Hi we’re live today
from the Health Care Authority for our
first COFA Islander Health Care program
Facebook live event. My name is Francesca Matias.
I am a medical program
specialist with the Office of Medicaid
Eligibility and Policy at the Health
Care Authority. I am joined by Ari Pyrtek
and Shaunie McLeod, who are our program
managers for the COFA Islander Health Care program.
Today for about the next
hour or so we will be discussing the program
and answer any questions you may
have so please feel free to submit your
questions as we go along and we will
answer as many as we can So before, we�ll go
and get started with some questions and go from there.
So Ari what exactly is
the COFA Islander Health Care program.
Compact of Free Association or in COFA Islander Health Care
as a program offered by the Washington
State Health Care Authority to help COFA Islanders pay
for their insurance premiums and
out-of-pocket costs for silver-level qualified
health plans that are purchased through Washington Healthplanfinder.
Okay and Shaunie what’s the difference
between COFA Islander Health Care and an insurance plan?
I know there’s some confusion
between the two. so sure so COFA Islander
Health Care is a sponsorship program
and it does pay for the monthly insurance
premiums and out-of-pocket expenses
for enrolled COFA Islanders. It’s different
from the actual insurance plan. The
insurance plan is what you will select
when you enroll in the program and that
is what you use when you go for
doctor’s visits or pick up a prescription or something along those lines. So
who’s eligible for this program? Individuals from
COFA Islands so that is the Federated States of Micronesia, the Republic
of the Marshall Islands, and the
Republic of Palau. So Washington residents from those countries are eligible to apply.
There are income limits so
people have to have household income
under 133 percent of the federal poverty level.
Individuals applying cannot
have other minimum essential coverage,
so that’s for example like employer sponsored
insurance or Medicare. They must
file taxes to be eligible for
advanced premium tax credits that are applied to a silver-level qualified
health plan. So you say they must file so even individuals who have zero income?
That’s Correct. Okay. And so Shaunie, how
and when can an individual apply
for this program? Well right now we are
in open enrollment. Open enrollment goes
until December 15, so this is the best
time for somebody to apply for the program. There are several ways that
one can go about applying for COFA
Islander Health Care. You can apply online at wahealthplanfinder.org.
You can download the WAPlanfinder
mobile app through either the Google
Play Store or the iPhone store the Apple Store.
You can also sign up by
calling 1-855-923- 4633 and through that phone number
you can receive assistance and apply
for the program. And one other possibility
is by submitting a paper application
that can either be sent in by mail or fax.
Great, so Ari, you had mentioned that this is a sponsorship program
and the Health Care Authority pays for
out-of-pocket costs. So how does someone
pay those who is enrolled in the
program, do they pay first, get reimbursed?
Can you kind of explain that process.
Yeah so once somebody is enrolled
in COFA Islander Health Care they will
be sent, it looks like a debit card
from the vendor Navia Benefit Solutions and
that card is what is used to pay for
out-of-pocket costs. There are two versions
of the card. One that was sent last
year has the Navia logo on it, the other
version that has been sent since February
of this year has the COFA Islander Health Care logo.
Each card is loaded with
a preset amount of 300 dollars to pay
for things like co-pays, prescriptions,
deductibles, coinsurance and then
that card is used at the doctor’s
office for covered services through an insurance plan.
Okay and the 300 dollar
amount, so if someone doesn’t use any or
all of it does it carry over, does it get
added to, how does that work? Yeah it does carry over.
Funds are not added, so for
example one month you don’t spend any
you don’t get an additional 300 it’s
just 300 for the next month. Another
way to look at that is if somebody’s
just spent $100 in a particular month and
had $200 at the end, $100 would be added
to bring that card back up to 300. Another point I just
wanted to make sure of is that each person
enrolled in the program will receive a card.
So if there’s two people
in a household that are enrolled in COFA
Islander Health Care, each person will
have their own card. Oh okay great, I
want to go back to something really quick.
You had mentioned that an individual
cannot have other minimum essential coverage.
So does that also include the Apple
Health program? That’s correct. Yeah Apple Health
medical care services, those are other
programs that if an Individual, a COFA
islander has, they could not have COFA Islander Health Care.
Okay and so this program
is really aimed for 19 and over population correct?
Yeah that’s correct, so
individual COFA Islanders that are
under the age of 19 may be eligible for
Apple Health for Kids depending on
other eligibility Criteria. So how can
someone contact you guys to know more
about the program, to apply, general questions.
Well we have a few different ways
that our clients can contact us for
assistance and please don’t ever hesitate
to reach out if you have questions or issues.
We’re more than willing to help. You
can reach us via the website at hca.wa.gov/COFA and through this website
you can also access our outreach toolkit
which has some really great and
valuable resources that will help explain the
program a little bit more. We also
have an email inbox that’s dedicated to
our COFA Islander Health Care program and that is [email protected]
We also have a dedicated toll-free line.
That number is 1-800-547-3109. And there are always
opportunities to speak to us if you need
help please please reach out we’re more
than willing to help. So I’m kind
of monitoring this screen. I’m not
seeing any questions coming in right now.
So this is our second open enrollment?
Yes this is our second open enrollment.
Great so we have some common questions
or scenarios we’ve run into right? So
maybe we can just go over some of those
and these are all fake names right and
but also common scenarios that we’ve seen.
Yes so so the first scenario, I
got a bill for my premiums, Maple enrolled in a silver-level qualified
health plan and has been approved for
COFA Islander Health Care. She receives
a bill from her insurance plan for
her monthly premium and is concerned
because she has an appointment next week.
Should she pay that bill? No, Maple
should not pay that bill. The Health Care
Authority pays the monthly premiums directly to the insurance plans on a
monthly basis. The bills that each COFA
islander receives on the program are
for their records only So the second scenario
Maple enrolled in a silver-level
qualified health plan and is approved
for COFA Islander Health Care. She went
to the hospital and gave them her insurance
information and later receives a
bill for two hundred and twenty five dollars.
What steps should she take? Well
Maple should take a few steps in order
to take care of this situation. First she
needs to confirm that her insurance
plan has paid for their part of the
bill and then she can use the cost-sharing
card for the remainder of the
bill, which is the patient responsibility.
So that’s the Navia card that
she would use to pay the remainder of the bill. Okay so scenario
three a very common scenario. Barry is
enrolled in COFA Islander Health Care
and keeps checking his mail for his
insurance card and cost-sharing card but
they never come so what steps should Barry take?
There are a couple steps that Barry
should take. The first one is to
make sure that his address is correct in Washington Healthplanfinder.
That is the basis of how the insurance
plan gets his address to mail cards and
how we also get the address to mail the
cost-sharing card or the Navia card. After
that if it is his insurance plan that he needs the replacement cards
for, he can contact them directly. For the Navia or cost-sharing card he
can call us at one eight hundred five
four seven three one zero nine and request
a replacement card. Okay moving on Barry
is selecting his silver-level qualified
health plan in the Washington Healthplanfinder.
He needs to go to the
dentist and sees that he can also choose
a qualified dental plan. Can he get dental insurance?
Yes he can however he will be
responsible for the dental premiums and
out-of-pocket costs. Dental insurance
is not currently covered by the COFA
Islander Health Care program. So our next scenario,
June has COFA Islander Health Care and applies for cash assistance with
Department of Social and Health Services. After her cash assistance application
is approved, she receives a letter
that states her COFA Islander Health Care
has ended because she has other coverage.
So why did this happen? So when COFA Islanders submit an application through
DSHS for cash assistance, if approved for cash assistance through
the aged, blind, disabled or housing
and essential needs program they are
also reviewed for a program called medical
care services. And when they are approved
for medical care services they are no
longer eligible for COFA Islander Health Care.
What that means is that the
Health Care Authority will no longer pay
the monthly premiums and out-of-pocket costs.
However if the COFA islander would
like to remain enrolled in the plan, that would be their responsibility to pay.
From the Health Care Authority or
from DSHS they will receive a ProviderOne
card that goes along with medical
care services to use if they would like to end their qualified health plan.
So we just had a question come in. It
says I have a child who was on Apple
Health and is a COFA Islander. She turned
19 years old, will she receive a
letter that she has to apply for COFA
Islander Health Care now? So when she turns 19, she would go
through the renewal process for Apple
Health and then if at that point she was
determined ineligible for Apple Health. She
may be eligible for COFA Islander Health
Care and may be able to enroll in a silver
plan at that time and have that plan
sponsored by the Health Care Authority. Great, thank you and
thank you for the question. That’s a
great question. Back to the scenarios.
I don’t see any other questions coming in.
So Oak had Washington Apple
Health pregnancy medical and had her baby in July.
She renews her medical
coverage but it will end in September. She
wants to keep free insurance after the
Apple Health ends. Can she enroll in COFA
Islander Health Care? Yes, so yes she if
she continues to meet all of the
eligibility requirements including enrolling
in that silver level Plan. She will be
granted a special enrollment period that
will allow her to enroll in the QHP due to the end of the
Apple Health. So this is our last scenario.
Oak enrolled in a qualified health
plan that starts September 1st and is
approved for COFA Islander Health Care.
She goes to the doctor on September 4th and
tells her doctor she has COFA but the
doctor says she doesn’t have insurance.
What are her next steps? I think this
is kind of a common thing we see as well. Yeah so when somebody
who has COFA Islander Health Care
goes to the doctor, what they want to
say is I have blank health plan instead
of I have COFA. That’s just the
vehicle to pay for a qualified health plan.
So that’s the first step, is to
make sure that the doctor knows which
plan that they have and then the second
one is to double check that the
doctor that they are going to accept the
insurance that they have. I’m just trying
to monitor to see if any questions are coming in.
Doesn’t look like it. Okay one
thing I wanted to bring up is that so
when somebody first enrolls in COFA Islander
Health Care. They want to be on the
lookout for some mail. The first thing is
a package of mail from the insurance
plan that they picked. In that will be
their cards and a welcome booklet from them.
The second is a plain white envelope
with the Navia benefit solutions or
cost-sharing card. That’ll again come
in a plain white envelope and then the
third is a welcome booklet from us and
then in this booklet there’s a lot of really helpful Information. There are
the phone numbers for all of the plans
so if you lost your card but know your
carrier you can look in here and give them a call.
The other thing that is in here
is what to do if you lost your Navia
card or what to do if you need more money
put on your card because you have a larger bill.
So that’s the other thing to be
on the lookout for. This is also on our
hca.wa.gov/cofa website so if by
chance this gets misplaced because I
know you know it’s just one little booklet here.
That’s online as well. And
now Shaunie you mentioned it’s currently
open enrollment. Are there any enrollment
events coming up that are specific to the COFA Islander population?
Yes so we keep a calendar on our website at hca.wa.gov/COFA and
on that calendar it highlights all of the
events that we are we’re aware of
that are occurring throughout the state
that gives an opportunity for COFA
Islanders to go in person together as a
group if they wish and go through and apply with a Navigator. There
are other ways, as we mentioned before
to apply and one thing that’s really
important to note is don’t you don’t have
to wait for any event to sign up for the program.
All of the different ways
to apply online, in person, via paper
application or phone will do the same
thing for you so you don’t have to wait
for an event if you can’t make it to an event.
That’s okay there are other
opportunities to apply. So no questions are
coming in which is Okay. That’s fine. What
are some some last things want to share
to the to the viewers about the
program maybe some like takeaways we’ve
gotten from the last year. One right
now again it’s open enrollment time so
this is the time to submit your application
or if you are currently enrolled
in COFA Islander Health Care but
realize the plan you picked for this year
isn’t the one you want to have moving forward.
This is your time to change your
plan for next year. So the same ways you
can call, go online, the mobile app, those
are all valid ways to change your plan
if you weren’t happy with your plan for this year.
That’s one take away again I think Shaunie made
a really good point of don’t wait to apply.
There are a lot of people ready to
help and willing and ready to help apply
and help you enroll in a plan. The other
point I guess is make sure you have
both of your cards if you don’t we’re here to help you navigate and make
sure you have both of your cards because
we want to�when you go to the doctor
for your regular regular checkup or
if you have a bigger health need that you
have both of those cards ready and
there’s no delay in getting you the care
that you need. And again with the plans
themselves it’s also a really important
part to make sure that the providers
that you want to see are covered under your plan because if they’re
out-of-network then the cost sharing card
won’t work and the insurance won’t pay for it. So very important
to check with your providers and when
you go to select a plan. Yeah I just thought
of the question. So what about so
individuals who are enrolled and it’s
open enrollment what steps do you think
you could take right Now? So if they are
enrolled they will get a letter stating
the steps that they need to take. So
they would be on the lookout for that letter their Applications. Most
were automatically renewed into their new
plan again that’s the time – this is
the time to pick a new plan if they don’t
like it – the one that they have this year.
Another thing to do right now is
to make sure their application is up to date.
Is the phone number that they have on their application their most
current phone number. Address, income, all
of that yeah so that’s this is the
time to make those Updates. So one thing that
we’re working on right now is
something that we’re calling Share your
Story and this is an opportunity for you
to tell us about what an impact COFA
Islander Health Care has made in your life.
And if you are willing to submit
that to us and your story is selected to use in our marketing materials
then you will receive a $50 gift card.
So it’s another great opportunity to
connect communities and individuals
with the resources. Spread the word. Spread the word.
How can they can submit that? They
can submit it via email. [email protected] So we did get a question come in.
So if someone is eligible for COFA
Islander Health Care, does coverage start the month of application? That’s
a great question That’s a really good
question so the one of the differences
between Apple Health and a qualified health
plan is that for most scenarios when
you enroll in a qualified health plan it is prospective,
meaning it is in a future month, so
typically it is not, it does not start the month you apply.
There is the for qualified
health plans there is a fifteenth of the
month rule so if you apply between the
1st and the 15th of this month your
plan will start the next month. If it’s
16the through the end, it’s the month after next. Yeah but what’s important
to note though is where we’re in
open enrollment when you are signing up for your COFA Islander Health Care
now that it is for the next year so it’s
for 2020, unless there’s a special
enrollment period that opens up for the remainder of 2019.
Okay so if you sign up now
it is for January first coverage. Yeah
I think that’s what we have for tonight.
Again if anyone has any questions about
the program you can email
[email protected] or call one eight hundred
five four seven three one zero nine
and so thank you for joining our Facebook
Life and we’ll see you all soon. thank
you thank you