Opportunity Information: Apply for CA CAP 12 002
Apply for CA CAP 12 002
- The CMS Consumer Information Insurance Oversight in the health sector is offering a public funding opportunity titled "Affordable Care Act Consumer Assistance Program Grants" and is now available to receive applicants.
- Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.519 Affordable Care Act (ACA) Consumer Assistance Program Grants.
- This funding opportunity was created on Jun 7, 2012 and posted on Jun 7, 2012.
- Applicants must submit their applications by Jul 9, 2012 No Explanation. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
- The funding agency has allocated a total of $29,900,000.00 to eligible and selected applicants.
- The number of recipients for this funding is limited to 56 candidate(s).
- Eligible applicants include: State governments.
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Opportunity Summary:
The Affordable Care Act (ACA) Consumer Assistance Program Grants are federal discretionary grant funds made available to state governments to help them create, expand, or support independent consumer assistance or health insurance ombudsman offices. These programs are intended to serve as a practical, public-facing resource for people who need help understanding and using health insurance coverage in a changing marketplace. The underlying legal authority comes from Section 1002 of the ACA, which added Section 2793 to the Public Health Service (PHS) Act. The overall goal is to improve accountability and consumer protection in health coverage by giving residents a place to turn for enrollment help, problem resolution, and education about their rights.
A central requirement of the grant is that funded consumer assistance or ombudsman programs must directly support consumers in several concrete ways. First, they must help people file complaints and navigate appeals when they believe an insurer or group health plan has made an incorrect decision, denied coverage, or handled a claim improperly. Second, they must assist consumers with enrollment into health coverage, which includes helping uninsured individuals understand available options and, when appropriate, connecting them to coverage pathways such as private insurance, employer-sponsored plans, or public programs. Third, they must educate consumers on their rights and responsibilities related to group health plans and health insurance coverage, which is especially important as new ACA protections and rules take effect and as people encounter unfamiliar terms, processes, and eligibility rules.
Another major purpose of the program is market oversight through structured data collection. Grantees are expected to collect and report data on consumer inquiries, complaints, and the types of problems people are experiencing. This information is meant to help the Secretary of Health and Human Services identify patterns and emerging issues in the health insurance marketplace and strengthen enforcement of major health laws, including the ACA itself and the Mental Health Parity and Addiction Equity Act. In practical terms, the consumer assistance office is not only solving individual cases, but also acting as an early warning system that can reveal whether health plans or issuers may be out of compliance and where enforcement or policy attention might be needed.
The announcement also anticipates the expanded role these programs would play starting in 2014, when ACA health insurance marketplaces (referred to in the notice as Affordable Insurance Exchanges established under Section 1311 of the ACA) became central to coverage access. From that point forward, programs were expected to help consumers resolve problems related to obtaining premium tax credits for exchange-based coverage. That includes troubleshooting situations where a consumer cannot access the financial assistance they appear eligible for, where paperwork or verification issues arise, or where there is confusion about how subsidies interact with plan choices and enrollment timing.
The grant description makes clear that HHS interprets consumer assistance responsibilities broadly when it comes to helping uninsured individuals obtain coverage. Programs should be able to guide people toward appropriate sources of coverage and make referrals to Medicaid, the Childrens Health Insurance Program (CHIP), or the Pre-existing Condition Insurance Plan (PCIP), which was an early ACA-era coverage option for some individuals with pre-existing conditions before broader market reforms took effect. For data collection, programs are expected to capture information primarily about private coverage inquiries, but also to track the kinds of issues consumers report when those issues touch public coverage, state high-risk pools, or PCIP, since real consumer experiences often cross program boundaries.
At the same time, the opportunity sets a boundary around Medicare, Medicaid, and CHIP problem-solving. Programs do not have to be built to provide direct, specialized casework on Medicare, Medicaid, or CHIP issues. However, they must be capable of making appropriate referrals so that consumers who contact them with those needs can be directed to the right agency or assistance channel. This requirement recognizes that consumers often do not know which program governs their issue, and the consumer assistance office should function as an effective entry point rather than a dead end.
Administratively, the opportunity was issued by the Centers for Medicare and Medicaid Services (CMS) under the Consumer Information and Insurance Oversight area. It is listed under Funding Opportunity Number CA CAP 12 002 and CFDA 93.519. The total estimated funding amount was $29,900,000, with an expected 56 awards, and it did not require cost sharing or matching funds. Eligible applicants were state governments. The posting date was June 7, 2012, with an original and current closing date of July 9, 2012, and the opportunity archived on August 8, 2012. For technical access issues, the notice points applicants to the Grants.gov Contact Center, which provides 24/7 support (excluding federal holidays).
Affordable Care Act (ACA) Consumer Assistance Program Grants (CFDA 93.519) - FAQs
What is the ACA Consumer Assistance Program (CAP) Grant?
The ACA Consumer Assistance Program Grants are federal discretionary grant funds made available to state governments to help create, expand, or support independent consumer assistance or health insurance ombudsman offices. These offices are intended to be practical, public-facing resources that help people understand and use health insurance coverage in a changing marketplace.
What law authorizes this grant program?
The legal authority comes from Section 1002 of the Affordable Care Act (ACA), which added Section 2793 to the Public Health Service (PHS) Act.
What is the overall goal of the CAP Grant program?
The goal is to improve accountability and consumer protection in health coverage by giving residents a place to turn for enrollment help, problem resolution, and education about their rights and responsibilities related to health insurance and group health plans.
Who was eligible to apply for this funding opportunity?
Eligible applicants were state governments.
Which federal agency issued this funding opportunity?
The opportunity was issued by the Centers for Medicare and Medicaid Services (CMS) under the Consumer Information and Insurance Oversight area.
What is the Funding Opportunity Number and CFDA number?
The Funding Opportunity Number is CA CAP 12 002, and the CFDA number is 93.519.
How much total funding was estimated to be available?
The total estimated funding amount was $29,900,000.
How many awards were expected?
The notice anticipated 56 awards.
Was cost sharing or matching required?
No. The opportunity did not require cost sharing or matching funds.
What kinds of offices or programs does the grant support?
The funding supports independent consumer assistance programs or health insurance ombudsman offices that help residents with health coverage questions, enrollment, complaints, appeals, and education about rights and responsibilities.
What core consumer support activities are required of funded programs?
Funded programs must directly support consumers by: (1) helping people file complaints and navigate appeals when they believe an insurer or group health plan made an incorrect decision, denied coverage, or mishandled a claim; (2) assisting consumers with enrollment into health coverage, including helping uninsured individuals understand available options and connecting them to coverage pathways when appropriate; and (3) educating consumers about their rights and responsibilities related to group health plans and health insurance coverage.
Does the program include help with complaints and appeals?
Yes. A central requirement is helping people file complaints and navigate appeals related to incorrect decisions, coverage denials, or improper claims handling by insurers or group health plans.
Does the program include help with enrolling in health coverage?
Yes. Programs must assist consumers with enrollment into health coverage, including helping uninsured individuals understand their options and, when appropriate, connecting them to coverage pathways such as private insurance, employer-sponsored plans, or public programs.
Does the program provide consumer education on rights and responsibilities?
Yes. Programs must educate consumers about their rights and responsibilities related to group health plans and health insurance coverage, especially as ACA protections and rules take effect and people encounter unfamiliar terms, processes, and eligibility rules.
What role do these programs play in marketplace oversight?
Grantees are expected to collect and report data on consumer inquiries, complaints, and the types of problems people experience. This information is intended to help the Secretary of Health and Human Services identify patterns and emerging issues in the health insurance marketplace and strengthen enforcement of major health laws.
What types of data are grantees expected to collect and report?
Grantees are expected to collect and report structured data on consumer inquiries and complaints, including the kinds of problems consumers are experiencing. The description notes a primary focus on private coverage inquiries, while also tracking issues that touch public coverage, state high-risk pools, or PCIP when consumer experiences cross program boundaries.
How is the collected data intended to be used?
The data is meant to function as an early warning system, helping identify potential noncompliance by health plans or issuers and highlighting areas where enforcement or policy attention may be needed. The notice specifically references strengthening enforcement of the ACA and the Mental Health Parity and Addiction Equity Act.
How does this program relate to the ACA health insurance marketplaces (Exchanges)?
The announcement anticipates an expanded role beginning in 2014, when ACA health insurance marketplaces (referred to as Affordable Insurance Exchanges established under Section 1311 of the ACA) became central to coverage access. Programs were expected to help consumers resolve problems related to obtaining premium tax credits for exchange-based coverage.
Do funded programs help with premium tax credit issues for exchange-based coverage?
Yes. The notice describes troubleshooting situations where consumers cannot access financial assistance they appear eligible for, where paperwork or verification issues arise, or where there is confusion about how subsidies interact with plan choices and enrollment timing.
How broadly does HHS interpret consumer assistance responsibilities for uninsured individuals?
The grant description states that HHS interprets consumer assistance responsibilities broadly for helping uninsured individuals obtain coverage. Programs should be able to guide people to appropriate sources of coverage and make referrals to Medicaid, CHIP, or the Pre-existing Condition Insurance Plan (PCIP).
What is PCIP in the context of this opportunity?
PCIP (the Pre-existing Condition Insurance Plan) is described as an early ACA-era coverage option for some individuals with pre-existing conditions, before broader market reforms took effect.
Are programs required to handle Medicare casework?
No. The opportunity sets a boundary around Medicare problem-solving, stating programs do not have to be built to provide direct, specialized casework on Medicare issues. However, programs must be capable of making appropriate referrals.
Are programs required to handle Medicaid or CHIP casework?
No. The opportunity states programs do not have to be built to provide direct, specialized casework on Medicaid or CHIP issues, but they must be capable of making appropriate referrals so consumers can be directed to the correct agency or assistance channel.
Why does the grant require referral capability for Medicare, Medicaid, and CHIP?
The requirement reflects that consumers often do not know which program governs their issue. The consumer assistance office should work as an effective entry point that routes people to the right place rather than leaving them stuck.
What were the posting and closing dates for this funding opportunity?
The posting date was June 7, 2012. The original and current closing date was July 9, 2012.
Is this funding opportunity still open?
No. The opportunity was archived on August 8, 2012.
Where were applicants directed for technical access issues related to applying?
For technical access issues, applicants were directed to the Grants.gov Contact Center, which provides 24/7 support (excluding federal holidays).
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