Indian Health Care Reform Manual for WA State (click below to view all chapters)
Health Care Reform ChaptersChapter 1: Overview of Indian Health Care Reform
- Indian Health Care Reform Overview
- CHIP, Medicaid, Medicare and the Health Insurance Marketplace At-A-Glance for AI/ANs
Chapter 2: Washington Apple Health/Medicaid
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- Washington Health Care Authority – Tribal Affairs Page
- 2019 FPL Guidelines
- FAQ Regarding FPL Guidelines
- FPL Calculator
- Find Washington Apple Health/Medicaid Forms Here
- Washington State Health Care Authority Apple Health (Medicaid) Manual
- Eligibility Overview for Washington Apple Health (Medicaid) Programs
- Washington Apple Health Medicaid programs for AI/AN
- 19-year-old Aging out of Apple Health Demo
- Spend Down Rules
- Incarcerated Individuals
- Declaration of Non-Incarceration Status Form
- Tribal Foster Care WA Request Form
- Tribal Foster Care Child Aging Out of Placement WAH Request Form
- Retroactive Health Care Coverage Request form – MAGI Medicaid
- ProviderOne Billing and Resource Guide
- Community-Based Staff Contacts
- HCA Area Representatives
Chapter 3: AI/AN Cost Sharing Benefits and Premium Tax Credits
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- Tribal Self Governance FAQ on AI/AN CSR and APT
- How Health Coverage Affects Your Taxes
- Example Letters
- Forms Sent to Individuals With Insurance Coverage
- 1095-A (Individuals With Healthplanfinder/QHP Coverage Will Receive This) (See “1095-A Frequently Asked Questions“)
- 1095-B (Individuals With Washington Apple Health Coverage and Medicare Will Receive This) (See “Understanding Your Form 1095-B“)
- 1095-C (Individuals With Employer Coverage Will Receive This) (See “Understanding Your Form 1095-C“)
- Forms to File With Tax Returns
- Form 8962 – For Individuals Who Have Applied Premium Tax Credits to Purchase of QHP Coverage through Healthplanfinder
- For 2019 the Shared Responsibility Payment (sometimes called the health care “mandate” or “penalty”) no longer applies.
- Form 8965 – For Individuals Who Did Not Have Insurance Coverage that Meets the Definition of “Minimum Essential Coverage” for 3 or More Months in a Calendar Year
- “Instructions for Form 8965” (Special Attention to Pages 12-15)
- Form 8965 – For Individuals Who Did Not Have Insurance Coverage that Meets the Definition of “Minimum Essential Coverage” for 3 or More Months in a Calendar Year
- WHBE Letter Re AI/AN Verification Process
- 2019 Exemptions and Catastrophic Coverage
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Chapter 4: Tax Penalty Exemptions- for Tax year 2018 and prior
How to Claim an Exemption for AI/AN from the “Individual Mandate” Tax Penalty
American Indian/Alaska Native and IHS User Tax Penalty Exemption Guidance 1-7-15
IRS Guidance – Health Care Law — What Is New for Individuals and Families
Chapter 5: AI/AN Income and Resource Exemptions
CMS Guidance Document – American Indian and Alaska Native Trust Income and MAGI
Chapter 6: Washington Healthplanfinder
Washington Health Benefit Exchange Information for American Indians and Alaska Natives
- Resources:
Troubleshooting
Contact Deb Sosa, deborah.sosa@wahbexchange.org
Healthplanfinder Password Reset: 855.256.9598
Certified Tribal Assister Welcome Packet June 29 2016
Problems–Who to Contact (Cross-Agency Desk Aid) (update in progress)
- Washington Apple Health – HCA Training Modules – Explains changes to WAH and detailed application requirements including household composition and financial guidelines (rev. 9/18) | Module 1 | Module 2 | Module 3 | Module 4 | Module 5
How to Create Applications for Families with AI/AN members and non-AI/AN Members
Per Capita Payments – One-Time Income Discrepancy (update in progress)
Special Enrollment – Enrolling Outside of the Open Enrollment Period, For Individuals Not Enrolled in a Federally-Recognized Tribe Need (update in progress)
Transitioning from QHP to Medicare Demo
Access HBE’s Navigator Program Resources (Including: Operator’s Manual, Troubleshooting Desk Aid, Training, etc.)
HBE Navigator Program Web Resources
Username: Client
Password: Cl1#nt!
Chapter 7: WHBE Tribal Assister Certification
To Become a New Tribal Assister, Contact:
Deb Sosa, deborah.sosa@wahbexchange.org
For a Learning Management System (LMS) Account, Contact:
Deb Sosa, deborah.sosa@wahbexchange.org, or
Monica Chambers, monica.chambers@wahbexchange.org
For Problems Using the LMS System, Contact:
Learning Management System (LMS) support: navigator.lms@wahbexchange.org
Chapter 8: Indian Health Care Providers and Qualified Health Plans
COMPLAINTS Against Insurance Companies, Agents, Brokers, or Agencies
What the OIC (Office of Insurance Commissioner) Can and Can’t Do
Simple On-Line Process for Submitting a Complaint
What is the Path or Process Flow of a Complaint
WHBE Guidance for Participation in Exchange (update in progress)
Washington State Indian Health Provider Addendum (QHP) 7-24-14
Managed Care Organization (MCO) Indian Addendum 3-28-16
Washington Insurance Issuer Requirements for AI-AN 9-30-15 (update in progress)
AIHC PowerPoint for Washington Issuers – Contracting With Indian Health Care Providers–Washington Requirements (update in progress)
How to Remain On or be Added To the Federal List of Essential Community Providers
Chapter 9: Tribal Premium Sponsorship
Contact:
Deb Sosa, deborah.sosa@wahbexchange.org
Jami LaBathe, jami.labathe@wahbexchange.org
Washington Health Benefit Exchange Premium Sponsorship Webpage
HBE Premium Sponsorship Program – Summary for Coverage Year 2019
Tribal Premium Sponsorship Toolkit:
AIHC Tribal Premium Sponsorship Model Policy and Checklist
Top 10 Sponsorship Policies Dos and Don’ts
Review of Tribal Premium Sponsorship in Washington State 2015 – Report
Examples of Tribal Premium Sponsorship Program Workflows (update in progress)
Chapter 10: Tribal Consultation
WHBE Letter Re Tribal Consultation Policy
WHBE Tribal Consultation Policy
Chapter 11: Outreach and Education Materials
Indian Health Care Reform Overview (update in progress)
Understanding Medicare (update in progress)
Medicaid-Spenddown-and-Washington-Connection (update in progress)
NIHB Enrollment Assistor Toolkit
2020 Meeting Documents
Work in progress!
Archives:
2019
American Indian Health Commission Insurance Carriers Fair & Tribal Assister Training: April 30- May 1, 2019 Meeting Documents in a Google folder
Washington State Tribal and Urban Indian Health Program Electronic Health Records Workshop:
Wednesday, May 8, 2019 Meeting Documents in a Google Folder
