Presented at Enroll America's 2016 State of Enrollment conference.

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Tracy Zander, MPH, Navigator, Family and Children’s Service | 05.13.2016
Working Productively with the Marketplace Call Center:
An Emphasis on Immigrant Populations

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Objectives:
• To enhance productivity and experiences with the Marketplace call center
• To discuss and share other solutions and advice from other assisters
• To uncover solutions while working with the Marketplace call center with more
challenging immigrant cases

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• Increasingly challenging cases
• Less buy-in from consumers
• More time spent with consumers who aren’t eligible due
to coverage gap
• More time needed for outreach to find uninsured
consumers
Why Enhance Productivity?

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• To demonstrate to consumers that they can count on us
• To ensure the enrollment process is positive
• To help the consumer learn how they can navigate the
system
• For the consumer to be empowered and proactive
• To avoid filing an appeal
• To make our jobs easier and more positive
Why enhance the experience?

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…..Seriously!!
Take out your phone!

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Top 10 states: Call Center Volume
INFORMATION NOT RELEASEABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publically
disclosed and may be privileged and confidential, It is for internal government use only and must not be disseminated, distributed, or copied
to persons not authorized to receive the information. Unauthorized disclosure may result in the prosecution to the full extent of the law.

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Background
• Tennessee uses the Health Insurance Marketplace as the only application
portal to apply for Medicaid and CHIP
• There is no specific Medicaid or CHIP application
• State offices stopped offering Medicaid assistance December, 2013
• “You can also go to your local Medicaid office”  Not an option.

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• In 2012 Nashville had the fastest-growing immigrant
population of any American city
• One out of every five Nashville students is Latino
• Over 140 languages are spoken through city schools
• New international arrivals are responsible for 60 percent of
the city’s population growth in the past decade
Background

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Background
• Nearly 90% of patients are foreign-born coming from more than 80
countries and speaking more than 70 languages
• 5,000 patient visits per year translating into 21,000 patient encounters

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Top 10 Languages Requested at Call Center
• In total, the call
center received
45,067 calls for
languages other
than English and
Spanish during
OEP Year 3
• The top 4
languages
represent over
50% of all
requests to the
Language Line
n= 8,564
n= 7,326
n=3,495
INFORMATION NOT RELEASEABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publically
disclosed and may be privileged and confidential, It is for internal government use only and must not be disseminated, distributed, or copied
to persons not authorized to receive the information. Unauthorized disclosure may result in the prosecution to the full extent of the law.
Spanish n= 919,045
English n= 13,302,655

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What is the best
way to address
inconsistencies?

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PREVENT THEM!

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London, Kentucky
In our experience…
• (701) area code number
does not go through
• Bottom line: if possible,
upload to account
online because it is
updated in real time
• Ask for more time

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Inconsistencies
SUBMITTED
VERIFIED
1.
2.
3.

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After you submit the required
verification, inform the consumer
that the Health Insurance
Marketplace will still send notices
of the inconsistency until it is
verified. These notices cause
many consumers unnecessary
panic.

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Prevent inconsistencies
• When healthcare.gov asks for certificate of citizenship:
• Go back to the beginning of the application and start again
• Remove that application and start anew
• Go back through application when you have the certificate
information
• Optional, but an inconsistency will remain…
Alien number/USCIS
Certificate number

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Selecting documents properly
This should not be checked
for undocumented
individuals

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Common immigration documents
Sometimes the number is
written here instead

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Identity verification
Allowed
2
submissions

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Allowed
2
submissions

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Optional

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The application ID is created early
on during the application. Have it
easily accessible if you need to
call the Marketplace and offer to
reference it first with the state
you are calling from.

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Then STOP. Do not press “Save and continue.”

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Read and explain the agreement
statements to the consumer
before calling the Marketplace to
avoid confusion and to keep
consumer prepared and informed

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If you see this screen, you’ve gone too far…

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• Call volume increased by 7.6% from November 15th to
December 31st and decreased by 7.2% in the last 30
days of Open Enrollment.
• Shift is likely due to increased number of consumers
renewing coverage and can be expected to continue
• Customer Satisfaction increased – OE2 vs OE3 73% to
78%
• Strong focus on soft skills in CCR training and quality
Consumer Call Patterns
INFORMATION NOT RELEASEABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publically
disclosed and may be privileged and confidential, It is for internal government use only and must not be disseminated, distributed, or copied
to persons not authorized to receive the information. Unauthorized disclosure may result in the prosecution to the full extent of the law.

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Marketplace Call Center Volume
INFORMATION NOT RELEASEABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publically
disclosed and may be privileged and confidential, It is for internal government use only and must not be disseminated, distributed, or copied
to persons not authorized to receive the information. Unauthorized disclosure may result in the prosecution to the full extent of the law.

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Call Arrival Pattern
INFORMATION NOT RELEASEABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publically
disclosed and may be privileged and confidential, It is for internal government use only and must not be disseminated, distributed, or copied
to persons not authorized to receive the information. Unauthorized disclosure may result in the prosecution to the full extent of the law.

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•
• For 60 of 92 days of Open
Enrollment, there is
less than a 5 minute daily
average speed of answer.
• On 28 or 92 days, speed of
answer was under 30
seconds.
Customer Wait Times
INFORMATION NOT RELEASEABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publically
disclosed and may be privileged and confidential, It is for internal government use only and must not be disseminated, distributed, or copied
to persons not authorized to receive the information. Unauthorized disclosure may result in the prosecution to the full extent of the law.

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Marketplace Call Center Volume
Spanish n= 919,045
English n= 13,302,655
INFORMATION NOT RELEASEABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publically
disclosed and may be privileged and confidential, It is for internal government use only and must not be disseminated, distributed, or copied
to persons not authorized to receive the information. Unauthorized disclosure may result in the prosecution to the full extent of the law.

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Call Center Topics
Plan Compare and Enrollment Closing Language:
Creating and Managing Your Healthcare.gov Account
Online Application Lead-In
Marketplace Plan Re-Enrollment/BAR
Ending Marketplace Coverage
Marketplace Call Center Information
How/Where do I send my docs
Lowering Costs on Monthly Premiums
Resolving Data Matching
Reporting a Life Change
Call Topics
OEP3 OEP2
INFORMATION NOT RELEASEABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publically
disclosed and may be privileged and confidential, It is for internal government use only and must not be disseminated, distributed, or copied
to persons not authorized to receive the information. Unauthorized disclosure may result in the prosecution to the full extent of the law.

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Common Marketplace Referrals
Top 10 Referrals
1. Medicaid 162,695
2. 1-800 Medicare 18,620
3. IRS 13,519
4. CHIP 11,259
5. Certified App Counselor 11,238
6. State Dept of Insurance 8,109
7. HRSA 6,541
8. Agent / Broker 5,885
9. Navigator 5,188
10. SHOP Call Center 3,365
INFORMATION NOT RELEASEABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publically
disclosed and may be privileged and confidential, It is for internal government use only and must not be disseminated, distributed, or copied
to persons not authorized to receive the information. Unauthorized disclosure may result in the prosecution to the full extent of the law.

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Leaving the Medicaid GAP SEP

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• Can only be accessed by contacting the
marketplace call center
• Call center representatives can no longer
automatically grant this SEP
Receive
eligibility for
APTC
Call the call
center to
request SEP to
enroll in
coverage
Representative
will forward
application for
review
10 business
day processing
time
Receive mail
confirming SEP
granted
Enroll online or
via the call
center!
Leaving the Medicaid GAP SEP

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*Online option to file an appeal coming December, 2016!!!
* Wait
about
3-11
months
A note about appeals…

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• Wrong eligibility determination? Why?
• Try to avoid/prevent them
• 90 days or ‘as administratively feasible as possible’
• Expedited appeals
• Separate entity: not associated with Marketplace call
center nor London, KY
Appeals continued

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Even with sophisticated
design, user experience
is what matters

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• What have you found helpful that we haven’t
yet mentioned?
Your experience

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• What constructive feedback do you have for the
Marketplace Call Center?
Your feedback

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Moving away from…

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…to this!

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Please fill out survey for this presentation!
(Just Kidding!!!)