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The Center for Consumer Information & Insurance Oversight

 

Frequently Asked Questions on Allowable Uses of Section 1311 Funding for States in a State Consumer Partnership Marketplace

This Frequently Asked Question (FAQ) provides clarification about grant funding under Affordable Care Act Section 1311(a) available to states in which the federal government will operate a Federally-facilitated Marketplace (FFM), including State Consumer Partnership Marketplaces (SPMs). This FAQ is applicable to the amended Funding Opportunity Announcement (FOA) released on November 30, 2012 (“Cooperative Agreement to Support Establishment of Affordable Care Act’s Health Insurance Exchanges”), and related section 1311 (a) funding opportunities, which can be found at http://www.grants.gov - Opens in a new window , under Catalog of Federal Domestic Assistance number 93.525.

These FAQs are considered general guidance only and are in no way guaranteeing approval of funding requests. All requests for funding are reviewed for allowability, allocability, and reasonableness and other requirements set forth in the funding announcement.

Q1:  If a state is in a State Consumer Partnership Marketplace, what types of activities are allowable uses of 1311 funds?

A1: For states that are in a State Consumer Partnership Marketplace, the list in the table below outlines generally allowable activities for the use of 1311 funds. This list is not exhaustive, but provides examples of potential eligible activities. States are encouraged to consult with HHS regarding the use of 1311 funds for these and other activities before submitting grant applications or expending funds.

As CMS recently advised, Affordable Care Act section 1311(i)(6) prohibits Marketplaces from using section 1311(a) grant funds to fund Navigator grants. See 78 Fed. Reg. 20581, 20583-84: http://www.gpo.gov/fdsys/pkg/FR-2013-04-05/pdf/2013-07951.pdf.  In State Consumer Partnership Marketplaces, Navigators are a federal responsibility funded by a separate federal grant program.

Section 1311(a) grant funds are available for non-Navigator assistance programs (also known as “in-person assistance programs”) in Consumer Partnership Marketplaces because the state has elected to establish and operate outreach, educational, and assistance activities as a condition of its participation in the Consumer Partnership Marketplace and to assist in its possible transition to a State-based Marketplace.   See the 1/3/2013 Guidance on the State Partnership Marketplace.  In State Partnership Marketplaces, the non-Navigator Assistance Program will supplement – not supplant – the Navigator Program, which is administered by HHS.

Additionally, while section 1311(i)(1) directs that the federal Navigator program be a grant program, state partners in a Consumer Partnership Marketplace have the flexibility to build a non-Navigator assistance program through contracts, direct hiring, or grants, subject to state law.

 

Operational AreaState Activities
Consumer and Stakeholder Engagement and Support
  • Build and fund first year operations of an in-person assistance personnel (IPAs) program (also known as “non-Navigator assistance personnel”)
  • Help HHS ensure that Navigators and IPAs have completed required federal training and passed required federal exam
  • If the state so chooses, create supplemental training materials for Navigators and IPAs that include state-specific component
  • Help HHS ensure that Navigators and IPAs are educated about and know how to refer consumers to Consumer Assistance Programs (CAPs) throughout the state as appropriate
  • Assist  HHS in monitoring the conduct and performance of Navigators and report any noncompliance
  • Establish mobile units throughout the state to help individuals complete Marketplace eligibility applications and choose a Qualified Health Plan (QHP)
  • Provide consumers/stakeholders with information about how the Pre-existing Insurance Plan (PCIP) program transition will occur and assist PCIP enrollees transitioning to the Marketplace
  • Develop and execute, with HHS approval, activities to publicize Marketplace activities in the state
  • Engage local stakeholders in the role of disseminating Marketplace information to eligible populations
  • Coordinate with other health and human services organizations in the state to broaden outreach (such as Marketplace information on applications for other programs, websites, emails or through IPA call centers)
  • Develop state-specific materials – or use those developed by the FFM – to educate consumers about eligibility and enrollment options as well as benefits and services available through the Marketplace
  • Produce and disseminate marketing/campaign materials, including but not limited to:  brochures, direct mail, print ads, social media and digital/online ads, and TV and radio buys. Materials must use federal messages and language and conform to other requirements detailed in the Marketing FAQ
  • Ensure that public education and outreach materials are culturally and linguistically appropriate, and accessible for persons with limited English proficiency and disabilities
  • Brand the State’s consumer assistance program (Navigators, IPAs) with a single identity such as a distinct name and tagline to use on a consumer website, earned and paid media, and outreach and education activities
  • Provide tailored search capabilities on any branded in-person assistance website
  • Ensure that the IPA program is consistent with all applicable federal regulations and guidance
  • Manage State IPA program so that it coordinates with the Federal Navigator program in order to avoid duplication of efforts
  • Identify and recruit in-person assistance personnel
  • Help ensure that all Navigators and IPAs adhere to federal conflict-of-interest standards; all materials comply with Culturally and Linguistically Appropriate Services (CLAS) standards; and all categories of in-person assisters have received training on privacy and security standards concerning the handling of Personally Identifiable Information (PII)
  • With HHS, resolve any problems or complaints about IPAs reported directly to the State Marketplace or referred from the federal complaint tracking system
SHOP
  • Help HHS monitor Navigators to ensure that Navigators are reaching out to and trained to assist small businesses with enrollment in SHOP plans.
  • Operate an IPA program that will assist small businesses with enrollment in SHOP plans
Contracting, Outsourcing, and Agreements
  • Inform HHS about contracting and outsourcing agreements
 
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