I'm going to go ahead and have Kendra, my colleague here at OCLC welcome you all, and again, please post your technical questions to the Q & A panel.  
>> Kendra: Welcome everyone. 
This is Kendra Morgan. 
I'm a senior program manager here at Webjunction. 
I'd like to thank you all for joining us today. 
We do have a nice big group of panelists and moderators today to help with the session. 
We're joined by Liz Morris, eHealth project coordinator. 
David Santana, and Tarnisha Brown joining us. 
You will notice CMS after her name. 
When she is chatting, you will know that the responses are coming from CMS. 
It's great to have them here. 
Wonderful partners in helping to connect libraries to information about the Affordable Care Act. 
Our panelists today, we have a nice set. 
So we're joined by Susan Hildreth, director of IMLS. 
Susie Butler, deputy director of partner relations at CMS. 
Evan Gallagher, part of the team at ZeroDivide who are our partners in this project. 
We will be talking about some of the policy issues surrounding the ACA. 
And we're also going to hear today from two great libraries.
We've been excited to be able to start connecting with libraries who already have plans in place to support patrons in their community who have questions around the ACA and general eHealth questions. 
We have Carmen Patlan and Tatiana Alonso from the Waukegan Public Library in Illinois. 
And Lissa Staley from the Topeka and Shawnee county public Library. 
You will hear what is happening in their Libraries and the plans they have moving forward.
We're going to go ahead and start today's session. 
Today's webinar, meaningful use, libraries connecting -- 
working on with the institute of museum and library services.
Put context around the project and work that is happening in the libraries, please welcome Susan Hildreth.
>> Good afternoon. 
It is great to have all of you joining us. 
I'd like to acknowledge the great interest in the work with the Affordable Care Act and we're excited to be able to create such a great team of partners to help support the important efforts going on in our library. 
I would like to officially thank our partners joining us today. 
Centers for Medicare & Medicaid Services, they're doing a terrific job. 
Also we're working closely with the national network of libraries of medicine. 
We don't have a representative on our discussion today. 
But that's a great network for us to connect with and get information out. 
Of course, our good partnership with Webjunction and ZeroDivide, who really brings a unique point of view to all of our work. 
And I'm really excited also to welcome our libraries today, Waukegan and Topeka, Shawnee. 
And I just can't resist plugging the Waukegan Public Library, IMLS national medal winner for 2013. 
We're proud that they're taking on this great effort seriously.
If you go to the IMLS web page, you can find out all about applying to be a national medal-winning library or museum, and you still have until October 15th to do that. 
So, you'll have a few weeks after October 1st hits when the ACA roll-out goes on to think about that. 
Just briefly, I wanted to ensure all of you that we really want to focus the role of libraries on connecting patrons with help and knowledge about the Affordable Care Act. 
We don't anticipate that all of our library staff will be experts in information regarding the Affordable Care Act. 
In fact, our partnership with CMS is really helping us understand the facts and specific information about activities in the program and we're really most focused on making sure that all of our customers know where to go to get good information. 
But, again, we don't expect or think that librarians are going to be experts in this very complex topic. 
Also, we want to make sure that in your local institutions, you are following the guidance or direction of your library board, your city, county. 
We certainly think supporting and getting the information out about the Affordable Care Act is critical activity for all of our public libraries.
But we also know that you're operating in your own local context and you should certainly follow any kinds of local advice or guidance you have in terms of your effort and involvement with this work.
I'm going to hand this off to the rest of our exciting presenters. 
A great group today. 
And I know it's going to add to your knowledge base and I'm really excited that we're archiving this so that folks can come back and check it as if they weren't able to get on and it is just really a great opportunity to continue to inform all of you about this important work. 
Thank you all. 
I'll pass it back to Kendra. 
>> Kendra: Thank you, Susan. 
Before we dive into today's presentation, we wanted to make a quick note and you'll actually hear Evan discuss this in a little bit when he talks about some of the policy issues. 
It's really important to know how your state is choosing to participate in the ACA. 
There are three different set-ups that can really impact the types of resources that are available within your state. 
And so we have -- libraries or states that are participating in the federal exchange and they are in the light blue on the map. 
And then we have a partnership exchange, they'll also be relying on federal resources. 
They're in the medium blue. 
And then state-based exchanges who are taking the lead in developing their own marketplaces for health insurance, and also have their own web site. 
So, it's really important to take note of which state you are in. 
And what resources might be available to you. 
Our folks and partners at CMS will talk a lot about the federal marketplace. 
But you can also connect to the state marketplace through HealthCare.gov and we will cover that more when we get to that section. 
We want to highlight that it's very important that if you are in a state that is running a state-based exchange, that you definitely wants to look at your state resources and opportunities as well to make sure that you have the most comprehensive information. 
And with that, it is my pleasure to welcome Susie Butler from CMS, who is going to give us an update of what's been happening with the health insurance marketplace and with the CMS team. 
Welcome, Susie.
>> Thank you so much. 
I want to thank Susan for the warm welcome and introduction. 
And I want to thank all of you on the line. 
As Susan said, each of you need to decide how your library will participate, but we know that people will come to the library because they're looking for information. 
And the library is an honest broker of that information, and often the only holder of that information particularly in small communities. 
We thank you for being there. 
We hope that you can participate at some level. 
I will also say, and she didn't know I was going to say this, one of my colleagues, Lynn Johnson, on our staff is a librarian. 
We keep the libraries close to our heart and in our daily business because a librarian is always a librarian, as Lynn quickly reminds me. 
She may have been in federal service for a number of years, but she is still a librarian. 
Let me talk to you a little about some of the resources that have been in the news lately. 
You may have heard that health and Human Services recently announced a $67 million grant award to 105 navigators. 
These applicants are in federally-facilitated and state partnership marketplaces. 
The navigator grantees and their staff will serve as in-person resources for Americans who want additional assistance in shopping for and enrolling in plans in the marketplace this fall. 
The marketplace opens October 1st. 
We see that the navigators may reach out to as libraries for a place to meet people who may not be able to come to their place of business. 
Just know that the navigators are people that we've awarded grant moneys too. 
HHS has recognized more than 100 national organizations and businesses who volunteered to help Americans learn about the health care coverage available in the marketplace. 
Navigators will be among the many resources available to help consumers understand their coverage options in the marketplace and the network of volunteers on the ground in every state. 
Health care providers, business leaders, faith leaders, community groups, advocates, local elected officials can help to spread the word and encourage their neighbors to get enrolled. 
Navigators are trained provide unbiased information in a -- 
health insurance, qualified health plans, public programs, including Medicaid and the children's health insurance program. 
Navigator funding opportunity announcement was open to eligible private and public groups and self-employed people who met certain standards to promote effectiveness, diversity, program integrity. 
Navigators will be required to ADhere to strict security and privacy standards. 
Complete between 20 to 30 hours of training to be certified, additional training, and renew their certification each year. 
All types of enrollment assisters, in-person assist TER -- assisters, required to complete specific training, subject to federal criminal penalties for violation of privacy or fraud statutes. 
Vital role in helping consumers prepare electronic and paper --
enroll in coverage, marketplace, and potentially qualify for an insurance affordability program. 
They provide outreach in education to raise awareness about the marketplace and refer consumers to health insurance ombudsmen and consumer assistance programs when necessary. 
Navigators play a role in all types of marketplaces. 
Are funded through state and federal grant programs. 
Must complete comprehensive training.  
There is a lot of training material that is available for partners. 
Web-based training, there is an overview of the marketplace, health insurance marketplace 101. 
All sorts of things that might be interesting to you as librarians as well as just people who might ask you questions coming in looking for information. 
Most of these are available at the link that is at the bottom of the slide on the screen right now. 
Anything that is on the marketplace.GOV site or -- 
these are considered in the public domain and are usable by anyone.  
On the next slide, I will talk to you about the champions for coverage. 
This program has just started three weeks ago but has become wildly successful.
It is a way for you to get enrolled and involved and in your community do something special. 
A champion is someone who is willing to share information or outreach materials, be that a business card with a link on it, or a web address on it, a poster in your place of business. 
In this case, maybe at the information desk, or just tells people about where to find more information.  
To be a champion, you should go to HealthCare.gov and scroll down to the bottom of the page and it says information for partners. 
You click on that link and it takes you to champions and assisters and you can click on the champion button and then sign up there. 
We've had a number of libraries sign up because they're willing to distribute information and help people in their community. 
One of the things that you can also do is if you have an outreach mechanism to your community, you can post the marketplace widget or use downloadable materials on these resource pages to send information and educational articles to people in your community or your library patrons. 
These are updated on a regular basis and we're seeing more and more materials go up each week.
This week we posted a number of materials for back-to-school. 
Again, we're trying to be attentive to the people where they are and what they're doing. 
We also have a number of ways to follow, including Facebook and Twitter. 
And we also have our Spanish language web site.  
So, with that, I'll send it back to Kendra.  
>> Kendra: Thank you, Susie. 
A quick note to everyone. 
We do see your questions coming through and we know that the team at CMS will be able to answer some of them through chat. 
And we will also write down your questions and talk to our presenters at the end during the Q & A session.  
So, with that we'll move on to Evan Gallagher, from ZeroDivide. 
Evan, welcome.  
>> Evan: Thanks, Kendra. 
Good morning everyone from here on the west coast and thank you, Susie. 
I'm going to go ahead and build on, reiterate a lot of what Susie started to talk about and then dive a little deeper into some of the issues specifically relating to libraries. 
What I want to start with, is a little bit more about what exactly the different health insurance marketplaces are.  
The marketplace, exchange, a competitive marketplace for insurance created by the ACA. 
This marketplace provides a space for consumers and small businesses to shop for qualified health plans with clear mandated and defined levels of coverage and benefits. 
It also allows for the consumer to use it to quickly determine whether they qualify for subsidies or for state-run health insurance like Medicaid.
The marketplaces will be operating in every state either by the state itself, federal government, or a partnership between the state and federal government. 
For all of the federal exchanges, the actual web site will be HealthCare.gov.  
So, as a first step for libraries, you should try to understand exactly what type of exchange is operating in your state and identify what is the most direct source of information that you can have for your exchange. 
First thing you can do for any state is go to the HealthCare.gov site. 
And what is my marketplace in my state drop down menu?
You can get the basic information here.  
Here you can get the basic information and a link to your exchange's web site. 
If your state is using a federal exchange or partnership exchange, HealthCare.gov will host the marketplace in your state. 
Otherwise there will be an equivalent state-run exchange opening on October 1st.  
So, what does enrollment actually look like starting October 1st?
The system will have multiple options to enroll, including an old paper and mail system, as well as enrollment via phone. 
But the majority of new enrollees are expected and will be encouraged to use the online system.  
The online application is convenient for a number of reasons. 
Primarily because it includes applications not just for private insurance, but also for Medicaid and other public forms of insurance. 
And in addition, the exchanges will offer nearly instant verification of important eligibility criteria, such as income and employment status. 
Related to that, because eligibility for subsidies will be determined immediately in real-time, patrons will know which insurance they can get almost on the spot rather than waiting weeks in traditional insurance application processes. 
Key thing to remember, regardless, is that everyone will be eligible for some sort of insurance, no matter what their income or employment status is.  
So, I want to talk for a moment about an important trend related to libraries. 
Increasingly today's public libraries are serving as critical resources for information related to health and well NIS -- wellness. 
Library role is continuing to grow and will continue to grow.
Recent study demonstrates that 47% of patrons who use the library computer in 2012 said they retrieved some sort of health information. 
At the same time, patrons who have been shown historically the value utilized and use the libraries the most, low income or minority communities, are also the same patrons who will be encouraged and most eligible to enroll in new health care coverage under the Affordable Care Act.  
A parallel trend I want to talk about for a moment is the growing importance of electronic health tools. 
Our health care system is increasingly encouraging individuals to engage with health care online and via digital tools. 
Experts believe this will improve quality, patient experience of care, lower cost and improve overall health and wellness in the future. 
Emerging group of apps, web sites, online resources that allow you to engage with health online, eHealth. 
EHealth is part of a broader role that libraries can play in providing equal access to -- 
digital mandates, make the goal of digital inclusion very critical. 
Affordable Care Act requires and encourages folks to enroll via the web. 
The federal government is encouraging and -- use electronic health records. 
And in a related associated patient rights law, providers are required to share electronic health data with individuals and ability to access, view, and control one's health records as part of a broader movement to increase patient empowerment and engagement. 
These three trends make eHealth and digital inclusion more important as a role for libraries. 
What does enrollment support look like at the libraries?
Key message I wants to convey, library staff can play a wide-range of roles in connecting patrons to ACA information. 
Some may choose to direct patrons to information and exchange web site. 
That's fine. 
Others may offer a dedicated computer space for enrollment processes, and for patients to apply independently. 
Others, as you will see later in today's presentation, may have staff trained to provide in-person assistance or provide library space for other organizations. 
Whatever your library chooses to do, that's up to you and will be based on your local needs and priorities. 
Patient privacy. 
We know that is an important priority for libraries. 
One thing to know, this process will not require your patients to enter an extensive medical history. 
They will have to enter some detailed and personal information. 
And this is where -- this is where understanding your library's privacy guidelines and policies is very important.
Staff may use to review and apply your current and previous policies regarding information services for other government resources that involve personal information. 
Examples would be ones related to tax forms, unemployment application, immigration resources. 
And you can take those policies and perhaps apply them to the Affordable Care Act. 
However, I'd like to reiterate, an is a librarian, you should not expect to sit down and take patrons through the entire application process unless that is a decision that your library makes on its own.  
Libraries are an important resource for ACA information, you're by no means the only resource for your information in your communities. 
You're not alone. 
Libraries should think of themselves as part of a mutually re-enforcing network of organizations. 
As discussed previously by Susie, network of local community organizations designated as assisters and navigators in your community. 
They're there to take your patron step by step through the process. 
Local community health clinics also have trained individuals to help educate and enroll patrons. 
Some of these trusted organizations may choose to locate themselves at community anchor institutions such as libraries. 
You may want to consider reaching out to these organizations -- in addition to the community resources, other resources will also be available at the federal level, including a 24-hour call center with language support for those states operating federal and partnership exchanges. 
And remember that information on all of the community resources can be found at the HealthCare.gov site, CMS site, or your local exchange site as they become available closer to October 1st.  
Now, you should adopt strategies that make the most sense for your library, providing ACA information and enrollment support is an opportunity to expand the influence and role in your local community. 
First identify what type of insurance exchange is operating in your state. 
Who your potential partners are, and then assess how your staff and your library can meet your patrons information needs best. 
Then define the role that best fits your library. 
And the resources available to you. 
And finally, remember to familiarize yourself with the HealthCare.gov, Webjunction, and state exchange resources available to you. 
Thanks a lot. 
I'm going to throw it back to Kendra right now.  
>> Kendra: Thanks, Evan. 
I think that little overview about the importance of figuring out where your library can fit in the information request and how you can respond to patron needs is going to be really important for each library to decide as we move forward. 
And we're going to have the opportunity now to hear from two libraries who have decided some of the actions that they would like to take in their communities. 
So, please join me in welcoming Carmen Patlan and Tatiana Alonso from the Waukegan Public Library. 
Welcome.
>> Thank you. 
And first of all, I wanted to say, thank you to Susan Hildreth for the IMLS win shoutout. 
We are very proud here. 
My name is Carmen Patlan, community engagement outreach manager for the Waukegan Public Library.
>> Hi everyone. 
I'm Tatiana Alonso, the Promotoras/Ambassador coordinator with the Waukegan Public Library.
>> We will give you background of our work and efforts in engaging our community. 
The community is comprised of 54% Latinos. 
In our efforts to build relevant programming and services, we implemented the award-winning Promotoras/Ambassador program. 
Made up of trusted community members who volunteered to do market research via surveys. 
Allowed us to structure our programming, some of the barriers our community faces. 
By responding to the needs of the community, WPL is viewed as a trusted institution and relevant to the many individuals participating in our classes and services. 
So much so that word of mouth is our best promotional material.  
Our library is fully committed to the success of our community from top to bottom. 
Our director publicly stating his support for the well being of our community including the Affordable Care Act. 
Our role of the Affordable Care Act would not be possible without the full support of our director and staff. 
Not only are we relevant with the Affordable Care Act, being mindful that not all VIED individuals in -- health literacy one of our most recent initiatives. 
Literacy class that educates individuals on health care, accessing care via the local health department and clinics.
The library is a member of the alliance for Human Services in Lake County, ill  -- Illinois. 
One of those services being access to health and primary care. 
Lake County health department, alliance for Human Services, Waukegan Public Library part of the grant funded by the state. 
Allow the Waukegan public library to dedicate three existing staff members to focus on the Affordable Care Act. 
Based on the community demographics, we knew that language, trust, would play a factor. 
The three IPCs identified are key in reaching our target audience. 
Fully bilingual, active, trusted in the community. 
Our goal is to help enrollees feel confident knowing that they are at a trusted institution that will provide adequate space for enrollment to take place. 
I will now hand it over to Tatiana who will give you an overview on how the Waukegan Public Library will effectively serve our community with education on the Affordable Care Act and -- 
>> Thank you. 
Before I go into detail of the work plan, I would like to again share a brief explanation regarding in-person counselors, otherwise known as IPCs and Affordable Care Act navigators.
Navigators and IPCs. 
Navigators and IPCs have the exact same responsibility, to help individuals make an educated choice for health care coverage. 
The only difference is funding and the navigators are funded federally, and IPCs are funded through a statewide effort. 
The county and Waukegan Public Library will work in three faces in order to achieve our -- three phases. 
The first phase is extremely important for us to complete our overall goal. 
We will be conducting outreach and engagement. 
Meaning we are taking the time to have a conversation with individuals and collect demographic data, explaining the importance of the Affordable Care Act and letting them know that the library will be available to assist them throughout the process. 
This will be an ongoing phase until March 31st, 2014, when the market closes. 
The second phase, we are expecting the marketplace to be open on October 1st. 
On this day individuals can begin to enroll in their new health insurance plans. 
But their benefits will not begin until January 1st, 2014.  
Phase three. 
The final stage is post enrollment. 
Our IPCs will continue to case manage enrollees to ensure that they're adequately enrolled and receiving their health coverage benefits.  
In the state of Illinois, all IPCs must attend a two-day state certified training and are required to attend webinars provided by the state throughout the enrollment process in order to be updated and informed on the most current information regarding the Affordable Care Act. 
As IPCs, our goal will be to assist individuals in making an educated choice on health care options via the marketplace. 
We will not be influencing a decision on their part. 
We will accomplish this by through workshops, one on one sessions. 
Workshops will be a 45 minute overview of the Affordable Care Act, allowing time for Q & A. 
Our IPCs will be available for one on one enrollment sessions averaging an estimated 45 minutes per enrollee. 
And for those individuals who feel comfortable with the online marketplace, but might still need assistance throughout the process, we are offering drop-in labs scheduled to run for a two hour time period at our computer lab during the open enrollment time frame.  
This effort cannot be completed with IPCs alone. 
This is an all library staff effort. 
Specifically with our customer service and reference staff. 
Our staff will be trained and prepared with basic information regarding the Affordable Care Act so that they may be able to engage patrons and collect basic demographic information from potential enrollees. 
Then our IPCs will be expected to follow up and schedule the enrollee in the appropriate working session. 
The demographic data is kept private and only IPCs once collected.  
What can you do at your library?
Research. 
What is the current status of the Affordable Care Act in your state?
Contact your local state agency overseeing the Affordable Care Act. 
Build a relationship and partner with your local organizations that are already taking an active role with the Affordable Care Act. 
Create and post a listing of enrolling agencies in your community. 
Train your reference desk, host educational workshops and, if possible, host an IPC. 
We would like to end with a list of resources that we have found to be very useful both for IPCs and reference desks. 
With that, back to Kendra. 
Thank you. 
>> Kendra: Thank you so much. 
It is amazing all of the work that has been happening and I know that is in part because of your partnership, a unique partnership, certainly other libraries and other counties and cities could look at. 
Powerful partnership in Waukegan and impressive. 
I want to remind everyone that the links that have been provided in these presentations will be available in the archive as well as on the archive page for you to reference. 
You will be able to get straight to them. 
We are collecting your questions for the Q & A. 
We will be able to get to that in a few minutes. 
But first, we're going to hear from Lissa Staley. 
Welcome, Lissa, from the Topeka Shawnee public library in Kansas.
>> Thank you. 
I'm the health information librarian here. 
In Kansas, we have the federal exchange. 
As a librarian on the front lines, I know we all want to help our customers and answer their questions. 
This emphasis on the marketplace and libraries is giving us a really great opportunity to advertise our services overall. 
The Library is here to help customers accomplish whatever they need to get done, and in this case, it includes applying for insurance. 
I try to work in everything else, too. 
When I was interviewed a few weeks ago in the local paper, my message was really simple. 
The library will provide information, handouted, compute equipment and referrals. 
Everything that libraries need is right there for us or it will be there soon. 
I'm excited about what is coming still. 
If you are looking for a strategy, I can shares ours with you. 
Our plans have come together in the last few weeks. 
CEO said what are we doing for this?
I said I'll get right back to you on that. 
Since the marketplace can be accessed online, I reserved our computer training center at a variety of dates and times, help people by giving them more computer time. 
I had dates and a vague description, and I could begin advertising the sessions right away. 
I added the HealthCare.gov widget which you can see to the library health web site to remind customers and staff of the go-to place for information. 
You won't have all of the details today. 
And that's okay. 
Be transparent with your staff about what's still in the works. 
Be transparent with your public about what is still in the works and what the library can provide. 
For us, just in time training is scheduled closer to October 1st for front-line staff who are thrilled to hear that local navigators and other assisters will be available in the fall for referrals. 
In the related resources for the webinar, I recommended a link labeled identify possible partners. 
I think that's the one that keeps getting posted over and over in chat. 
We're librarians. 
The skills being asked of us are some of our best skills. 
Coworkers are comparing this to income tax season. 
We don't do our taxes for them.
We help them get the forms and use the computers. 
Provide contact information for customer support and locate the local in-person assistance that is available for them. 
This is something that we're great at. 
Communicate your expectations to your staff and coworkers. 
Make basic assistance with the health insurance marketplace part of everyone's daily work, same as every other reference question. 
Things you can do to support your staff in this new thing would be to make a display of handouts from the marketplace web site, encourage staff to give those to customers and use that as a point of discussion. 
Interaction with customers will likely begin as directional, reference questions. 
The customer may be referred to a trained navigator, or many can be directed to HealthCare.gov by the first person who helps them at the library. 
Decide what exceptions to normal rules you can easily make. 
If you can help customers by extending computer time, proviing free computer printer, library phone to call the marketplace support line, decide as a library what you can do and let your staff know what the new rules are for helping with this.  
I really lucked into partnerships. 
I did not want to focus on how magically lucky I was. 
Let me say, our partnerships have been successful because we have advertised to community agencies interested in outreach in partners. 
We focused on what we can provide, which is access to computer, internet, printers, tech support, distributing information from reliable sources and open a lot of evening and weekend hours and other agencies are not. 
That is something that libraries have going for them. 
If it is too late to schedule big events at your library this fall, consider supporting the plans of your community health partners, advertise or cosponsor their events, and offer your library space to the local navigators and the certified application counselors, whatever they're called in our area, as a neutral public space to meet clients and use public computers. 
I think Evan had the best slide. 
Don't get overwhelmed by the details. 
Increase customer access of information about the marketplace and opportunities for customers to successfully apply. 
From ideas and resources, hopefully you can choose a few things to do to set up your staff and customers for success. 
>> Kendra: Thank you so much, Lissa. 
I think you have, one, an amazing attitude, and I think it is fantastic. 
And I think that the analogy that you made is certainly one that we've seen come up a lot with questions around providing access to this information and that is similar to tax season, where a lot of libraries provide access to downloadable forms or computer time for patrons and certainly provide access to the web site and online information and I think that is a very similar analogy here. 
Of course, there is an opportunity as we have heard from the team in Waukegan, of taking it a step further where they're going to be actually providing in-person assistance and working through a partnership. 
And, so, the bottom line, and I believe it is something that we want to keep reiterating, is finding the right path for your library. 
A lot of that comes down to resources and time. 
It's a matter of sitting down and devising a plan. 
And, so, with that, we've had the chance to hear from all of our presenters. 
We're going to take a few -- 
the next 20 minutes to talk about some of the questions that have come through for our presenters, and we actually have from CMS, we have David Santana, who is going to answer some of the questions that have come in regarding enrollment. 
So, David, I'm going to start with you, and a few of the questions that came up around eligibility. 
Can you talk -- one of the questions that we saw a few times was about eligibility enrollments and citizenship. 
Can you talk a little bit about what the requirements are for being eligible to participate in the ACA?
>> David: Sure. 
There are three basic, rather four basic requirements to participate in the marketplace.
They're really broad. 
Nothing really new here. 
The first one is the fact that an individual needs to leave --
they need to live in the service area. 
The service area of the marketplace is usually the state. 
You have to be a resident of the state that you are applying for coverage. 
The second one is that you have to be either a U.S. citizen or national, or be a noncitizen or national lawfully residing here in the U.S. 
That means an individual who, for example, is undocumented. 
They don't have an immigration status here in the U.S. 
They're not eligible to participate in the marketplace, even if they want to buy health insurance and pay on their own, they're not able to purchase health insurance in the marketplace. 
The last one is individuals cannot be incarcerated. 
That is because individuals in those institutions, they get health insurance through other means. 
Either through the state Medicaid or other means while they are in those types of institutions.  
>> Kendra: Thank you, David. 
>> David: You're welcome. 
>> Kendra: Can you talk a little about whether or not it is beneficial for people who already have insurance coverage, perhaps through their employer or through a spouse, is it beneficial for them to check out the coverage that's available on the marketplace?
Through the marketplace?
>> David: The answer to the question is really it depends. 
If you have a health insurance right now through either your own employment or through a spouse, the decision relies on the individuals. 
What we encourage individuals to do is once the marketplace is open, if they wanted to go and compare health insurance plan in the marketplace with what they currently have, they are certainly free to do so. 
A couple of things to keep in mind. 
There will be financial assistance for individuals in the marketplace, for example, to help them pay for their premiums and also to pay out of pocket expenses when they received the service. 
If an individual has an offer of health insurance through an employer plan, to themselves, individual, spouse, family member, and that plan is affordable and it offers a minimum value, that individual, although they can leave that plan and go to the marketplace, they will now qualify for financial assistance, if they have access to an employer health plan, again, that is affordable and also offers the minimum value. 
That applies to individuals who have access to government-sponsored health plans, for example, Medicare, Medicaid, Chip, veterans administration health care. 
Those who are enrolled in those plans as well as those who have access to Tri-care benefits. 
Access to health insurance through those means, and even if they meet the financial requirement to qualify for the credit, they will not be able because they already have it offered through either an employer or through government.
>> >> Kendra: Great. 
Thank you. 
Another area that has come up, definitely people are interested, especially because libraries might be looking to navigators or in-person assisters or counselors, a searchable data base expected in September to help people connect to navigators. 
Will that include both the federal and the state-based exchanges or just navigators and the federal exchange?
>> What happens, if an individual is a state-based marketplace, and they go to the web site, and they choose -- 
the first thing you will do is choose which state are you in and you will be redirected to that state marketplace, if it is a state-based marketplace and you will be able to find information about which navigators participate within the state-based marketplace. 
It will be a triage. 
Once you choose that state, you you will be sent to that state marketplace.
>> And in the state-based marketplace, if libraries want to connect with their navigators or in-person assistance counselors, would they do that through their state-based exchange?
>> David: That is correct. 
Because the state-based marketplace. 
They have flexibility under the Affordable Care Act, in terms of how they establish navigators and personal assisters and certified application counselor. 
We encourage you to go to the state-based marketplace and there will be a toll free telephone number that you will be able to call and get information, and a web site about how they're operating their marketplace, and of course, navigators and other assisters available to help individuals. 
>> Kendra: Okay.  
And we talked a little bit, I think there is a good link and we will provide it, but if you could talk a little bit about the navigator in-person assister and certified application counselor. 
Are all of those positions, roles, are they required to get training?
>> David: All of them are required to get training. 
Navigator, we are expecting kind of required that the navigators will go through 20 to 30 hours of training and they have to pass a test, as well as at the end of the training, with the 80% level or above passing score. 
Certified application counselor also will go through a training, not as lengthy as the navigator, but they will go through about probably like five hours of training as well, and then there is also a separate training for the in-person assister, which, again, is pretty much similar to the navigator training. 
Agents and brokers also will be available to help in the marketplace and also they will go through some sort of training as well.  
>> Kendra: Great. 
Lots of training.  
>> David: Lots of training and certifications. 
>> Kendra: Wonderful. 
Okay. 
A little bit now about the enrollment period. 
I think we're now well aware that October 1st is the first day of open enrollment, and we know that March 31st, 2014, is the end of the period. 
Can people enroll after that time period, after that initial open enrollment period and what would that look like?
>> David: Sure, the initial enrollment period lasts for six months. 
That starts in October 1st of this year, and ends on March 31st of 2014.  
After that initial enrollment period, in order to access a plan in the marketplace, you have to qualify for a special enrollment period that will allow you to -- outside of this initial enrollment period. 
Special enrollment period, for example, entails an individual who is losing, for example, an employer plan or some sort of plan that they have and they're losing that plan. 
They can access the marketplace at that time after March next year. 
For example, if you have extending your family, for example, you become an independent. 
Families that have children, getting married, divorced, things like that will allow you to access a plan outside of that open enrollment period. 
For example, immigrants who are adjusting their immigration status here in the U.S., to the point that they would qualify to purchase a plan, they could do so at any time -- not at any time, but, rather, after they adjust their status, they have about 60 days to choose a plan. 
Gaining or losing eligibility for premium tax credit, we talk about that. 
Individuals who are applying for premium tax credit or losing the eligibility, they will be able to join a plan or change a plan at that point. 
And, of course, individuals who, for example, are moving from one place to another and as a result of the move, they will have access to health insurance outside of that initial open enrollment period.
So, to sum it up, there are many special circumstances that will allow an individual to join a plan outside of that initial enrollment period. 
Keep in mind, that every year from October 15th through December 7th, individuals will be able to join a plan or change a plan at that point. 
So, this is the -- the 6th month here is just the initial enrollment period. 
Thereafter, every year from October 15th through December 7th, they can come and join plans or change. 
One more thing that I wanted to mention. 
It is a question that comes up a lot. 
And that's a question of an individual who enrolls in a plan and then, you know, in May or June say this is not for me.
I don't want to be enrolled in this plan. 
They will be able to drop that plan at any time. 
They just have to give about 14 days' notice to the plan so that the plan can terminate their plan. 
If you do that, keep in mind that you wouldn't be able to re-enroll again until the annual open enrollment period. 
>> Kendra: Thank you, David. 
Just a few more questions and then a few for the team at Waukegan.  
And this is one that has come up a lot about online enrollment. 
One, I want to clarify, because we definitely heard this before. 
Online enrollment is not required and a paper-based form is available and can be printed off. 
And you can confirm that?
>> David: That is correct. 
There is -- there are multiple ways of -- that individuals can go about -- the preferred method is online. 
You have the real-time response right there. 
But you can also do it by phone by calling the marketplace. 
You can do it by mail by requesting a paper application, or just call the marketplace and say I would rather meet with someone in person to help me fill out that application. 
There are multiple ways to go about doing that. 
>> Kendra: Great. 
Thank you. 
I have a few questions now that have come in for the team at the Waukegan Public Library.  
One of them was about how you were able to determine how many people in your county were without health insurance?
Did you do a statistical analysis, or other research that was conducted? 
>> This is Carmen. 
We are part of the county grant, spearheaded by the Lake County health department. 
They have done extensive market research on the community itself and how many individuals are currently uninsured in Lake County. 
It was determined that our goal as a partnership with other organizations that are also part of the county, that we would target to seek out and engage about 20 to 25,000 uninsured individuals in the community.  
I hope that answers the question. 
>> Kendra: It does, thank you. 
You also mention that three of your staff were hired to become in-person counselors. 
Are these new staff that you were able to hire or existing staff who have been trained?
>> Thank you for that question as well. 
The county allowed us to utilize our existing staff. 
We had the option of hiring out. 
We determined that within our staff, we were going to take an active roll with the county and aAffordable Care Act. 
We dedicated three individuals who were on staff. 
We used existing personnel and divided 40 hours amongst the three to dedicate to this program.  
The county allowed us to get a grant and this grant will be able to offset some of the expenses with our staff and personnel. 
>> Kendra: Can you talk a little about how the partnership with the county health department has evolved and how you were able to build that relationship? 
>> It's been a 2 1/2, almost three-year process where we, providers, community resources, came together and began to have focus groups and round-table discussions to see how we could all collaborate and effectively serve our community and our Human Services better. 
A long process of having one on one conversations and focus groups to help us better determine how to be relevant and serve community and addressing barriers and needs. 
So, a strong partnership with the health department is very important, and your organizations, in your libraries, because that is where it made the biggest difference for us.  
>> Kendra: Thank you. 
Now, I have a few questions for Lissa at Topeka and Shawnee county. 
Lissa, could you talk a little about how partnerships have played a role in your community and in the services that your library plans to offer?
>> Lissa: Definitely. 
As health information librarian, I have been attending local coalition meetings where a lot of different people are getting together at the same table. 
I try to represent the library there. 
As this came up, I kept politing raising my hand and saying how can the library help?
What do you need us to do?
Those things. 
As different things, including this come up, oh, yeah, could you do this?
Could we hold an event at your library?
Those kind of things. 
We were doing a partnership with the local community health center on the Thursday that navigators were announced and the person who got the navigator grant was at our event. 
That is how those things -- 
like I said, I -- I worked hard to get the library at the table for those things. 
>> Kendra: Great. 
Thank you.  
And how have your patrons been responding to your efforts so far?
Is it something that they're noticing and participating in?
>> I think for the most part, honestly, a lot of my handouts are still on the wall. 
People aren't picking them up. 
I think that's okay. 
This doesn't start until October 1st. 
Not much to do at this point. 
Staff are feeling good that we have information up, we know how to answer their initial questions. 
My mantra is everything there be in place by October 1st, don't worry. 
Because I think it will be. 
>> Kendra: That's great. 
Thank you, Lissa. 
>> Lissa: Sure. 
>> Kendra: All right. 
Looking back through some of the questions. 
I know there are a lot. 
Some are very specific. 
I'm not sure we will get to all of this. 
 Tarnisha, she has been putting in some answers to the questions. 
David, I have a few more questions to you. 
One about the online enrollment and whether or not an email address will be required to submit an online application.  
>> David: One of the things that the online application will require is for you to -- 
for the individual to create an account. 
So they will be asking specific questions in there. 
I'm not sure that ultimately we will require an individual to have an email account. 
But they do certainly need to register or rather create an account. 
That -- in terms of the email address, I will have to research that further and provide an answer to that later.
>> And the estimated online enrollment time, has there been an estimate of how long it will take to complete the federal application?
>> That would depend, of course, the individual specific situation. 
You're talking -- if there is a single individual who is not asking to be screened for tax credit and reduction and stuff, application is fairly fast. 
But, of course, if you are a family of five, six, eight individuals that you have to put the information for each and everyone of them, it's going to take you much longer to fill out an application and, of course, they will be asking for income information. 
They're going to be asking about whether you have an employer plan and what type of employer plan. 
So, it is going to take much longer. 
It depends, of course, on the situation of an individual.  
>> Kendra: Thanks, David. 
>> David: You're welcome. 
>> Kendra: We're at the top of the hour. 
I know there are still lots of questions and there will be continue to be questions as we move toward the open enrollment period. 
Some of these we're going to work to clarify to put on the Webjunction eHealth page. 
So, Jennifer Peterson has posted the link to our page that we will try and update, especially the questions that we have heard most frequently from participants in the webinars and we will continue to schedule events going forward as we have new information. 
And you can also sign up to receive updates from this project that relate specifically to libraries. 
For example, last week, when the announcement was made about navigators being awarded, we sent out an announcement to the folks who are signed up to that list. 
So, please consider that as a way to stay informed with the project. 
And you can also subscribe to Crossroads, which is our newsletter and it comes monthly at the beginning of the month. 
We appreciate all of today's panelists for sharing their stories and information about the ACA and how libraries can help. 
We look forward to hearing more about what each of you are doing. 
It's by far been one of the most amazing things to get emails from libraries around the country sharing their stories with us and we are starting to capture those so that we can share them back to you. 
We know how powerful that is that you can share with your staff, director, boards, how libraries can help meet some of the information needs in the community. 
Thank you for all that you do and the time you spent on today's session. 
The archive will be posted and available. 
Feel free to forwards that to any other staff that you think might be interested. 
We look forward to bringing you more information soon. 
Thank you all so much. 
Have a great day.