The Affordable Care Act: Implementation in Illinois

1. The Affordable Care Act: Implementation in Illinois Impact on People with Disabilities and Special Health Care Needs Stephanie F. Altman, J.D. December 2013

2. ACA 101

3. ACA 101: Key Components Available Now… 2014 and Beyond… New Marketplace to buy insurance and receive financial help to pay for it New Medicaid Adult Group available to adults under 138% FPL Financial Assistance to purchase private insurance Medicaid available to former foster children up to age 26 at any income level No pre-existing condition exclusion for adults All plans must cover Essential Health Benefits (exception for some current plans) No annual limits on care No gender rating Closing Medicare Part D donut hole Individual and Employer Responsibility (but employer penalty delayed) • Extended dependent coverage to age 26 • No pre-existing condition exclusion for children • Preventive services without cost sharing • CountyCare-the early expansion of Medicaid in Cook County • No lifetime limits on care • Small business tax credits • No insurance rescissions except in cases of fraud/intentional misrepresentation

4. ACA 101: Essential Health Benefits All health plans in the Marketplace, individual & small group, are qualified health plans (QHP). Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services including chronic disease management Pediatric services including oral and vision care Illinois’ Benchmark

6. ACA 101: New Pathways to Coverage

7. Get Covered Illinois • www.getcoveredillinois.gov • Media and Marketing Campaign • Administered by Governor’s Office Marketplace Team in partnership with DOI, HFS, DPH and DHS as well as other state agencies. • Community enrollment assistance. • Includes both insurance and Medicaid.

8. Important Dates • OCTOBER 1, 2013 - Open Enrollment in the Marketplace/New Medicaid Begins. • DECEMBER 23, 2013 - Must be enrolled by this date for Marketplace health coverage to begin by 1/1/14 • JANUARY 1, 2014 - New Medicaid Adult Group Coverage begins. (No backdating before this date.) • MARCH 31, 2014 - Open Enrollment for Marketplace ends (Medicaid is always open).

9. In Person Assistance

10. The Uninsured

11. 1.5 million uninsured non-elderly adults in Illinois

12. Young adults in Illinois are the most likely to be uninsured

13. The Uninsured: Past Experiences have shopped for insurance outside their job 44% have been uninsured for 2 years or more 67% Connecting Communities to Coverage 2013

14. The Uninsured: Understanding of Law Do you feel you have enough information about the health reform law to understand how it will impact you personally, or not? NOTE: Don’t know/Refused answers not shown. SOURCE: Kaiser Family Foundation Health Tracking Poll (conducted March 5-10, 2013)

15. Illinois Medicaid Expansion

16. Medicaid in IL: New Programs

17. Medicaid Expansion • 19-64 and not eligible for other Medicaid category • No asset or disability test • Under 138% FPL • State currently seeking input from stakeholders in coverage package called ABP • Waiver programs and LTSS • Managed Care Roll Out • Interaction with Medicare

18. Illinois Marketplace

19. Marketplace Overview • Get Covered Illinois is a web-based portal for individuals and small businesses to enroll in coverage. Can also access by mail, on phone, or in person. • Enroll in public and private health insurance, as well as access financial assistance to pay for coverage. • Federally Facilitated Marketplace is linked to Get Covered Illinois • Gives consumers the tools and power to have control over their insurance decisions • Apples-to-apples comparison of plans • Plan Finder and Individual Pricing

20. 2014 Open Enrollment ***Those who are eligible for Medicaid can apply for coverage any day of the year! Note: Coverage is not retroactive

21. Insurance Rating and Pricing Demographics Plan factors Out-of-Pocket limits Benefit levels Insurance Affordability Programs Premium tax credits Cost-SharingReductions (CSR) • Age (3:1) • Household Income • Family size • Tobacco use • Location/Zip code (13 rating areas)

22. Cost: Two Types of New Financial Assistance

23. Who Is Eligible for Tax Credits/Subsidy?

24. * lawfully present residents below 100% FPL and ineligible for Medicaid may qualify Connecting Communities to Coverage 2013

25. Impact of Marketplace Financial Help on People with Employer Insurance • Not intended for those with employer coverage. • Provisions in place to discourage those with employer offer buying into exchange with financial help. • Employer offer to employee is not more than 9.5 % of the HH income. • Dependent coverage “glitch”

26. Exemptions from Shared Responsibility

27. How To Stay Informed in Illinois • Bookmark www.illinoishealthmatters.org • To Enroll: www.getcoveredillinois.gov • Sign up for IHM newsletter, Linkedin, Facebook page, Twitter (@ILHealthMatters), and Blog