NY STATE OF HEATH ASSISTOR CERTIFICATION TRAINING Module

NY STATE OF HEATH ASSISTOR CERTIFICATION TRAINING Module 5: The NY State of Health Application nystateofhealth. ny. gov 1

LEARNING OBJECTIVES By the end of this lesson, you will be able to: • Identify what information is entered into the portal and how it is entered. • Explain how to build the consumer’s household. • Explain how to build household income by each household member. • Explain how to complete additional questions for eligibility determination. • Describe the high-level process the portal engages in to determine program eligibility. nystateofhealth. ny. gov 2

ASSISTOR ROLE When scheduling appointments, let applicants know they need to provide the following information for each person in their household: • • • Social Security Number Document Numbers for Immigrants Birth Dates Employer and Income Information about any additional insurance available for the consumer and their family nystateofhealth. ny. gov 3

BEST PRACTICE • Explain to the applicant that you must ask every question exactly as it’s written, even if the question is something that they feel you should already know, such as gender. • Do not skip over any questions, even if they are listed as not required. • Explain that the NY State of Health is a secure system and that you are required to maintain confidentiality. • Do not answer questions based on assumptions or comments the applicant made earlier in the application. nystateofhealth. ny. gov 4

NY STATE OF HEALTH APPLICATION TIPS • Hover the question icon for explanatory text. • When entering information, do not add extra spaces after text. • When entering a number for income, do not include commas. • Be sure to always confirm spelling is correct. Don’t assume. • Capitalization matters. nystateofhealth. ny. gov 5

APPLICATION STEPS Step 1 • Identity Proofing Step 2 • Build Household Step 3 • Income Step 4 • Additional Information Step 5 • Eligibility Determination nystateofhealth. ny. gov 6

STEP 1: IDENTITY PROOFING & CONTACT INFORMATION • The first screen of the application asks for basic contact information for the account holder for the application. • All information that is entered for the consumer will be verified through a match with third party data sources. • Be sure to have correct spelling. • You must ask all questions, including gender. Note: In most cases a parent must be listed as the account holder even if the parent cannot pass electronic identity proofing. However, there are some exceptions. If the child/young adult is living on their own, if they are independent and not claimed as a dependent, then the Assistor may enter the child’s information as head of household. If needed, manually identity proof the young adult/child. nystateofhealth. ny. gov 7

ACCOUNT AND IDENTITY INFORMATION nystateofhealth. ny. gov 8

ACCOUNT AND IDENTITY INFORMATION – SOCIAL SECURITY NUMBER Applicants who have a SSN and are seeking coverage must provide their SSN in order to receive coverage through the NY State of Health. • This option “I do not wish to provide my SSN” can only be chosen due to religious reasons. • Parents can enroll their children in CHPlus without having a SSN or being legally documented. This is done by clicking the checkbox for “I don’t have one”. nystateofhealth. ny. gov 9

ACCOUNT AND IDENTITY INFORMATION – SOCIAL SECURITY NUMBER If a consumer does not have a Social Security Number, new questions are presented after selecting a reason for not having an SSN. nystateofhealth. ny. gov 10

ACCOUNT AND IDENTITY INFORMATION If “New York State Driver’s License” is selected, you will be required to enter the consumer’s driver’s license number. If “New York State DMV non-driver ID card” is selected, you will be required to enter the consumer’s non-driver ID card number. If “Client Identification Number (CIN)” is selected you will be required to enter the consumer’s CIN. nystateofhealth. ny. gov 11

HOME AND MAILING ADDRESS nystateofhealth. ny. gov 12

TELEPHONE NUMBERS nystateofhealth. ny. gov 13

CONTACT PREFERENCE nystateofhealth. ny. gov 14

EXPERIAN DATABASE VERIFICATION nystateofhealth. ny. gov 15

IDENTITY NOT FOUND Review information on screen for accuracy with the applicant. Message will also appear to direct applicants to call the Contact Center. nystateofhealth. ny. gov 16

IDENTITY PROOFING ALTERNATIVE OPTIONS • Use or create a DMV account for the applicant or • Contact the NY State of Health Customer Service Center to access previous public health care coverage records or • Request Identity Verification form from the NY State of Health Customer Service Center. Applicant completes the form and submit to NYSOH with appropriate documents. Applicants who don’t have a SSN may have to use the paper ID proofing process. nystateofhealth. ny. gov 17

ACCOUNT AND IDENTITY INFORMATION VERIFIED nystateofhealth. ny. gov 18

APPLICATION STEPS Step 1 • Identity Proofing Step 2 • Build Household Step 3 • Income Step 4 • Additional Information Step 5 • Eligibility Determination nystateofhealth. ny. gov 19

STEP 2: BUILD HOUSEHOLD nystateofhealth. ny. gov 20

STEP 2: ENROLLMENT PERIODS APPLICATION nystateofhealth. ny. gov 21

STEP 2: BUILD HOUSEHOLD nystateofhealth. ny. gov 22

STEP 2: BUILD HOUSEHOLD nystateofhealth. ny. gov 23

STEP 2: BUILD HOUSEHOLD The applicant must provide information about everyone in the household. This includes: • Anyone who is listed on their tax return • Spouse, if married • Children who are dependents of the consumer • Qualifying relative nystateofhealth. ny. gov 24

STEP 2: BUILD HOUSEHOLD Non-Tax Filer Rules: Non-tax filers follow different household composition rules than tax filers. Adults: The household size is the individual and, if living together, spouse and children who are under 19, or 19 & 20, if a full time student (natural, adopted, step). Under age 19, or 19 & 20, if full time student: The household is the individual and, if living together, their parents (natural, adoptive, step) and siblings (natural, adoptive, step under 19 or 19 & 20 if full time student). Consumers who do not file taxes should let the NY State Of Health know the names of the parents, step-parents, spouse, children and siblings of the person who wants health insurance (if living together), even if those individuals are not applying. nystateofhealth. ny. gov 25

SCENARIO - THE REYNOLDS FAMILY Sandra is completing an application in the NY State of Health with you: • She is married to Dennis. They have two children, Charlie and Makenzie. • She has a yearly income of $24, 000. • Dennis earns $22, 000/year. What will be the Reynolds’ family household size? • They are all applying for health insurance. nystateofhealth. ny. gov 26

SCENARIO - THE ESPINOSA FAMILY Alma and Martin are looking for coverage for themselves and their granddaughter, Zoe. They are married and file their taxes jointly. Their granddaughter, Zoe, lives with them and is claimed as a dependent. What will the NY State of Health calculate the family’s household size to be? Alma is 57 and earns $37, 000/year. Martin is 58 and not currently working. Zoe is 18 earns $6, 700/year. nystateofhealth. ny. gov 27

SCENARIO - THE KWONG FAMILY Mei and David are domestic partners who are completing a NY State of Health application with you. They have one child in common, Jessie, who is 4 years old. David earns $23, 000/year and does not file taxes. What will the NY State of Health calculate the household size to be for Mei, David and Jessie? Mei earns $40, 000/year. She files taxes and claims Jessie as a dependent. nystateofhealth. ny. gov 28

STEP 2: BUILD HOUSEHOLD nystateofhealth. ny. gov 29

CITIZENSHIP AND IMMIGRATION US Citizen: Person born in the U. S. (or certain territories) or has at least one parent who is a US citizen or has gone through the naturalization process. Naturalized Citizen: Person who was not born in the United States voluntarily becomes a U. S. Citizen. Immigrant Non-Citizen: Person who lives and works in the United States with the permission of the United States Citizenship and Immigration Services (USCIS). Non-Immigrant Visa Holder: Person with short-term visas such as tourists, foreign students, or temporary workers. Other: This box should be used if the person is not a U. S. citizen or does not have a valid immigration status or visa. nystateofhealth. ny. gov 30

IMMIGRATION DOCUMENTS I-551 Permanent Resident Card I-688 B or I-766 Employment Authorization Card nystateofhealth. ny. gov 31

IMMIGRATION DOCUMENTS I-94 Arrival/Departure Card nystateofhealth. ny. gov I-797 Notice of Action 32

RACE AND ETHNICITY nystateofhealth. ny. gov 33

RACE AND ETHNICITY • Answering this section is optional, but should not be skipped over. • Read the question to the consumer exactly as it is written. • It is helpful to obtain this information to assess if and how different communities are accessing the NY State of Health. nystateofhealth. ny. gov 34

ADDITIONAL INFORMATION SCREEN nystateofhealth. ny. gov 35

GENDER SPECIFIC QUESTIONS All women of child bearing age (10 to 65) are asked to identify if they are pregnant. • If yes, consumer must indicate the number of children expected anticipated due date. • This question may affect program eligibility, and could help women receive more affordable benefits. nystateofhealth. ny. gov 36

AGE SPECIFIC QUESTIONS Full time student status is only a factor when a 19 or 20 year old falls under non-tax filer rules when determining household composition (household size). College students living at a different address than family’s home have a choice as to where they would like to apply for health insurance. Parent must be account holder. Parents’ income is counted. College student’s income would count if they earn enough to meet the earned income threshold for a tax dependent. nystateofhealth. ny. gov 37

AGE SPECIFIC QUESTIONS These questions, in conjunction with the age of the consumer, will impact Medicaid Eligibility. nystateofhealth. ny. gov 38

AMERICAN INDIAN/ALASKA NATIVE All consumers who mark “Yes” to this question will be asked to identify which federally recognized tribe they belong to. nystateofhealth. ny. gov 39

DISABILITY STATUS SCREENS Consumer’s answers to these questions may categorize them as non-MAGI, resulting in a referral to Local Department of Social Services or Human Resource Administration. nystateofhealth. ny. gov 40

DISABILITY STATUS SCREENS nystateofhealth. ny. gov 41

DISABILITY STATUS SCREENS nystateofhealth. ny. gov 42

RECENT MEDICAL EXPENSES This question is asked for Medicaid retroactive coverage. nystateofhealth. ny. gov 43

HOUSEHOLD RELATIONSHIPS When defining household relationships in the NY State of Health, relationships must be reciprocal and matching. Sandra Dennis Mackenzie and Charlie nystateofhealth. ny. gov 44

HOME ADDRESS nystateofhealth. ny. gov 45

HOME ADDRESS nystateofhealth. ny. gov 46

HOME ADDRESS The NY State of Health allows applicants who indicate they have no fixed address to only indicate city and county for their residence address. nystateofhealth. ny. gov 47

HOME ADDRESS The NY State of Health allows participants in the address confidentiality program to use a PO Box as their residential address. nystateofhealth. ny. gov 48

OUT OF STATE RESIDENTS There are certain circumstance when an out of state resident may apply in NY State of Health. This could be if they are: • Moving to NY State within 90 days for employment or seeking employment. This application will pend (up to 90 days) until the applicant has a NY State residence address. • A full time student who may live out-of-state if their permanent address is in NYS. nystateofhealth. ny. gov 49

IDENTITY PROOFING – DEATH MATCH nystateofhealth. ny. gov 50

HOUSEHOLD SUMMARY nystateofhealth. ny. gov 51

OTHER PUBLIC HEALTH COVERAGE If a consumer is listed as enrolled in a public health insurance program, they will be presented with this question, which asks them if they are currently enrolled in public coverage. nystateofhealth. ny. gov 52

HOUSEHOLD COMPOSITION ACTIVITY Objective 1: Each group should identify what type of questions they will get from the applicant and the answers you will provide to help determine who should be included on the application. Objective 2: The group should be able to explain why they answered the way they did. Objective 3: Be able to answer household composition rules for the provided assumptions. nystateofhealth. ny. gov 53

APPLICATION STEPS Step 1 • Identity Proofing Step 2 • Build Household Step 3 • Income Step 4 • Additional Information Step 5 • Eligibility Determination nystateofhealth. ny. gov 54

INCOME INFORMATION nystateofhealth. ny. gov 55

HOUSEHOLD INCOME - TAX STATUS In the first section of building household income, the applicant must indicate their tax status. This is how they plan to file their taxes for the year. • Single • Married filing single • Head of Household (with qualifying individual) • Qualifying widow(er) with dependent child • (Name) is a dependent and will be filing taxes • (Name) will not be filing taxes • Married filing jointly nystateofhealth. ny. gov 56

HOUSEHOLD INCOME – TAX STATUS • Consumers must attest to filing taxes for the upcoming year to be eligible for tax credits. • Filing taxes is not a requirement of CHPlus, Medicaid, Essential Plan or full pay QHPs. • It’s important to enter tax status correctly, as this directly impacts program eligibility. • Remember, information entered in the NY State of Health application is verified through a match with 3 rd party data sources. • Tax status and income information is verified through the IRS records of the applicant’s last year’s tax return. nystateofhealth. ny. gov 57

TAX STATUS nystateofhealth. ny. gov 58

HOUSEHOLD INCOME INFORMATION nystateofhealth. ny. gov 59

INCOME FROM JOB nystateofhealth. ny. gov 60

ADDING INCOME SOURCE nystateofhealth. ny. gov 61

INCONSISTENT/SEASONAL INCOME nystateofhealth. ny. gov 62

INCOME -TAX FORMS 1099 Form W-2 Form nystateofhealth. ny. gov 63

SELF-EMPLOYMENT INCOME nystateofhealth. ny. gov 64

UNEMPLOYMENT BENEFITS nystateofhealth. ny. gov 65

ADDING UNEMPLOYMENT INCOME nystateofhealth. ny. gov 66

SOCIAL SECURITY BENEFITS nystateofhealth. ny. gov 67

ADDING SOCIAL SECURITY INCOME nystateofhealth. ny. gov 68

DEPENDENT INCOME AND TITLE II (SOCIAL SECURITY INCOME) Under MAGI rules, the income of a child or tax dependent who is not required to file a tax return is not included in the household income. • The income threshold for dependents for tax year 2015 is $6, 300 for earned income and $1, 050 for unearned income. • The unearned income threshold of $1, 050 does not apply to Title II Social Security income including Social Security income a dependent receives due to a disabled or deceased parent. • The income filing threshold varies each year and can be found on the Internal Revenue Service (IRS) website, www. IRS. gov. nystateofhealth. ny. gov 69

ADDITIONAL INCOME nystateofhealth. ny. gov 70

ADDING ADDITIONAL INCOME nystateofhealth. ny. gov 71

DEDUCTIONS nystateofhealth. ny. gov 72

ADDING A DEDUCTION nystateofhealth. ny. gov 73

PAST INCOME nystateofhealth. ny. gov 74

CURRENT VS. YEARLY INCOME nystateofhealth. ny. gov 75

CURRENT VS. YEARLY INCOME nystateofhealth. ny. gov 76

INCOME SUMMARY nystateofhealth. ny. gov 77

DATA SOURCES FOR INCOME Federal Tax Information IRS Department of Labor Unemployment Title II – Social Security Income Social Security Administration Department of Tax & Finance New Hire / Wage Reporting nystateofhealth. ny. gov 78

INCOME DISCREPANCIES If there is an income discrepancy, the NY State of Health notifies the applicant and gives them the opportunity to select a reason for the discrepancy. nystateofhealth. ny. gov 79

ABSENT PARENT INFORMATION nystateofhealth. ny. gov 80

THE REYNOLDS FAMILY What will the NY State of Health calculate Sandra’s household income to be? Sandra is completing an application in the NY State of Health with you: She is married to Dennis. They have two children, Charlie and Makenzie She has a yearly income of $24, 000 Dennis earns $22, 000/year Everyone’s household size: 4 They are all applying for health insurance nystateofhealth. ny. gov 81

THE ESPINOSA FAMILY What will the NY State of Health calculate Alma’s and Martin’s household income to be? What is Zoe’s household Income? Alma and Martin are looking for coverage for themselves and their granddaughter, Zoe. They are married and file their taxes jointly. Their granddaughter, Zoe, lives with them and is claimed as a dependent. Martin’s household: 3 Alma is 57 and earns $37, 000/year. Martin is 58 and not currently working. Zoe is 18 earns $6, 700/year. Zoe’s household: 1 nystateofhealth. ny. gov 82

THE KWONG FAMILY What will the NY State of Health calculate David’s and Mei’s household income to be? What is Jessie’s household income? Mei and David are domestic partners who are completing a NY State of Health application with you. They have one child in common, Jessie, who is 4 years old. David earns $23, 000/year and does not file taxes. David’s household: 2 Mei earns $40, 000/year. She files taxes and claims Jessie as a dependent. Mei’s household: 2 Jessie’s household: 3 nystateofhealth. ny. gov 83

APPLICATION STEPS Step 1 • Identity Proofing Step 2 • Build Household Step 3 • Income Step 4 • Additional Information Step 5 • Eligibility Determination nystateofhealth. ny. gov 84

OTHER COVERAGE nystateofhealth. ny. gov 85

OTHER COVERAGE nystateofhealth. ny. gov 86

OTHER COVERAGE nystateofhealth. ny. gov 87

OTHER COVERAGE nystateofhealth. ny. gov 88

EMPLOYER SPONSORED COVERAGE If an applicant has access to affordable health insurance through an employer, he/she will be ineligible for Essential Plan or tax credits through the NY State of Health. • Affordable Coverage: Employer-sponsored coverage that meets Minimum Value Standard (60% AV or greater) and costs less than 9. 69% of the household income for employee-only coverage. • If an individual has employer sponsored coverage, they could be eligible for Medicaid. If cost effective for Medicaid, the NY State of Health will pay the employees share of employer sponsored coverage. nystateofhealth. ny. gov 89

NON INCOME FACTORS: IMMIGRATION Immigrant non-citizen and Non-immigrant visa holders are Non-U. S. Citizens who have permission to live or work in the United States. Residency Test: To be eligible for Medicaid, Essential Plan, Child Health Plus or QHP in New York State, an immigrant must meet several criteria, that include, but are not limited to: Lawful presence in the United States; or a certain PRUCOL classification; and Must Reside in New York State; or Must be moving to New York State within 90 days for a job. If the person is moving to NY for a job, they will need to complete and submit their application once they move to New York and have an address in New York. Students, depending on their circumstances, may be residents. Certain visitors and tourists that do not meet the New York State residency requirements, but are otherwise Medicaid eligible may be eligible for the treatment of an Emergency Medical Condition nystateofhealth. ny. gov 90

INCARCERATION Question appears when data sources indicate that the applicant may be in jail or prison. *In this case, Grace is attesting that she is not currently incarcerated. nystateofhealth. ny. gov 91

INCARCERATION Question appears when data sources do not indicate that any household member is incarcerated. *In this case, Marla has indicated that she is incarcerated, and will need to complete the additional information fields. nystateofhealth. ny. gov 92

ADDITIONAL QUESTIONS nystateofhealth. ny. gov 93

APPLICATION SUMMARY nystateofhealth. ny. gov 94

VOTER REGISTRATION NY State of Health is required to provide voter registration services at the application, at annual renewal or at change of address. • Voter registration will not affect the consumer’s enrollment. • Whether an individual decides to register to vote through the NY State of Health will remain private. • Assistors cannot offer any incentive to have someone register to vote. • NY State of Health will not determine who is eligible to vote. You should ask everyone if they are interested in registering. nystateofhealth. ny. gov 95

Terms, Rights & Responsibilities nystateofhealth. ny. gov 96

TERMS, RIGHTS &RESPONSIBILITIES • The consumer must initial for each member of their household, electronically signing and indicating that they agree to have everyone's data used to complete the application process. • At this point the consumer can download a PDF copy of the “Terms Rights and Responsibilities, ” if they choose. nystateofhealth. ny. gov 97

TERMS, RIGHTS &RESPONSIBILITIES nystateofhealth. ny. gov 98

APPLICATION STEPS Step 1 • Identity Proofing Step 2 • Build Household Step 3 • Income Step 4 • Additional Information Step 5 • Eligibility Determination nystateofhealth. ny. gov 99

ELIGIBILITY DETERMINATION Medicaid Essential Plan Child Health Plus Qualified Health Plan with Advanced Premium Tax Credit and Cost Sharing Reduction Full Pay Qualified Health Plan nystateofhealth. ny. gov 100

ELIGIBILITY CHECK NY State of Health Programs Medicaid Essential Plan 1 & 2 Essential Plan 3 & 4 US Citizen / Lawfully Residing Residents x x x NYS Resident x x x EP 1: Income greater than 150% to 200% of the FPL EP 3: 100% to 138% of the FPL EP 2: above 138% to 150% of the FPL EP 4: at or below 100% of the FPL Eligibility Criteria Up to 138% of the FPL for adults Income Requirements FPL Up to 154% of the FPL for children ages 1 -18 Up to 223% of the FPL for pregnant women and children under the age of one Medicaid Emergenc y Services Only x QHP w/ APTC & CSR Full Pay QHP x x x x Subsidized premiums are available under 400% of the FPL Above 200% to 400% FPL *Married couple must file jointly Above 200% to 250% *Married couple must file jointly CHPlus Up to 138% of the FPL for adults Up to 154% of the FPL for children ages 1 -18 Up to 223% of the FPL for pregnant women and children under the age of one nystateofhealth. ny. gov No Income requiremen t 101

ELIGIBILITY DETERMINATIONS nystateofhealth. ny. gov 102

ELIGIBILITY DETERMINATIONS nystateofhealth. ny. gov 103

ELIGIBILITY DETERMINATIONS nystateofhealth. ny. gov 104

RETROACTIVE MEDICAID DETERMINATIONS nystateofhealth. ny. gov 105

VERIFICATION DOCUMENTS NEEDED nystateofhealth. ny. gov 106

SPECIAL ENROLLMENT PERIODS nystateofhealth. ny. gov 107

REASONABLE COMPATIBILITY Outcomes of the NY State of Health Data Sources Check: • Exact Data Match = No action required • Reasonable Compatibility = No Documentation Needed • Eligibility Not Affected = No Documentation Needed • Eligibility Affected = Supporting Documentation May be Needed nystateofhealth. ny. gov 108

VERIFICATION DOCUMENTS When documentation is required, it must be received prior to the due date provided on the eligibility determination. • Verification Documents must be provided by one of the following methods • Upload* • Fax • Mail nystateofhealth. ny. gov 109

DOCUMENTS CLOCKS Medicaid Income – 15 days from the date consumer receives the notice. • No Enrollment CHPlus Income – May enroll with a higher premium pending income documentation Essential Plan Income – 90 days from the date consumer receives the notice • May enroll using previous tax data APTC / CSR Income – 90 days from the date consumer receives the notice • May enroll using previous tax data nystateofhealth. ny. gov 110

DOCUMENTS CLOCKS • SSN – 90 days from the date consumer receives the notice • Citizenship – 90 days from the date consumer receives the notice • American Indian/Alaskan Native – 90 days from the date consumer receives the notice o Documentation required for APTC/CSR As a Assistor, you will need to make sure that you completely read every message regarding documentation. Not all messages will be the same, since many programs have different requirements. nystateofhealth. ny. gov 111

HOUSEHOLD CHANGES All household changes must be reported to the NY State of Health. This includes: o Address change o Income changes o Adding a dependent due to birth, adoption, placement in foster care o Marriage/divorce Consumers can make changes to their account by: o Meeting with an Assistor o Logging in to their account o Contacting the NY State of Health Customer Service Center Remember, Medicaid and CHPlus have 12 months of continuous coverage, so a consumer who is enrolled in either program will not lose coverage because of an increase in income reported during the continuous coverage period. nystateofhealth. ny. gov 112

NY STATE OF HEALTH RENEWALS The Marketplace must re-determine the consumer’s eligibility each year. This is a requirement of the Affordable Care Act (ACA) to ensure that consumers are receiving the appropriate coverage based on any changes that have occurred throughout the year or that may occur in the upcoming year. • Consumers enrolled in Medicaid/CHPlus/Essential Plan will receive a renewal notice 60 -90 days prior to the end date of their current coverage. • Consumers enrolled in a Qualified Health Plan will receive a notice 45 days prior to the end date of their current coverage. • To ensure that consumers do not experience a gap in coverage, they must renew no later than the 15 th of the month that the coverage ends. nystateofhealth. ny. gov 113

NY STATE OF HEALTH RENEWALS There are three types of renewals: Administrative, Partial Administrative and Manual. An Administrative renewal allows the Marketplace system to determine the consumer’s eligibility for the upcoming year of coverage. As part of the Administrative Renewal process, the Marketplace checks Federal and State data sources to collect the information necessary to re-determine eligibility for the upcoming year. If consumers do not agree with their Administrative Renewal decision, they will be able to update their application following the Manual Renewal process up to the 15 th day of the month during which their current eligibility ends. This will ensure that the consumer does not experience a gap in coverage. nystateofhealth. ny. gov 114

NY STATE OF HEALTH RENEWALS Auto-Enrollment - eligibility has been automatically determined by the Marketplace and consumers are enrolled in their plan without any further action required on behalf of the consumer/household. • Eligibility for auto enrollment is based on the consumer’s current and proposed eligibility. • Auto-enrolled Qualified Health Plan consumers will be enrolled in the same plan, tier, and metal level for the upcoming year. • Consumers can switch Qualified Health Plans during Open Enrollment even if they were auto-enrolled. nystateofhealth. ny. gov 115

NY STATE OF HEALTH RENEWALS Partial Administrative Renewal - eligibility has been automatically determined by the Health Plan Marketplace and consumers must come back to their Marketplace accounts to select a health plan to complete their renewal. • To avoid a gap in coverage, a health plan must be selected by the 15 th day of the month during which the current coverage ends. • The consumer could have to come back to select a health plan for the following reasons: o Change in program eligibility from Medicaid to CHPlus, Qualified Health Plan to Medicaid, etc. o Age out of current health plan (CHPlus). o Plan not available in the upcoming year. nystateofhealth. ny. gov 116

NY STATE OF HEALTH RENEWALS Manual Renewal – If NY State of Health is unable to verify data and determine eligibility, the consumer will need to manually log in to the NY State of Health account or call the Customer Service Center to update the account. When one or more household members do not have a SSN, is pregnant, PRUCOL, or eligible only for Emergency Medicaid, the household will follow the manual renewal process. Manual Renewals will not be auto-enrolled. Once eligibility has been re-determined through the manual process, the consumer should proceed to plan selection to choose the health plan they would like to enroll in for the upcoming coverage year. Note: Some household members may need to submit new verification documents to complete the renewal process. nystateofhealth. ny. gov 117

THE REYNOLDS FAMILY What will each family member’s eligibility determination be? Everyone’s household size: 4 Everyone’s household income: $46, 000 Sandra’s Eligibility: Essential Plan 1 Dennis’s Eligibility: Essential Plan 1 Charlie’s Eligibility: Subsidized CHPlus Makenzie’s Eligibility: Subsidized CHPlus nystateofhealth. ny. gov 118

THE ESPINOSA FAMILY What will each family member’s eligibility determination be? Alma’s and Martin’s HH: 3 - Income: $43, 700 Zoe’s HH: 1 - Income: $6, 700 Martin’s Eligibility: QHP with APTC and CSR Alma’s Eligibility: QHP with APTC and CSR Zoe’s Eligibility: Medicaid nystateofhealth. ny. gov 119

THE KWONG FAMILY What will each family member’s eligibility determination be? David’s HH: 2 - Income: $23, 000 Mei’s HH: 2 - Income: $40, 000 Jessie’s HH: 3 – Income: $63, 000 David’s Eligibility: Essential Plan 2 Mei’s Eligibility: QHP with APTC Jessie’s Eligibility: Subsidized CHPlus nystateofhealth. ny. gov 120

HOUSEHOLD COMPOSITION ACTIVITY • Determine HH income • Federal Poverty Level Percentage • Program Eligibility Determination nystateofhealth. ny. gov 121

WHAT QUESTIONS DO YOU HAVE? nystateofhealth. ny. gov 122