Welcome, everyone. My name is Kendra Morgan and I'm a senior program manager here at WebJunction. We would like to welcome you all today to the session on the Federal Depository Libraries and the Affordable Care Act and with us today, we have a panel that includes Susan Hildreth, the director of the institute of museum and library services, Susie Butler who is the deputy director of partner relations. Robbie Sittel, a government documents librarian at the Tulsa city county public library and we're also joined by Ashley Dahlen who is the outreach librarian with the government printing office who helped pull this webinar together so thanks to Ashley and Susan at the GPO. And we will also be joined in a few minutes by David Santana who will help during the question and answer period about questions regarding anything that comes up that the team can help to answer. So thank you very much to all the panelists who have joined us today. And with that I'll turn it over to Susan Hildreth from imls for a quick welcome and an overview of the work that's been happening in libraries. >> Well, thank you, Kendra and good afternoon, everybody, it's really great to be here and I first want to really acknowledge the work of the government office and our Federal Depository Libraries and all their programs. I've been responsible for a couple of those in my past life. So I'm really excited today to be able to present this information and talk with you about our partnership to move forward with the Affordable Care Act. So I would just briefly again like to acknowledge, this is a really good partnership that I think is a model that we can think about for other federal, state and local work. And the key partner of the institute of museum and library services is our centers for Medicare and Medicaid services part of health and human services and they're a great partner and we're working with them I think effectively to get information to our libraries and librarians about the Affordable Care Act. We also have a great partner in WebJunction and they are working with ZeroDivide that's very involved in the content aspects of health and health services. They've been a really good partner, as well as our national network of libraries of medicine so we have a really good team preparing everybody for -- excuse me, for October 1st, which is just around the corner. You know I think that what I.M.L.S. is interested in in doing this work is making sure that we're providing a good opportunity for libraries to participate in getting this information out. I think the role of our Federal Depository Libraries is really a little unique, because you have all our federal government information and it's your job to get that out there. With some of our other public libraries, I think they're making some local decisions in terms of the investment of resources they want to make in making this information accessible for all their customers but I think our federal partners have a really unique role to play. We're emphasizing the role of our libraries and librarians as connectors to really help their customers, their users, their patrons, understand what resources are available to become involved and knowledgeable about the Affordable Care Act, really to be community facilitators, to help their customers connect with the resources in their community. So we don't expect librarians to know every single policy about this service provision but we do hope that we can help you understand the information and resources available in your community to help the folks that use your facility. So we're not advising on insurance decisions; we're really just trying to get people together with information. And I think it's going to be particularly interesting to see how our Federal Depository Libraries can do this. They're often seated in very active public libraries. So it's a great chance to talk with all of you. I look forward to hearing about what's going on in Tulsa and some of us will also be addressing you at your fall meeting here in D.C. in I think next month. So thanks everybody for being great partners and for listening today. And I know you'll enjoy the chat. We always have great answers to all your questions there and I'm going to hand it back to Kendra and our great panel. >> Thank you, Susan. We will like tory a little probable Ashley Dahlen. She's with the government printing office and is the outreach librarian there to put a little context around today's session and the work of the F.D.L. community in supporting and distributing information and working with patrons with the ACA. Welcome, Ashley. >> Hi, everyone. Thank you. Again, my name is Ashley Dahlen and I'm an outreach librarian here at the government printing office. I, too, want to thank everyone here for pulling together to put this webinar on and as Kendra stated, I have the distinction of getting to provide some of the framework for how this webinar came to be and where the idea came from. In short, we in Washington, D.C. are very aware of the great public interest in the Affordable Care Act. It's actually one of the few public laws that can be purchased as a separate publication in our GPO online bookstore because of that widespread interest. The fact that it's a 900-page law seems to lead to desire in the public to just purchase a copy as opposed to actually printing it out at home and, of course, because we host the authenticated digital version of that law, we continue to get a great number of questions about the law and its impact for medical and health professionals all the way down to the general public. And, of course, like you all, we do our best to direct those with questions to the appropriate federal resources. We thought we all as Federal Depository Libraries staff would also be interested in learning about the law itself and its impacts, the timeline of what is being released and the federal resources that are available, or the ones that are in development. So working with the panelists from these agencies, we hope that this webinar will help inform you all of the main issues surrounding the October 1 roll-out and connect you all with the appropriate resources so you in turn can connect the public with the information that they need. Personally, I feel that the partnership between the centers for Medicare and Medicaid services, the institute of museum and library services and WebJunction is a wonderful example of the government working together with the library community to share timely information and to meet the needs of information consumers. We've also asked a member of our FDLP community, Robbie Sittel, to share with us some of the actions taken at the local level and we did this because we hope that with her help, you're better able to envision and strategize how you and your institution can approach this topic. That's it from GPO's perspective. I hope you all learn a lot in the next hour or so and I turn it back over to Kendra. >> Thanks, Ashley. One of the things that we wanted to talk about before we dive into the content today is that while I know that many of you on the line today represent Federal Depository Libraries and so a lot of the emphasis that you have clearly is on materials that come out of the government printing office. When it comes to distributing information about the Affordable Care Act, there is a difference if your library hobbies to be located in a state that is hosting its own state-based exchange, which is where individuals will be able to go online and find out if they are -- what type of insurance they are eligible for and that they can purchase. And a state-based exchange, you can find out which states are hosting their own and which are using the federal exchange and that's an important thing to keep in mind as you look for resources connected to the Affordable Care Act because the ones that are state-based will have local resources. So you'll want to check into that. And then you can find, we just posted a link into the chat box, how to find out what the marketplace is in your state and there's a nice dropdown menu available on that page so that you can find out exactly what is happening in your state. And doing a webinar for WebJunction for the F.D.L. community, this is a first for us. We're very excited to have all of you here and one of the things that Susan mentioned at the beginning was that we do really like to see an active chat environment. We love to see your questions come through as the presenters are talking. We'll have a good amount of time at the end of the session for Q&A. So feel free to post your questions into the chat box and we'll be able to collect those and if you have thoughts on something another person has asked, go ahead and respond to that. And one of the things we would love to hear to start getting the chat active is as an F.D.L. library, for those of you, what have you seen so far, what interest have you seen in your community, what questions have been coming up? Or if you've already scheduled events or trainings, if you're working with other partners, we would love to see you post that in the chat and share your experiences. So feel free to do that at any time. It really does help to make the experience a little bit richer because you're sharing with each other. So we would encourage you to do that. So with that, we're going to pass it over to Susie Butler and she is going to talk a little bit about what's been happening with C.M.S. They've been very busy as they move towards the launch. Welcome Susie. >> Thank you so much Kendra and thank you everyone both on the call and on the panel. Before I get started, I want to say thank you again to folks participating in this call. I will echo what was said earlier by Susan. The value of this partnership is on all sides. I know that not only C.M.S. but H.H.S., the department of health and human services, as well as the White House, have been looking to the fact that we have this partnership and how valuable it is because the libraries are such a part of the communities where we live, work, play and participate in community activities. So we just really appreciate the broadness of this partnership and the fact that libraries can participate at whatever level they want to, but mostly, they're a place where the community can come together and get information. I want to talk a little bit about some of the resources that are available. You may have been hearing a lot about the navigators. Navigators are grantees and the health and human services department announced $67 million in grant awards to 105 navigator applicants in federally facilitated and state-based partnership marketplaces. These navigator grantees and their staff serve as an inperson resource for people who want additional insurance in shopping for and enrolling in plans in the health insurance marketplace beginning October 1st. We also recognize more than 100 national organizations, businesses who have volunteered to help Americans learn about the healthcare coverage available in the marketplace. Navigators are among the many resources available to help consumers understand their coverage options. A network of volunteers on the ground in every state, healthcare providers, business leaders, faith leaders, community groups, advocates, local elected officials, all of these people can help spread the word and encourage their neighbors to get enrolled. The navigators are trained to provide unbiased information in a culturally competent manner to consumers about health insurance, the new marketplaces, qualified health plans and public programs, including Medicaid and the children's health insurance program. The navigator funding opportunity announcement was open to eligible private and public groups and people who are self-employed who met certain standards to promote effectiveness, diversity and program integrity. Navigators will be required to adhere to strict security and privacy standards, including how to safeguard a consumer's personal information. They'll be required to complete about 30 hours of training in order to be certified and they will take additional training throughout the year and will renew their certification annually. All types of enrollment assistors, counselors, agents and brokers are subject to federal criminal penalties for violations of statutes on top of any relevant state law Pendleton. Navigators have a vital role in helping consumers prepare electronic and paper applications to establish eligibility and enroll in coverage to marketplaces and potentially qualify for an insurance affordability program. They also provide outreach and education to raise awareness about the marketplace and refer consumers to health insurance ombudsmen and navigators where necessary. They are funded through state and federal grant programs and must complete comprehensive training. Also on this slide, you'll see towards the bottom, a couple of resources that I want to make sure you bookmark. One of them is marketplace.cms.gov. On there, you will find updated materials and training resources. This is a place -- I wouldn't say it's hidden because it's bookmarked on healthcare.gov, just above it, but it's where the public goes to look at and compare plans. Those plans will be on site next Tuesday, a week from tomorrow when we open our doors for business. But the marketplace site is where we have our training materials and downloadable educational materials. So you can go through the same training as the navigators go through or as the certified application counselors or just download a few modules to get smart about some particular area that you would like to learn more about. In addition at the bottom, the very last link on the slide, talks about product ordering. Click on that and make sure you're registered to order products. We aren't going to have a lot of products available for order, but when they do come into the warehouse, you want to make sure that you have an account set up so that you can order those products. Most of our products, our information is going to be electronic so it will be a print on demand as you see fit. I also want to talk a little bit more about the training material that we have available. We're doing a whole series of web-based trainings, including an overview of the marketplace, the 101 training, which is the very basic and then the more advanced training. We're trying to put these onto video or closed captioned video with subtitles, so that if you want to use any of these that we have online and you can find this again in the link I told you about earlier, the marketplace.cms.gov training, you are free to use these for yourselves or the public. You can even use a portion of these, anything that we have on any of our websites is in the public domain. So you may use those freely. Then I also want to talk a little bit about a project because I've been running this one, the champions for coverage. Becoming a champion means that you want to share information and you want to educate the public. And you're taking that same information that I just referenced within the public domain and making sure that people have access to it. It can be as little as taking one of our messages and putting it on an eight and a half by 11 piece of paper and tacking it up at your desk or in front of a counter or it could be as much as opening your doors and saying we're going to hold education events in our place of business. But we love the fact that so many different and diverse groups have said we want to be a champion, we want to help, we want to carry this forward. The way to do that is to go to the marketplace page and say there's -- there's a button there to click that says I want to be a champion. And there's about six fields. It says this is the name of my organization, this is who I am, I have the authority to say that my organization would like to be listed as a champion. In the coming weeks, we're going to be listing state by state who the champions are. It's not a link. It's just a list. But you can also be a champion if you would prefer not to be listed and just say I want to get the information but I can't list my organization. And we've had a number of those because of political reasons as well as some others such as the board of directors but they do want to continue to get the information. We also want to make sure that you are aware that there are ways to spread the word through social media. There's Facebook, it's slash healthcare.gov. Our Spanish site, and also the Twitter handle @healthcaregov. So I want to thank you for letting me be on here for a little while today and be part of your conversation. David will continue that conversation online by answering your questions and please again know how much we appreciate the work that you're intrigued by and some of you are already beginning to carry out. I'm here to answer questions and to help. So please know that we value this relationship so much and we look forward to working with you, not only on this but other projects in the future. Kendra, back to you. >> Thank you so much, Susie. And let's see, we'll go on here. I'm just going to mention again real quickly as a reminder that you do need to check to see what the health insurance marketplace is in your state just to make sure that you're getting access to all of the resources that are relevant within your state. Because it can create a more robust set of information that you can pass along to patrons and I've already seen some great chat, people sharing resources about what's happening within their states, which is great. Please keep that up. We love hearing what's happening in libraries and learning from those experiences. We wanted to spend a few minutes talking about the enrollment process and how libraries can be involved with spreading information in their community and helping to connect people to the right information when they have questions about the ACA. So one of the things to note that we did hear a lot questions about early on in this process just to confirm that there are multiple ways that people can enroll if they're interested in getting coverage. That will be that they can apply via phone, they can apply via mail as well as online. Now, the application, it's very helpful if people do it online for several reasons: One is that there is a single application for those who are participating in other programs such as Medicaid as well as the private insurance options and that will be on a single application when they do this online. So that's very helpful and one reason to do that. Another is that when people complete the application form online, they're going to get electronic verification, which is really helpful to give people a little bit of peace of mind that they have completed the application successfully. And they'll also get realtime eligibility. So they'll get to see what programs they're able to participate in and the rates for those programs. So while there are other options, the phone and mail being one of them and there will be printed application forms, as much as possible, we want to direct people to looking at doing the application online and that certainly will have -- will present an opportunity for libraries when people come in, in the door, interested in using public access computers, for example, to complete those application forms. So we wanted to talk a little bit about what's happening in libraries and health is happening in libraries and we really see that, you know, libraries do serve as a critical resource for information and services relating to healthcare and wellness. And we really think that libraries are going to continue to serve a role as a partner in health and we've had great partners in this program. We worked with the national networks of libraries of medicine, with C.M.S., with I.M.L.S. and we're really all are the American library association, and now with the GPO and we're really all working towards the same common goal, which is to get people accurate information when they need it. And one of the things that's important to note is that, you know, people are already doing this in libraries and a recent I.M.L.S. study found that 28 million public library patrons used a computer and sought assistance in libraries, which is just an amazing number. And health is happening in libraries as people seek out information about health and wellness, about diet and exercise, and they depend on the access that they get in public libraries. And we expect that a lot of this applies to F.D.L. organizations, as well. Many of you are located within public library systems so you probably see a lot of the same common interests. There was also a study with the pew Internet and American life project that looked at library use in America and no surprise but patrons have been found to value and utilize and need their libraries more, but particularly those in minority and low-income communities, and many of these same patrons are going to be the ones who are encouraged to enroll in health coverage under the Affordable Care Act. And this group of people are often lacking in home broadband, which makes the access that they get in libraries even more important. So one of the things that's important as we look at not just connecting patrons to information about the Affordable Care Act, but it's the larger picture of the importance of connecting people to accurate and relevant information and one of the topics that we have been focusing on, obviously, with this project is the idea of ehealth and the healthcare system really encourages people now to engage with their health online because the belief that it's really going to improve the quality and experience of care and overall health and wellness. And when we look at that collection of applications, online applications, websites and resources that allow people to engage with health and wellness, those are broadly what we call ehealth. It's a very similar connection but this is focused on those resources that are connected to health. And it's really part of a broader role that libraries play in creating equal access to resources. And throughout the evolution of the Internet, libraries have made amazing strides in promoting digital inclusion in their community by providing access. So if we look at a couple of different aspects, one when it comes to online and digital inclusion, one of the -- the ACA enrollment process which I mentioned on the previous slide, when people do it online, they're going to get realtime confirmation in the options that are available to them which makes it really desirable. The second is that healthcare providers, both through mandates and on their own, are moving to electronic records. And finally patient -- through patient rights laws, providers are required to share those records with individuals to help with decision making and informed decisions. And I actually had this experience myself where I, you know, went to a doctor's visit and the first time I actually had access online and I thought I had all my instructions clear and knew what I was supposed to do for my doctor and when I logged in online to double check because I could see my records, I was actually a little bit wrong. I was able to use that online information to help correct some of the things that I didn't hear clearly when I was in the appointment. And so it really helped me to make a better decision. And that's what the end goal is really to get people the right information at the right time. So libraries are definitely helping to do that in pointing people to reliable and critical information. When we look ahead at what libraries can do with regards to enrollment support, providing patrons with access to information, libraries -- one of the most important things that we think is going to happen is that libraries really have to review and apply their own policy regarding information services, and this would be really similar to what many of you already do with regards to tax forms or unemployment applications or immigration resources. There's a lot of private information that many of you have already had to think about in terms of your policies. And this will be very similar. So libraries can play a wide range of roles in connecting patrons to this information. Some people are going to choose to provide information just to connect people to the exchange. If you're in a federally based exchange, for example, you would point people to healthcare.gov and you know you've pointed people to the right site. You know you're getting them to the right place. Others may have dedicated computer space and we've even heard from libraries, the public library in Illinois, for example, has received the training required to operate as in-person counselors to actually help people with enrollment. So libraries are taking a broad set of approaches to meeting the needs in their communities. And one of the things that we know is because of the public access, computer availability, the questions around privacy may definitely come up and we do know that, you know, mentioned that the paper is available, as is telephone but many people are going to want to do it online. And we also know that understanding your library's privacy guidelines is going to be important. And we would encourage you to think about how those apply to people who may come in asking about these questions related to the ACA. So we would encourage you to think about and apply that to this situation, as well. And one of the other points that we want to emphasize that while libraries are definitely an important resource, they're not alone in helping to connect people to relevant and accurate information about enrollment. So we would encourage you to really think about yourself as being part of a network and we have, for example, local nonprofit organizations who may be designated as either navigators or assisters who have actually been funded and trained to provide assistance to people in the enrollment process and this might be a really great opportunity to reach out to these navigator and assister organizations and find out if there's a way to partner and provide, for example, for those of you who have meeting room space, would you like to work with one of these organizations to connect training opportunities in the library because it's already a trusted location. So that's one partner that you can look at and we'll also have resources at both the state and federal level for 24-hour call centers that people can call to receive assistance. And all of these resources can be found online at healthcare.gov and will be part of the resources that are part of this archive at the end of the session. When you think about the types of strategies that might make the most sense for your library, providing ACA information and support is a great opportunity to expand your influence and role in the community, where there's a need present. So this is a bit of a way to help look at how your library may be involved with helping with this local need. So one is to identify the type of exchange in your state, we talked about either having a state partnership or a federal exchange, so that's an important first step. Assess how your staff can contribute to this patron need if you find that patrons are coming up with questions and I would love to see comments in the chat about what you're hearing from patrons and what questions may have been coming in already and we'll spend some time at the end talking with David Santana from C.M.S. about answering some of those questions for you and your staff. Defining a role that best fits your library and resources. How libraries choose to respond to the local questions and how engaged they get is a local decision and we hope to provide a range of models that people can look at as an option for participation, everything from being able to point people to the right resources through to serving as in-person counselors and assisters. It really depends on the local situation and we would encourage you to spend some time looking at what would work best for your library. And familiarize yourself with the resources that are available on healthcare.gov. We talked about the publications that are available and I'm sure many of you as F.D.L.s already have many of those resources in your libraries. And with that, I am going to pass it over to Robbie Sittel who is with the Tulsa city county library. And I'm going to pass you the ball, Robbie. And one of the things that we really enjoy being able to do is to allow you through these webinars to hear from libraries that are doing work that is connected to the topic and that are looking at an approach that's going to work for their community and we're pleased to have Robbie with us today. Welcome. >> Thank you. Thanks for having me. Again, my name is Robbie. I am the depository coordinator at the Tulsa county library in Tulsa, Oklahoma. And my presentation is just my experiences in what we're trying to do in our public library and in our state to assist people with the ACA. So what can we expect? It is coming. We don't really know yet. Many of the provisions of the ACA have already begun to roll out. The opening of the marketplaces and the individual insurance mandate are raising additional questions amongst many Americans and the expectations of how libraries, whether you're an F.D.L. or not, is still yet to be seen. So a bit about my community and my state. I am located in Oklahoma. And it is estimated that 1 in 5 Oklahomans are uninsured and will therefore likely need some form of information or assistance finding health coverage. Because Oklahoma opted out of Medicaid expansion and chose the federal healthcare exchange, state agencies are not providing direct assistance with the ACA. But instead are referring Oklahomans to nonprofits, community health clinics and libraries for help and answers. So we do expect to see some kind of impact within our libraries. So we can help as libraries and especially as federal depository libraries. And why a library? This statement is from A.L.A. and it illustrates that A.L.A. supports the library's role of assisting the public with access to government information and services. Libraries offer this assistance through physical collections, Internet access, online resources, workshops, outreach, research and reference assistance. I especially like the final statement. Libraries have continued to play the role of advocate for the public. Libraries have long served as the great equalizer by giving everyone access to information and the assistance that we provide with the ACA is just another way that we can take the role as advocate in our communities. So why an F.D.L.? Though, there is no legal requirement for an F.D.L. to provide e-government services, I believe that all F.D.L.s share in GPO's mission of keeping America informed. And this more and more incorporates assisting our public with e-government services. F.D.L.s differ by type, size, staff, accessibility and therefore carry out our charge in very different ways. What I'm sharing today is simply my experience and what I'm trying to do as a depository coordinator in a public library. So why a public library? And why my public library? The statement on the screen is one of five goals that the Tulsa city county library system uses as the framework for your service philosophy and model. Our F.D.L.P. is part of the research center which serves as the core research and reference division for the library system. As such, they have a long-standing history of taking the lead to inform the library's front line staff of major information and events that can affect staff or patron needs. I want to emphasize that our goals drive our service model at our library and if someone comes into our library with a question, we work to find an answer or connect that person with a resource or service in our community that matches their needs. The Tulsa city-county library embodies both A.L.A.'s and GPO's approaches of advocating for the public and keeping America informed. All public libraries are positioned within communities to provide neutral, unbiased information. So what am I doing in my library? The Tulsa city-county library system is a county-wide network of 25 libraries. Each branch is a community of its own. It serves a unique community. My job as depository coordinator is to provide our staff with government information and resources that answer the community's questions and meet the individual community needs. One way to ensure that all staff have access to information is through resource guides. T.C.C.L. happens to use web guides. The guides are linked from the library's website, which makes it easily accessible to all of our staff and patrons. The guides are easily edited and served as a compact vehicle for providing information throughout the community. Additionally wherever there is a major government event, I do also attend our branch manager meetings where resources are shared, expectations and ideas of what they might expect are given to the managers so they can in turn take that information back to their front-line staff. We also went one step further with just providing internal information and we started offering workshops with the community service council of Tulsa, which we feel closely aligns itself with the library's goals and service model. We originally offered this session in October of 2012 and the turnout and response was so phenomenal, bringing it back in time for the opening of the insurance marketplace was a no-brainer. The associate director of the community service council provides a full overview of the law, its origin, its coverage, its cost, the good, the bad and the ugly. The sessions give the public an opportunity to ask questions, listen and hopefully leave with a better understanding of what they can expect of the ACA. Each library or library system can and is encouraged to take a proactive role to assist their communities. The statewide FDLP community in Oklahoma wanted to take a role to help our state librarians and their communities. So some in the FDLP community might have heard the joins of being a depository in Oklahoma. I think it's a great place to be a depository librarian. We have a strong network amongst our F.D.L.s, which carries over to our state library association. Our regional librarians are actively engaged in the community and serve to facilitate statewide collaborations. Plus, we're passionate about the F.D.L. program and government information and want to do what we can to ensure that librarians in our state understand and can use government resources. So to let them know what's out there, we created OKiE-Gov. And OKiE-Gov is a wiki that we conceived of when A.L.A. launched its e-government tool. It's been out there a while but we haven't done much with it or promoted it. The regional librarian at our state library has long been teaching and advocating for a role in e-government resources and the wiki was thought to serve as a way to provide advocacy information and assistance. And so on our OKiE-Gov wiki, we do have a portion dedicated to the ACA. When the Oklahoma depository community began discussing how we might be able to help librarians in our state, the OKiE-Gov wiki seemed the best vehicle. So why a wiki? It's collaborative, it's organic, it's free, and it's a familiar platform to most people. Currently,, we have four editors and contributors to our wiki, two academic librarians, a public librarian and the state library. Though the wiki we feel would be helpful to anybody anywhere in the U.S., we want it to directly address the needs of those in Oklahoma and so we hope that it does that. Our state is a little different than others but not by much. So we just want to make sure that those in our state are finding answers to their questions. And we also want the wiki to continue to evolve to address other topics and ideas within state and federal e-governments. All right. So October 1 is coming. How can we continue to help? We want to stay poised to assist. What October 1 will bring remains to be seen. The Tulsa city-county library as well as the Oklahoma FDLP community remain poised to see how we can continue to assist as we experience patron questions and needs with the insurance marketplace and further implementations of the ACA. By staying informed about the law and its provisions, all libraries can try to anticipate questions and needs from our communities. We can keep our partners like the community service council, other FDLPs or others close by to fill in the gaps where our library expertise stops. T.T.C.L., my system, is already working with our community health clinics serving as navigators in our state to bring help into our libraries. So that's me. Thanks. >> Thank you so much, Robbie. It's great to hear -- and I think one of the things that's good about the approach that you are taking is that you are, you know, ready to help, poised to help and waiting to hear what the needs are and what types of questions start surfacing from your patrons. So we look forward to hearing more about how other libraries in the F.D.L. community are looking to address those local needs. So we have -- we've finished up the main part of the presentation and we have about 15 minutes to do some question and answers and you may have seen David Santana from C.M.S. answering questions in the chat box and we're going to spend some time asking David a few questions that have come up and if any of the other presenters, as well. So if you do have questions, please feel free to post those into the chat. So David, one of the first questions that we have is discuss a little bit about what happens if someone is already enrolled in Medicaid? Do they also need to enroll in the marketplace? >> No. If someone is already enrolled in either Medicaid or the children's health insurance program, they will stay enrolled in the program up until they have the determination, however -- I guess the time frame that they usually do every determination, I can tell you that under the Affordable Care Act, the states have now the option to redetermine individuals every 12 months, specifically for children, pregnant women, and those individuals if the state is expanding their Medicaid program in 2014. They also have the option to redetermine individuals under the Medicaid expansion for that new childless adult group as well as parents to 12 months. So the short answer is if you already have Medicaid, just wait for the state to let you know when is the time to redetermine your eligibility. >> Okay. Let's see. The best way -- what is the best way for individuals -- and I would say actually for F.D.L.s to identify the navigators in their state? We did post a list that's on the C.M.S. site but the P.D.F. is not the best way -- the link that we provided or are there other recommendations for getting in touch with navigators? >> Right. That is one way, of course, but after we relaunched the website on October 1st, we're going to be -- there's going to be a link on the website that is called local assistance and it would help the navigators listed within that state and other non-navigator agencies that would be linked in there for individuals to access or to have access to the phone numbers as well as the website and other ways to go about getting in touch with those entities. >> And are those -- when that site launches on October 1st, are those navigators just going to be the ones that are part of the federal exchange or also in the state-based exchanges? >> The website, the healthcare.gov will list -- when you go there, you're going to select the state that you reside in. Once you go to that state, then the information that you will put from there, that you will pull from there is going to be about that state. That said, if you go to the marketplace website and you live in a state that is running their own marketplace, you're going to be redirected to that state's website, the marketplace website for that state, and you may be able to find the information in there about the navigators listed by the state. Keep in mind that the website, the state-based marketplace website, would not necessarily look the same as the federally facilitated marketplace. So keep in mind the information may be in a different format if you live in a state that is running their own marketplace. But nevertheless the information should be there. >> Okay, great. That pretty much answers the if you're a federal-based exchange state then you're going to use healthcare.gov and find all your resources there and if you are a state-based exchange site, then you will use the site that has been built by your state. So and that certainly seems to be one of the biggest takeaways from all of the webinars and trainings that we've had, is that it's really important to know what's happening in terms of the implementation in your state. And when it comes to individuals who already have coverage through their employers, what are they required to do? >> If an individual has coverage through their employer, that means that they have minimum essential benefits, which is the mandate in the law that each individual in 2014 should have a minimum essential benefit. If they do so, they don't really need to do anything if they're happy with that employer plan that they have or if there's a requirement employer plan that they're getting or even Cobra benefits, wharf form of health insurance that they have in 2014, those coverages are likely to be minimum essential benefits. I guess one of the questions that people keep asking is well I have that employer plan and I am not particularly satisfied with that plan, can I go to the marketplace and see what's there? The answer to that question is yes. It is up to you to go and look around the marketplace, look at the plans that are offered, the levels of coverage. If you think that one of those plans will better accommodate your needs, you're certainly welcome to come and join a plan, to abandon your employer plan and come and join a plan in the marketplace if you think it will better accommodate your needs. Two things to keep in mind if you do that. If you have been offered an employer plan that has a minimum value, you will likely not qualify for the premium assistance that is available in the marketplace. The second one is that if you leave your employer plan, you won't be able to re-- reenroll into that plan until the next season. If you leave the employer plan, the employer will not contribute anything towards your premium in the plan in the marketplace. Those are a few things to keep in mind as we tell individuals about their options they have. >> Great, thank you David. And so when we look at the online application, which we've certainly been encouraging people to do because of the benefits of realtime verification and being able to see their eligibility, what happens if someone submits an application and they need to edit it? Is that an option for something that's already been submitted if they have new information. Is that going to be an option? >> If they submit an application and they want to, for example, either change the information, add information, they could certainly go back or perhaps call the marketplace. I'm not particularly sure about the details in terms of how you go about doing that. But I would recommend for now if that is the case to call the marketplace and ask for instruction about amending whatever information they submitted in that original application. The marketplace does have the ability to pull that application and see about making any amendments but I do not have like particular instructions how would you go about doing that. More to come on that. >> We'll check in on October 2nd. >> Right. >> So a little bit about -- one of the things that I think there's a question about college students and their parents' plan, and I think that goes back if they also need to register. If someone is already covered under a current plan, they do not have -- this goes back to your earlier question, there's no need for them to have to enroll here. It's strictly an option if they want to look at additional coverage opportunities, correct? >> That is correct. If they have health insurance through their parents up until age 26, they can certainly opt to keep getting health insurance that way. Another option that those individuals have is to if they feel like they would be better off going to the marketplace and applying for health insurance, they could certainly leave that plan and go to the marketplace and see if they can qualify for a premium tax credit and co-sharing reduction on their own. You are talking about young adults who is dependent, is working, is making money, and they are in between, you know, the federal poverty level that may qualify them to get the premium assistance and those circumstances, they could leave those plans and go to the marketplace and see if they qualify for that assistance. That's another option they have. >> Great thank you. Can you explain the difference between -- so a partnership-based exchange and a federal exchange? >> It's basically the same thing. >> Okay. >> Federally facilitated and partnership is basically the federal government running the marketplace, and then the states running some functions of the exchange along with the federal government but everything that applies to the federally facilitated marketplace applies to the partnership exchange. >> Great. >> Marketplace. >> Okay. So this -- let's see. So can a state and I would assume the federal as well, add rules that hinder coverage, in particular for transgendered individuals or has there been a standard set for coverage for people who are transgender? >> One thing that we need to keep in mind is that coming January 1st, 2014, there is guaranteed coverage for each and every citizen in this country if you meet those basic requirements, you have to be residing in the state, be a U.S. citizen or be legally residing and not be incarcerated. If you meet those requirements, you will be granted coverage in the marketplace. There is no state law that could prevent an individual based on their orientation to obtain health insurance through the marketplace. The law is very clear about that. >> Great. So we have time for a few more questions. Do we know at this point what the penalty is for those who decide not to get health insurance and if there is a maximum penalty? >> Well, the penalty is going to be based on a couple of things. There's going to be a transitional period for that penalty. For the first year in 2014, the penalty will be based on a flat dollar amount of $95. That is half for children. If you have children, the flat dollar amount for those children will be $47.50 instead of $95. Or based on 1% of your annual household income, whichever is greater. And the $95, we'll divide that by 12 months. So it's $95 for the year divided by 12 months, that is about $7 a month for, however, many months you went without health insurance. So if you went for five months, that's seven times five is $35, just to give you an idea for the first year so it's 1% of your annual household income, whichever is greater. The second year is $325 flat dollar amount, and 2% of your household income and the third year, it's going to be $695, flat dollar amount. Or 2.5% of your annual household income, whichever is greater. Keeping in mind, thereafter it's going to be adjusted by cost of living and also keeping in mind that your penalty will never be higher than the lowest cost silver plan in the marketplace. So what that tells us is an individual who let's say an individual who makes $1 million, they will not pay a 1% penalty of that. They will pay up to the cost of the lowest cost silver plan that that individual could have gotten in the marketplace. It will never be higher than that lowest cost in the marketplace. For families, the penalty cannot be three times that amount. So, for example, $95, if you have a family of five individuals, it's going to be three times that amount. I think it's $285 for families, that is to protect families, large families from incurring very large penalties. I hope that was helpful. >> Yes. And one of the things we do want to make sure that you did call out in chat but we want to make sure people know that an e-mail address is going to be needed for online registration for anyone who does the online forms. So that will be something that they need to have and that C.M.S. will also have instructions online for signing up for an e-mail address if people don't have them. So one last question and I know there are a few more we didn't get to but this is what happens when someone travels or resides in one state for part of the year and another state for the rest of the year? So if they split, is it their state of residence where they apply for coverage? I'm assuming they have to pick? >> Right. Those individuals will basically do what they do today if they have health insurance in one state and they travel to another state for half of the year and so forth. They could always, you know, arrange with the plan to see if they could provide continuation of coverage in that other state. Or they have the option to basically drop that plan during that six months and go and enroll in another plan in the other state, and then when they come back, they will do the same thing. They do have a special enrollment period that will allow them to switch plans if they move out of the state. Another option in the marketplace that I want to mention is that there is -- there will be multi-state plans available in the marketplace. If that is available in the state that you live, you can certainly go and choose the multi-state plan option and that will cover you pretty much across the U.S. >> Great. Thank you, David. So there were a few questions that we didn't get to and I will follow up with C.M.S. directly and we'll post those to the archive page and I want to thank all of our presenters today and for the folks at the government printing office for helping us put together this webinar and working with the F.D.L. community. We hope that you will stay in touch and sign up for updates from WebJunction on new information that being released that is relevant to libraries and we appreciate you taking your time today to join us and we look forward to hearing your stories and learning more about implementation when things kick off on October 1st. Thank you all for being here today. And have a great afternoon. [ end of event ]