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The Affordable Care Act for Family Law Practitioners July 10, 2014 LAF & The Sargent Shriver National Center on Poverty Law. About Us: The Shriver Center.
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The Affordable Care Act for Family Law PractitionersJuly 10, 2014LAF & The Sargent Shriver National Center on Poverty Law
About Us: The Shriver Center The Sargent Shriver National Center on Poverty Law provides national leadership in advancing laws and policies that secure justice to improve the lives and opportunities of people living in poverty. We specialize in practical solutions. Through our advocacy, communication, and training programs, we advocate for and serve clients directly, while also building the capacity of the nation’s legal aid providers to advance justice and opportunity for their clients. Like us on Facebook: www.facebook.com/shrivercenter Follow us on Twitter: @shrivercenter www.povertylaw.org
AGENDA • 1:00 – 1:45 pm: ACA Overview • 1:45 – 2:00 pm: Questions • 2:00 – 2:45 pm: ACA/Family Law Scenarios and Considerations • 2:45-3 pm: Questions
Objectives This session will help you understand: • The basics of Medicaid and the Health Insurance Marketplace in Illinois. • Who might be eligible for premium tax credits and cost sharing reductions in the Marketplace. • Minimum essential coverage (MEC). • Individual and employer shared responsibility requirements.
Four New Ways to Get Covered #1New Medicaid Adult Group available to adults age 19-64. #2 New Insurance Marketplace to buy insurance and receive financial help to pay for it. #3 Medicaid available to former foster children up to age 26 at any income level. #4 Young adults 19-25 years old can stay on their parents’ policy.
1.8 Million Uninsured in IL – Most Have New Options for Coverage under ACA
New Consumer Protections for All Insurance • No pre-existing condition exclusions. • Essential Health Benefits must be covered. • Holds insurance companies accountable for rate increases. • Coverage information in plain language. • Preventive services available without cost sharing. • No rescissions. • No lifetime or annual limits on care. • Extended dependent coverage available up to age 26. • Marriage equality. *There are still some grandfathered health plans that do not need to provide these ACA protections: http://insurance.illinois.gov/cb/2014/CB2014-04.pdf Also, there are some noncompliant, non-grandfathered plans in the individual and small group markets that do not have to cover ACA changes until 2016 or 2017: http://insurance.illinois.gov/cb/2014/CB2014-04.pdf
New Household and Income Considerations for Families under the ACA • Tax Filing Status • Household Composition/Size • MAGI (Modified Adjusted Gross Income)
Determining MAGI Adjustments
Who is Eligible for the Medicaid Expansion? • Age 19-64 and not eligible for other Medicaid category. • Citizen or Qualified Non Citizen • Under 138% FPL or about $1340 per month for a household of one ($16,105/year). • No asset or disability test.
Medicaid Benefits for ACA Adults ACA Adults are receiving a Medicaid benefit/service package called the Alternative Benefit Plan (ABP). • The ABP for adults is required to include: • Essential Health Benefits • Early and Periodic Screening, Diagnosis, and Treatment services (EPSDT) for 19 and 20 year olds • Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) services • Non-emergency transportation • Family planning services and supplies
Cost Sharing under Medicaid • No Premiums • ACA Adults will have the same co-payments as other Medicaid adults, such as: • Hospital inpatient services: $3.90 • Prescription drugs: brand $3.90, generic $2.00 • Primary care provider visit: $3.90 • No co-payment for Immunizations, Preventive Services, Diagnostic Services or Family Planning. Family planning related medical services require a co-pay for office visits. • For more information: http://www2.illinois.gov/hfs/SiteCollectionDocuments/100app12.pdf
New Medicaid Managed Care in Illinois • 2011 Medicaid reform law (P.A. 96-1501) mandates 50% of clients to be enrolled in “care coordination” by January 1, 2015 • Different health plans for different Medicaid populations • Seniors and Persons with Disabilities (SPD) – Medicaid only & Medicare/Medicaid (duals) • Children, Parents/Caretaker Relatives, Pregnant Women – called “Family Health Plans (FHP)” • Children with Special Needs (CSN) • Newly Eligible Adults under the Affordable Care Act – called “ACA Adults” • 4 different models of Managed Care Entities • Managed Care Organizations (MCO) • Managed Care Community Networks (MCCN) • Care Coordination Entities (CCE) • Accountable Care Entities (ACE)
Care Coordination in Mandatory Regions • Clients are in process of enrolling or being enrolled in Health Plans in 5 mandatory regions • Chicago region – 6 counties • Rockford region – 3 counties • Central Illinois region – 3 counties • Quad Cities region – 3 counties • Metro East region- 3 counties • Clients in rural counties will continue to be in fee for service (IL Health Connect) for awhile • About 2 million Medicaid clients will be in Health Plans by mid-2015 http://www2.illinois.gov/hfs/PublicInvolvement/cc/Pages/default.aspx
Special Enrollment Periods are called “SEP” • Means that you can enroll in Marketplace any time during the year even outside of open enrollment. • Must be “triggered” by specific life event that causes loss of MEC or other designated limited circumstances. • Usually gives person 60 days after event to enroll. • Healthcare.gov has a screening tool to determine is someone is eligible to enroll in a SEP. https://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/
2014 Qualified Health Plans in Illinois * 165 plans and 6 carriers • Aetna • Blue Cross Blue Shield • Coventry • Health Alliance • Humana • Land of Lincoln * 13 Rating Areas In 2015? DOI Announces 10 IssuersApply to Offer 504 QHPs
Catastrophic Health Plans What is catastrophic coverage? • Plans with high deductibles and lower premiums • Pay all medical costs up to a certain amount • Includes 3 primary care visits per year and preventive services with no out-of-pocket costs • Protects you from high out-of-pocket costs Who is eligible? • Young adults under 30 • Those who qualify for a hardship exemption • Those whose plan was cancelled and believe Marketplace plans are unaffordable **Financial assistance (premium tax credits and cost sharing reductions) is not available
Expected Premium Contributions Premium Tax Credit Calculator:http://kff.org/interactive/subsidy-calculator/
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 of self-only coverage to employee is not more than 9.5 % of the household income. • Dependent coverage “glitch”
Culture of Coverage: Individuals • The Individual Mandate requires most Americans to have “minimum essential health coverage (MEC)” for each month starting January 1, 2014. • Also, called “Shared Responsibility Provision,” “Required Coverage,” or “Health Insurance Requirement.” • This applies to adults and children. The adult or married couple who can claim a child or another individual as a dependent on their federal income taxes is responsible for making the payment if the dependent does not have coverage (or an exemption). • Payments will begin in 2015
Culture of Coverage: Employers • Employer Mandate/ Employer Shared Responsibility • Only for Firms with 50+ FTEs (3.6% of firms in the US) • Small Businesses (below 50 FTEs) are exempt! • Must provide affordable and minimum value coverage to employees and dependents • Pay a penalty IF an employee takes a premium tax credit in the Marketplace. • Most larger firms already provide insurance • Penalty waived until 2016 for firms w/ 50-99 FTEs; for larger firms, it will be 2015 (must cover 70% of employees) ** More information: http://www.irs.gov/uac/Newsroom/Questions-and-Answers-on-Employer-Shared-Responsibility-Provisions-Under-the-Affordable-Care-Act
Requirement to Have Health Coverage • Everyone is required to have minimum essential coverage (MEC) • Those without MEC will pay a shared responsibility payment unless exempt • Taxpayer is responsible for dependents • Coverage requirement, penalties and most exemptions apply on a monthly basis • One day rule: • A person has coverage for the month if they have coverage for at least one day in the month • A person is eligible for an exemption for the month if they are exempt for at least one day in the month
What Counts As MEC? • Employer-sponsored coverage, COBRA coverage and retiree coverage • Coverage purchased in the individual market (inside or outside the Marketplace) • Government Sponsored Coverage, such as: • Medicare Part A coverage and Medicare Advantage plans • Most Medicaid coverage • Children's Health Insurance Program (CHIP) coverage • Certain types of veterans health coverage • Most types of TRICARE coverage • Refugee Medical Assistance • Self-funded health coverage offered to students by universities for plan or policy years that begin on or before Dec. 31, 2014 • State high risk pool plans that begin on or before Dec. 31, 2014 • Other coverage recognized by the Secretary of HHS as minimum essential coverage Full List here: http://www.irs.gov/uac/Questions-and-Answers-on-the-Individual-Shared-Responsibility-Provision
