Resources, Tips, and Tools for Enrolling Ryan White HIV/AIDS Program Clients in Coverage

Resources, Tips, and Tools for Enrolling Ryan White HIV/AIDS Program Clients in Coverage

July 2014
ACE TA Center
ACE TA Center

This resource guide is for anyone helping Ryan White HIV/AIDS Program (RWHAP) clients apply for health insurance, particularly RWHAP staff who are helping clients through the entire enrollment process. It lists the enrollment steps and has links to resources, tips, and tools to help enrollment assisters with each step.

Look at the resources before working with clients. Most are for enrollment assisters, not clients.

resources, tips, and tools

Step 1: Get started
Step 2: Address client questions, concerns, and fears
Step 3: Fill in application
Step 4: Submit application
Step 5: Follow up on submitted application
Step 6: Use benefits
Step 7: Stay enrolled

Step 1: Get Started

Figure out what coverage a client should apply for and how the AIDS Drug Assistance Program (ADAP) can help.
tool icon Eligibility Decision Tree
Decide if client should enroll in the Marketplace, with Medicaid, or neither. See how ADAP fits with other coverage.
Source: ACE TA Center
resource icon ADAP Eligibility & Insurance Assistance Resources
List of weblinks for state ADAP programs, including formularies and cost assistance programs when available.
Source: ACE TA Center
tool icon Contact Information for State ADAP Programs
Links to contact information for state ADAP programs.
Source: TARGET Center
Find out how much financial help a client can get.
tool icon Coverage and Help Calculator
A calculator to see how much help a client can get for monthly insurance costs.
Source: Get Covered America
tool icon ACA Premiums, Subsidies and Eligibility Calculators
A collecton of calculators to see how much help a client can get for monthly insurance costs.
Source: TARGET Center
tool icon MAGI Calculators
A collecton of calculators to for calculating Modified Adjusted Gross Income (MAGI).
Source: TARGET Center

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Step 2: Address client concerns, questions, and fears.

Address RWHAP client concerns.
tool icon Common Questions and Suggested Responses for Engaging Clients in Health Coverage
Discussion guide for talking with RWHAP clients of color about enrollment questions.
Source: ACE TA Center
Understand concerns and outreach approaches for specific communities.
resource icon LGBT Cultural Competency and Enrollment
Guide for conducting culturally competent outreach and enrollment to LGBT communities.
Source: Community Catalyst
resource icon Specific Concerns for Native Americans
Summary of special benefits and considerations for Native Americans in the Marketplace.
Source: Healthcare.gov
resource icon Frequently Asked Questions for Latinos
Answers to questions often asked by Latinos about enrollment.
Source: Enroll America
resource icon Cultural Competency with the Latino Community
Guide for conducting culturally competent outreach and enrollment to Latino communities.
Source: Community Catalyst
resource icon Effective Messaging to the Latino Community
Guide for talking about enrollment with Latino communities.
Source: Enroll America
resource icon Outreach Guide for African and Afro-Caribbean Immigrant Communities
Guide for conducting outreach to African and Afro-Caribbean Immigrant Communities.
Source: Enroll America
resource icon Cultural Competence & Sensitivity Around the African American Community
Guide for conducting culturally competent outreach and enrollment to African American communities.
Source: Enroll America
resource icon Effective Messaging to the African American Community
Guide for talking about enrollment with African American communities. Source: Enroll America
Address immigration concerns/questions.
resource icon Eligibility for Families with Mixed Immigration Status
Information about immigrant eligibility for health insurance and how to reach immigrant groups.
Source: Enroll America
resource icon

Frequently Asked Questions: The Affordable Care Act & Mixed-Status Families
Includes 16 FAQs about immigrant eligibility for health insurance.
Source: National Immigration Law Center

resource icon What do Immigrant Families Need to Know About the Marketplace?
Summary of immigrant eligibility for Marketplace insurance & financial help, and Medicaid.
Source: Healthcare.gov
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Health Reform Issue Brief: Immigrants and the Affordable Care Act
Issue brief focusing on the impact of the ACA on immigrant populations, including people living with HIV.
Source: NASTAD

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Step 3: Fill in application.

Address language barriers.
resource icon

Plain Language Quick Reference Guide for Health Care Enrollment
A glossary of plain language terms for words often used during enrollment.
Source: ACE TA Center

tip icon Tip: Healthcare.gov and many state Marketplace websites have a Spanish version.
tip icon Tip: Clients can call 1‑800‑318‑2596 to get personal assistance and help in languages other than English
for Marketplace applications.
Gather required information and documents.
tip icon Tip: Experts agree that one-on-one assistance is most helpful. If possible, get enrollment assistance from clinics or other organizations that your client already goes to.
resource icon Find Out Who Might be Providing Assistance in Your State
Information on the types of organizations helping with enrollment assistance in your state.
Source: Centers for Medicaid and Medicare Services (CMS)
Get help with enrollment.
resource icon Required Information
A summary of income and household information needed to apply for insurance.
Source: Healthcare.gov
resource icon Required Documentation
A summary of documents needed to apply for Marketplace insurance. Note that some state Medicaid programs
may have additional requirements. See “Get more detailed help” for more information.
Source: Healthcare.gov
Choose a plan and fill in application.
tip icon Tip: Your state ADAP program may have HIV plan selection guides specific to your state.
See ADAP Eligibility and Insurance Assistance Resources.
tool icon Health Care Plan Selection Worksheet
A tool for listing a client's health and medication needs, health care providers, and plan options to help choose a plan.
Source: ACE TA Center
tool icon A Guide for LGBT People Choosing Healthcare Plans (Page 5)
Includes questions LGBT may want to consider when selecting a plan.
Source: Strong Families

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Step 4: Submit application.

Figure out where and how to submit the application.
resource icon Applying for Medicaid in Your State
Use the “Get State Information” drop-down to get contact information for your state Medicaid program.
Source: Healthcare.gov
resource icon Applying for the Marketplace
Choose a state from the drop-down to access its Marketplace application.
Source: Healthcare.gov
Get more detailed help.
resource icon Enroll America State Map with Links to Exchange Websites and Enrollment Assisters
Get the link to your state's Exchange Website. Find more information about enrollment funding and initiatives in your state.
Source: Enroll America
resource icon Topics to Consider When Assisting People with HIV to Enroll in Health Care Coverage
A fact sheet for enrollment assisters who don't have experience working with people living with HIV.
Source: ACE TA Center

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Step 5: Follow up on submitted application.

Track application status.
tip icon Tip: Be sure clients record their password and submission information to Marketplace and Medicaid enrollment websites. In many states clients can get information on their application status through the site or from a call center staff person.
tip icon Tip: Sometimes clients can authorize an enrollment assister to get information on their behalf.
tip icon Tip: For clients who move a lot or don't have an address, you may suggest they use the enrollment assistance site address for correspondence.
Appeal a decision.
resource icon Appealing a Marketplace Decision
Lists the kinds of Marketplace actions that can be appealed (asked to be reviewed), and the process. Note that Medicaid appeal processes vary from state to state. See “Get more detailed help” for more information for your state.
Source: Healthcare.gov

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Step 6: Use benefits.

Help RWHAP clients use health insurance to get the care they need.
resource icon ACA & Ryan White: Using Your New Coverage
Considerations for RWHAP clients to keep in mind when using their new coverage.
Source: TARGET Center
resource icon

Fact Sheet: So you have insurance! Now what?
Tips for consumers who are using health insurance for the first time.
Source: HIV Health Reform

resource icon

Fact Sheet: Have a New Health Plan? Here's How to Make Sure You Get Your Meds
Tips for consumers to make sure their medication coverage will not be interrupted using new health insurance.
Source: HIV Health Reform

resource icon

Exceptions and Appeals: Knowing Your Patients’ Rights
Fact sheet to help HIV providers assist their patients to challenge adverse health plan coverage decisions.
Source: HIV Medicine Association (hivma)

resource icon Speak Up!
This project monitors problems experienced by people with HIV in the new health care system and works to address them. You can report a problem with Speak Up! by clicking the “click here to report a problem” button on the project homepage.
Source: HIV Health Reform

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Step 7: Stay enrolled.

Report changes.
tip icon Tip: Remind clients that they are responsible for reporting changes to the Marketplace or Medicaid. Requirements for Medicaid vary by state. See “Get more detailed help” to find more information for your state.
tip icon Tip: Make a note of the Medicaid or private insurance renewal date so you can help clients re-apply (unless you are acting as a navigator, because navigators can't keep client information).
resource icon Report Changes to Marketplace
Summary of life and other changes that clients must report to the Marketplace if they are covered.
Source: Healthcare.gov
Talk to the client about when and how to renew coverage.
tool icon 2015 Marketplace Plan Renewal Deadlines and Flowchart
A guide including a timeline and key questions to guide the renewal process for 2015 coverage.
Source: ACE TA Center

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