Show Me The Money!
If a member currently has no income and is not working, they can submit this type of signed, written statement under penalty of perjury.
What is an Affidavit to Verify Zero Income?
Remember: If the member receives 0 income, the income in the application should reflect the number 0.This vital step must occur at the beginning of every inbound call before an agent discusses protected account information.
What is authenticating the Head of Household (HOH)?
This required Salesforce Guided Workflow helps agents investigate why a member lost their financial assistance.
What is the Eligibility Guided Workflow?
A member requests cancellation of their Health Connector coverage on November 15. Under the standard cancellation rules, this is the last day they will have coverage.
What is November 30?
Income updates occur when an applicant completes one of these two actions in the HIX system.
What is Report a Change or Submit a First-Time/New Application?
These four items must be verified in order to complete authentication with the actual HOH on the account.
This expired type of verification can cause a member to lose financial assistance.
What is proof of income?
Also acceptable: What is an RFI?
Scenario: A member calls on December 27 requesting to cancel their Health Connector coverage. They are concerned that they missed the December 23 payment deadline and must wait another month. This is the date their coverage can end under the standard cancellation rules.
What is December 31?
When a member's current income changes, this income should be recalculated as well in HIX.
Remember: We should not calculate based on a 4 week month as that only accounts for 28 days. We should instead calculate for a 52 week year or 26 pay cycles for paychecks earned every 2 weeks.
These five elements complete the standard MAHC $100 Close for every call.
What are summarizing the call, asking if the member needs anything else, thanking them for calling, branding the call with Health Connector, and asking them to remain on the line for a brief survey?
Also Acceptable: What is the Summary, Additional Assistance, Branding, Thanking the Caller, Survey offer?
Scenario: A member loses their financial assistance due to an outstanding requirement for MassHealth. Before reassessing their eligibility, the agent must guide them through this process to resolve the issue.
What is the MassHealth Renewal Process?
Scenario: A member calls in March 2027 after losing their insurance through their job due to changing employment. Open Enrollment has ended, but the member wants to enroll in a Health Connector plan. The agent must investigate whether the member qualifies for this option to allow plan shopping.
What is a Special Enrollment Period (SEP)?
If members are asking agents complex questions about tax implications based on their eligibility, agents should refer the members to this type of resource.
What is a Tax Preparer/Professional?
This type of authorization form permits a designated individual to discuss a member's account but does not grant permission to make account changes.
What is a PSI form?
Scenario: A member loses their Health Connector subsidies because they are eligible for another qualifying source of health coverage. The agent should investigate whether the member has this type of coverage that may disqualify them from financial assistance.
What is Minimum Essential Coverage (MEC)?
A member selected a plan for January 1 coverage but missed the initial payment deadline. Their enrollment remains in “Awaiting Payment” status. To activate the coverage, the member must pay this premium amount by 1/23.
What is the full premium amount owed?
Also acceptable: What is the full premiums for January and February coverage?
Student loan interest is subtracted from a member's income because it is part of this category on their taxes.
What is a deduction?
A member's mother calls to discuss her adult child's eligibility and income information. She provides the member's name and date of birth but has no ARD/PSI forms on file. This must occur before the agent can discuss protected account details.
What is speaking with the HOH to authenticate and obtaining a One Time Verbal Authorization (OTVA)?
Remember! OTVA scripting must be read verbatim from the Authentication Study Guide Job Aid every time.
Scenario: A member calls because their financial assistance disappeared during renewal. Their income and household information are accurate, but HIX indicates the IRS could not verify their information, and the renewal was completed a week ago. This action can be taken by the agent in HIX to complete the IRS data matching process.
What is submitting the application?
Scenario: HOH calls to report that they are receiving a raise at work that begins on 1/1/2027. They advise it is salary, so they know the precise income they will receive in 2027 if no further changes occur. This is the application update the agent should complete.
Note: Answers must also include which application to update.
What is 2027 application income update?
Also acceptable: What is RAC to update income on 2027 application?