Canada or

Mexico for some part of the year. (IRS Publication 501)

Important: Income from household members who are not lawfully present needs to be reported even

if these members are not applying for healthcare coverage. They may be eligible for restricted or full-

scope Medi-Cal

SOURCES OF HOUSEHOLD INCOME


1/23/2014 7


1/23/2014 7 7 of 18

• An unmarried partner

• An unmarried partner’s children if they are not your

dependents

• Parents who live with you, file their own tax return,

and are not your dependents

• Other relatives living with you who are not your

dependents and who file their own tax return

• Dependents who live abroad more than half of the

year

INDIVIDUALS NOT INCLUDED FOR HOUSEHOLD INCOME PURPOSES


1/23/2014 8


1/23/2014 8 8 of 18

• Eligibility for subsidized health insurance through

Covered CA and for income-based Medi-Cal is calculated

using a household’s Modified Adjusted Gross Income

(MAGI).

• Consumers can find their AGI on these federal tax return

lines:

o Line 4, Form 1040EZ

o Line 21, Form 1040A

o Line 37, Form 1040

MODIFIED ADJUSTED GROSS INCOME (MAGI)


1/23/2014 9


1/23/2014 9 9 of 18

Covered California determines eligibility for premium assistance and cost-

sharing reductions based on an applicant’s MAGI. For MAGI calculations,

CC requires the following of applicants:

• They need to be prepared to attest to their current or projected income

for the current benefit year.

Note: Medi-Cal eligibility is based on current monthly income.

• If an applicant’s income varies from month to month, it should be based

on a monthly average of expected earnings for the current benefit year

(projected average annual income).

• If an applicant’s attested income is not reasonably consistent with

federal data, or if income information is not available, the applicant has

90 days to provide Covered California with documentation to resolve the

inconsistency (e.g., by presenting current paystubs or the previous

year’s tax return).

REPORTING INCOME – CURRENT AND PROJECTED EARNINGS


1/23/2014 10


1/23/2014 10 10 of 18

HOW TO DEAL WITH FLUCTUATING AND SELF-REPORTED INCOME • In cases where income fluctuates, it should be calculated by estimating how

much the consumer thinks they will get for the benefit year, enter it as a

annual amount and the system will determine the monthly amount.

• To make this income estimate, applicants must take the following factors into

consideration:

o Their income pattern over the last year.

o The actual income they received in the last month.

o Producing a statement of anticipated income, which can be presented as

a self-affidavit letter of income. A sample self-affidavit letter of income

can be found at:

http://www.healthyfamilies.ca.gov/Publications/EEs_CAAs/SampleSelfAffida

vitLetter_en.pdf

FLUCTUATING AND SELF-REPORTED INCOME

http://www.healthyfamilies.ca.gov/Publications/EEs_CAAs/SampleSelfAffidavitLetter_en.pdf

http://www.healthyfamilies.ca.gov/Publications/EEs_CAAs/SampleSelfAffidavitLetter_en.pdf


1/23/2014 11


1/23/2014 11 11 of 18

PREMIUM ASSISTANCE RECONCILED AT END OF YEAR All premium assistance you receive in advance for yourself and your family

members will be reconciled at the end of the year:

1. Your final premium assistance amount is calculated based on your actual

income reported at the time you file federal income taxes.

2. The IRS compares the premium tax credit you and your family members

qualify for at the end of the year with the premium assistance amount you

chose to receive in advance.

o If your premium assistance amount is less than amount of your

premium tax credit, you will receive the difference as a refundable credit.

o If your premium assistance amount is more than amount of premium tax

credit, you must repay the excess premium assistance amount with your

tax return.

END-OF-YEAR INCOME RECONCILIATION


1/23/2014 12


1/23/2014 12 12 of 18

The online application breaks household income into three distinct types:

1. Wages: income from an employer for which a W-2 form is issued and taxes are withheld

2. Net income from any self-employment or business (generally the amount of money you earn from your business minus your business expenses)

3. Other income, such as:

o Retirement income

o Rental income

o Social Security Disability Insurance (SSDI)

o Interest, dividends, and other investment income

o Pension income

o Other taxable income such as prizes, awards, and gambling winnings

Three Types of Household Income


1/23/2014 13


1/23/2014 13 13 of 18

KEEPING RECORDS FOR PROOF OF HOUSEHOLD INCOME

If applicants are unable to provide standard

documentation for proof of household income (such as

W-2 forms), are not paid directly by an employer, or are

self-employed, they should be prepared to provide

proof of income from basic records they keep of their

income and expenses. The table on the next slide

(from IRS Publication 552), as well as the online

application, list documents that serve as basic records

for proof of household income.

Proof of Household Income


1/23/2014 14


1/23/2014 14 14 of 18

RECORDS OF HOUSEHOLD INCOME

Item Records You Can Use

Income • Form(s) W-2

• Form(s) 1099

• Bank statements

• Brokerage statements

• Form(s) K-1

Expenses • Sales slips

• Invoices

• Receipts

• Canceled checks or other proof of payment

• Written communications from qualified charities

Home • Closing statements

• Purchase and sales invoices

• Proof of payment

• Insurance records

• Receipts for improvement costs

Investments • Brokerage statements

• Mutual fund statements

• Form(s) 1099

• Form(s) 2439


1/23/2014 15


1/23/2014 15 15 of 18

• Wages, salaries, tips, etc.

• Taxable interest and ordinary dividends

• Taxable amount of a pension, annuity, or IRA distribution

• Social Security benefits

• Business income

• Farm income

• Capital gains and other gains (or losses)

• Unemployment compensation

• Alimony received

• Income from rental real estate, royalties, partnerships

• Taxable refunds, credits, or offsets of state and local income taxes

• Other taxable income

WHAT INCOME IS INCLUDED IN MAGI


1/23/2014 16


1/23/2014 16 16 of 18

• Certain self-employment expenses

• Student loan interest deduction

• Educator expenses

• IRA deduction

• Moving expenses

• Penalty on early withdrawal of savings

• Health savings account deduction

• Alimony paid

• Certain business expenses of reservists, performing artists, and fee-

basis government officials

WHAT IS DEDUCTED FROM MAGI?


1/23/2014 17


1/23/2014 17 17 of 18

• Veterans’ disability payments

• Workers’ compensation payments

• Child support received

• Supplemental Security Income (SSI)

Also not included in MAGI because they are already subtracted from W-2

wages and salaries:

Pre-tax contributions:

• Child care

• Commuting

• Employer-sponsored health insurance

• Flexible spending accounts

• Retirement plans such as 401(k) and 403(b)

WHAT INCOME IS NOT INCLUDED IN MAGI?


1/23/2014 18


1/23/2014 18 18 of 18

• Scholarships, awards, or fellowship grants used for education purposes, but not used for living expenses

• Certain American Indian and Alaska Native income derived from distributions, payments, ownership interests, real property usage rights, and student financial assistance

Note: Medi-Cal eligibility is generally based on MAGI for:

• Parents and childless adults under age 65

• Children

• Pregnant women

Eligibility is not based on MAGI for individuals who are aged, blind, or disabled.

EXCLUSIONS FOR MEDI-CAL ELIGIBILITY


1/23/2014 19


1/23/2014 19 19 of 18

• http://laborcenter.berkeley.edu/healthcare/MAGI_summary13.pdf

• www.healthcare.gov

• http://www.irs.gov/pub/irs-pdf/p501.pdf

• http://www.irs.gov/publications/p552/ar02.html

• http://hbexmail.blob.core.windows.net/ipas-cms/Immigration.pdf

• http://sd15.senate.ca.gov/sites/sd15.senate.ca.gov/files/ans

• wers.forum_.pdf

• http://www.cdss.ca.gov/shd/res/pdf/50501.pdf

SOURCES

http://laborcenter.berkeley.edu/healthcare/MAGI_summary13.pdf



http://www.healthcare.gov/

Household Income_PPT_Rev 3_BPCH 01.02.14.pptx




Household Income_PPT_Rev 4_BP_ 01.07.14.pptx

http://hbexmail.blob.core.windows.net/ipas-cms/Immigration.pdf





http://www.cdss.ca.gov/shd/res/pdf/50501.pdf

http://www.cdss.ca.gov/shd/res/pdf/50501.pdf

21

Use Facebook, Twitter, YouTube and other social media to

promote your enrollment events, share important

information and announcements.

You can:

• Invite the public to your events.

• Record and send out public service announcements

about Covered California.

• Share stories about constituents that can benefit from

the affordable health insurance coverage available

through Covered California (Be sure not to disclose

PII).

22

Using Twitter is one effective way Covered

California partners can get the word out about

Covered California.

• It is a great way to engage consumers in

conversations about affordable health care and

to promote your community outreach and

enrollment events.

23

Five Easy Steps to Start Tweeting

1) Create a new account at Twitter.com.

2) Find others to follow. You may go to the #Discover button at the top of Twitter

and type a word into the search engine to find people and organizations to

“follow.”

3) Start tweeting.

– Tweets are limited to 140 characters. Compose a concise tweet about your event. Use hash tags (#) to categorize information, such as #CoveredCA or #GetCovered.

4) Add photos to your tweets. A picture is worth a thousand words. Take a photo

and upload it to Twitpic.com and attach it to your tweet message.

5) If you see something you like or want to share, retweet it on your Twitter

account to let others know.

25

Covered California needs your help!

Additional Certified Enrollment Counselors are needed to meet the high consumer demand that California is experiencing.

• Recruit additional CECs to expand your organization’s capacity.

• Extend hours of operation to include weekends and evenings to provide assistance.

• Reach out to your community and other organizations in your local area to let them know that your organization is providing enrollment assistance.

26

Log into your CEE application. https://ipas.ccgrantsandassisters.org/

https://ipas.ccgrantsandassisters.org/


27

Click on Certified Enrollment Counselors and Click “Add Certified

Enrollment Counselor”

28

Complete all of the fields to add a New Certified Enrollment Counselor

30

More than a Half-Million Californians Enrolled in

Covered California Health Insurance Plans through

December 31, 2013

• An additional 584,000 applicants were determined likely

eligible for Medi-Cal coverage

• The demand for health care coverage in California

remains strong.

31

Consumers have until January 28 to make their first premium payment for

coverage beginning February 1

32

Refer consumers to the

CoveredCA.com site for

information about paying.

Information for each plan is

provided at:

https://www.coveredca.com/

getting-covered/how-to-

pay.html

https://www.coveredca.com/getting-covered/how-to-pay.html









33

Consumers should not be referred to the EAS

Team or the CEE/CEC Help Desk

• Do not provide consumers with the phone

numbers or email addresses for the EAS

Team or Help Desk

• Consumers must call the Service Center at

(800) 300-1506

https://www.coveredca.com/getting-covered/

34

California Healthcare Foundation (CHCF)

• CHCF is developing an assessment of consumer and provider experiences with the Affordable Care Act.

• The goal of the study is to learn:

o Why consumers decided to enroll

o The consumer enrollment experience

o How they plan to use their new coverage

• PerryUndem is the firm conducting the research including:

o Interviews and focus groups with consumers

o Focus groups with Certified Enrollment Counselors

• Please respond promptly if you are contacted to participate in the research study. All participant information will be kept confidential.


35

CEC Dashboard

• The fix to the CEC dashboard has not been finalized.

• Covered California will run updates every two hours

to refresh the CEC dashboard.

• New applications and delegations will be delayed up

to two hours.


38

•

•

mailto:[email protected]

39

CEE Resource Purpose for Contact

Your Entity’s assigned Enrollment Assistance Specialist

Call: 888-402-0737 to find your EAS contact information

All Certified Enrollment Entities have been assigned an Enrollment

Assistance Specialist (EAS) who are well equipped to answer questions

and provide help

Enrollment Assistance Help Desk

Call: 888-402-0737

E-mail: [email protected]

General questions about the Enrollment Assistance program and process

Enrollment Entity application process questions

Delegation Codes questions

Certified Enrollment Entity application and resource

website:


Find resources such as recorded informational webinars, checklists and

worksheets

Application Change Request Form

Check that status of applications submitted

Consumer Help Desk

Phone: 800-300-1506

(Staffed with Service Center Staff who speak multiple

languages)

To access tools online to assist the consumer:

www.coveredca.com

Consumer or CEC general questions about health plan applications,

enrollment, benefits or current coverage

Online CoveredCa.com use the Shop and Compare Tool to help

consumers review plan options or download FAQs to answer questions



http://www.coveredca.com/

40

CEC Resource Purpose for Contact

Enrollment Assistance Help Desk

Call: 888-402-0737


General questions about the Enrollment Assistance program and

process

Enrollment Entity application process questions

Delegation Codes questions

Learning Management System (LMS) and Training Help Desk

Call: 559-573-3580


Link: https://learning.coveredca.com/

Login assistance

Help with Instructor-Led Training/Self-Guided Training Registration

Questions on the (2) Computer-Based Training

Assistance with the Certification Exam

Live Scan – Covered California’s Fingerprinting Provider

Criminal Disclosure Form:

http://www.healthexchange.ca.gov/Documents/CECdisclosure.pdf

To find locations for fingerprinting

Schedule appointments

Check the status of your background check clearance

Download Live Scan request form

CoveredCA.com Technical Support

[email protected]

CoveredCA.com password resets

Technical issues

Consumer Help Desk

Phone: 800-300-1506 (Staffed with Service Center Staff who speak

multiple languages)

To access tools online to assist the consumer:

www.coveredca.com

Consumer or CEC general questions about health plan

applications, enrollment, benefits or current coverage

Online CoveredCa.com use the Shop and Compare Tool to help

consumers review plan options or download FAQs to answer

questions



https://learning.coveredca.com/

http://www.healthexchange.ca.gov/Documents/CECdisclosure.pdf


http://www.coveredca.com/

41

• All Webinars are scheduled for Thursdays 10:00-11:30 am

o January 30, 2014: Immigration Update

o February 6, 2014: CEC CoveredCA.com Dashboard

o February 13, 2014

o February 20, 2014

o February 27, 2014

o March 6, 2014

o March 13, 2014

42

QUESTIONS?

All questions for next week’s webinar

should be submitted by COB today.

[email protected]

43

Questions Answers

Application

Why is the system asking for the social

security number of people that are not

applying? Are they not being counted as

part of the family house hold? If not their

income should not count as well.

All members of the tax household and

family size must enter their SSN# or other

eligible document information. They will be

counted as part of the household size and

any income will be added to the household

income.

A person who has an Employment

Authorization Card is allowed to apply

according to the lawfully present guidelines,

once the application is finish they ask for

lawfully present verification but when we

upload the document there is not an option

for that category, what do we do?

An Employment Authorization Card (EAD) is

otherwise known as a Work Permit and is

listed as INS form I-776. If you experience

issues with the upload of documents online,

you have the option to mail or fax those

documents as provided on the notification.

44

Verification

If live with parents, what can they use for

proof of residence? Plus have no income to

report. What can they submit for zero

income?

You may submit an attestation and indicate

you have no income.

Can we use bank statement as paystub

proof if job does auto deposit?

Yes, this is an acceptable verification

document.

45

Eligibility

While completing an application earlier today in

CalHEERS…I was trying to upload the Proof of

Citizenship for my client, however, there was not a

choice for a “Green Card”/I-551 card. Do you

know who I can email this issue to, it is an issue,

right?

The Green Card/I-551 is listed for upload as the

Permanent Resident Card and in parentheses

indicates Green Card.

I have been encountering many problems with

determining eligibility with clients. They are below

the Medi-Cal limits but are forced to choose a

health plan and pay for it. This is making us CEC’s

look bad when we are using the FPL guide lines

from the Covered California site to determine what

they are eligible for. 16,000 annually for a family

of 4 should be Medi-cal not Covered California. If

that is the case Covered California should adjust

their shop and compare calculator, preview plans

button and the FPL guidelines.

We cannot comment on specific cases without

knowing the full details. In cases where you think

the eligibility determination to be in error (there are

cases where this has happened) please withdraw

the application and submit a new application.

Otherwise contact the Service Center and they

can be of assistance. Consumers also have the

right to appeal their eligibility determination by

contacting the Service Center.

46

Eligibility

Will same-sex married couples be eligible for

APTC?

As long as same-sex married couples file jointly

for the benefit year they will be evaluated for

APTC just like any other married couple. The

same provisions apply if they file separately –

they will not be evaluated for APTC.

I am married but I file as Head of Household.

Will I be evaluated for APTC/CSR?

Generally, married couples must file jointly in

order to be evaluated for ATPC/CSR. Married

couples filing separately will not be evaluated

for APTC. There are instances that a married

individual may qualify to file as Head of

Household. If they meet the qualification to file

as HOH, they may also be evaluated for

APTC/CSR.

47

Income

I have someone coming in next Friday for an appt.

Her husband is a trucker and gets paid by loads.

According to client, her monthly income after

expenses for January will be about $2, 899 but

she is concerned that it changes month to month

and does not want to be stuck owing money at

the end of the year if her projected income based

off this amount is higher and she also does not

want to be calling in to report income changes

every month.

Is there a range of how much income can

increase without affecting the amount of PA tax

credit and therefore not having to call in monthly

and report and income increase? Overall, self-

employment income can fluctuate depending on

the type of work so how does Covered CA

suggest we address these types of concerns?

If your income is expected to fluctuate you should

enter your projected income for the benefit year

as annual income and let the system will

automatically determine monthly income.

48

Plans

I know a couple of CDL truck drivers. They both

want insurance and make over $100,000 yearly.

They travel out of state 70% of the year driving

cross country. Their homes are in Los Angeles

and so is the main trucking hub where they work.

Is Covered California the best option for them?

Should they instead get a national plan? Will

Covered California cover them if they are in an

accident in another state?

If you are out of network your plan will cover

emergency services. For more information about

how this works please contact your plan.

Medi-Cal

Can you please clarify what is the norm for

families to wait to be enrolled in Medical thru

Covered California? What are the documents they

will be asked for once the application gets turned

in?

Once your application has been submitted and

was determined eligible for Medi-Cal you may be

asked to submit verification documents. The

Department of Health Care Services has granted

presumptive eligibility to all those who applied

before the deadline while the county can process

their application.

49

CoveredCA

I am receiving a lot of calls from people who have

IT problems, I would advise Covered California to

have a separate number for people to call to

resolve that problem then the service desk

number that hangs up on them all the time. They

say that when they can’t log in they are told to

contact a CEC to help resolve that issue which we

cannot because we are not IT for Covered

California. They are not even directed to their

security questions. We have encounter many

unpleasant insults do to this issue please resolve

SOON. They should be a way for someone to

retrieve their information linking their personal

email to their account.

Consumers have the ability to reset their

passwords directly online. In the event they are

still unable to do so they should contact the

Service Center for further assistance. They should

not contact CEEs or CECs for assistance with

login issues. They may contact CECs for

assistance in completing an application.