The Affordable Care Act of 2010: What is Happening Next What You Need to Know

1. The Affordable Care Act of 2010: What is Happening Next What You Need to Know

2. Training Sections Recent History of Health Care Reform Overview of Changes in Affordable Care Act (ACA) Timeline of Major Changes Resources

3. Training Section 1: Recent History of Health Care Reform

4. Recent History March 2010 U.S. Congress passed: • Patient Protection and Affordable Care Act (HR 3590) • Health Care and Education Reconciliation Act of 2010 (HR 4872)

5. Recent History March 2010 President Obama signed into law, creating: • Patient Protection and Affordable Care Act (Public Law 111-148) • Health Care and Education Reconciliation Act of 2010 (Public Law 111-152 ) • Together, commonly known as The Affordable Care Act (ACA) of 2010

6. Training Section 2:Overview of Changes in Affordable Care Act (ACA)

7. Overview The Affordable Care Act (ACA) of 2010: • Impacts many areas of health care • Result of many compromises • Does not go into effect all at once • Relies heavily on state and local implementation

8. Overview Affordable Care Act makes major changes in 4 basic areas: • Insurance company accountability • Lowering costs and improving quality • Increasing access and choice • Patient rights and consumer protections

9. Key Strategies in Reform ApproachAdapted from Gerben DeJong, PhD, National Rehabilitation Hospital MedStar Health Research Institute • Leave “good enough” alone • No drastic changes • Share the Responsibility • Everybody in the pool • Market-Based Solutions • Shift to competition for price and quality • Contain Costs • Focusing on the populations that have the highest health care costs • Innovate and Test • Half of ACA text focuses on testing laboratories to avoid implementation mistakes

10. Overview: HealthCare.Gov

11. Training Section 3:Timeline of Major Changes

12. Explaining the Timeline How Timeline Works: • Changes take effect over many years, through 2020 • Timeline shows when major reforms go into effect • Designed to give more detailed information about changes coming soon, summarizes changes down the road

13. Explaining Timeline: [Date] [Type of Reform] Who: Population reform impacts Why: Need or problem reform is addressing What: Specifics of what reform does When: When reform goes into effect How: Details of how reform will be implemented or accessed

14. Timeline: in progress now

15. Timeline: In Progress Now Pre-existing Condition Insurance Plans Who: • People who can’t get insurance because of pre-existing medical conditions, including mental health conditions   Why: • Before ACA, people with pre-existing conditions often couldn’t get any insurance

16. Timeline: In Progress Now Pre-existing Condition Insurance Plans What: • People who can’t get insurance because of pre-existing medical conditions can apply for a Pre-Existing Condition Insurance Plan (PCIP)   • Law limits premiums to “standard rates” - the average amount private insurers in the state charge for premiums for similar coverage • Limits out-of-pocket expenses • $5,950/year for individual (does not include premiums)

17. Timeline: In Progress Now Pre-existing Condition Insurance Plans What: • States can run PCIPs, with federal funding, or use federal PCIP • 29 states chose to run plans themselves • 21 states chose to let the federal government run them • PCIPs in each state operate under ACA standards • But plans may vary from state to state

18. Timeline: In Progress Now Pre-existing Condition Insurance Plans What: • For people who live in states where the PCIP is run by the federal government, there are now three options for plans: • Standard plan • Extended plan • Health savings account plan • For more information about these plans, go to: http://www.healthcare.gov/news/factsheets/new_plan_options_2011.html • The federal PCIP will now offer a special child-only rate for children under 18.

19. Timeline: In Progress Now Pre-existing Condition Insurance Plans When: • States letting the federal government run their PCIP: • Can apply online now and get coverage within a month • States running their own PCIP: • Different application and enrollment dates

20. Timeline: In Progress Now Pre-existing Condition Insurance Plans When: • PCIPs are meant to be temporary: • End on January 1, 2014, when insurance companies won’t be allowed to deny people coverage because of pre-existing conditions • On January 1, 2014, the state-run health insurance Exchanges will be operational.

21. Timeline: In Progress Now Pre-existing Condition Insurance Plans How: • To apply for a PCIP you must: • Be a U.S. citizen or lawfully present in the United States • Have had no health coverage for the last 6 months • Have a pre-existing condition, as defined by each PCIP • You can apply no matter what your income is • To find details for your state: www.HealthCare.Gov/law/about/provisions/pcip/index.html

22. Timeline: In Progress Now Money Follows the Person Grants Who: • People on Medicaid who need long-term care services Why: • In the past, Medicaid’s Money Follows the Person grants have provided flexible funding that lets a person who needs long-term care services get services that are most appropriate to what they need and want • MFP funding gives flexibility to move from institutional to community-based services and keep funding

23. Timeline: In Progress Now Money Follows the Person Grants What: • ACA extends these grants and adds $2.25 billion in funding • Broadens eligibility standards • Helps states pay for the costs of moving someone from institution to home When: • MFP grants have been extended until September 2016 How: • The program is continuing to operate as before

24. Timeline: In Progress NowRescission Outlawed Who: • Anyone who has insurance and might get sick Why: • Before ACA, when someone with insurance got sick with an expensive or chronic illness, insurance companies would often go back and search their application for mistakes, looking for reason to drop their coverage • This is called rescission, and happened to thousands of Americans each year

25. Timeline: In Progress Now Rescission Outlawed What: • Under ACA, insurance companies aren’t allowed to drop people’s coverage because they get sick When: • Rescission is now illegal How: • Department of Health and Human Services is responsible for regulation and enforcement details

26. Timeline: In Progress Now Ban on Discriminating Against Kids with PEC Who: • Children under 19 with pre-existing conditions Why: • Before ACA, insurance companies could legally deny insurance to children because they had a pre-existing condition What: • Under ACA, it is illegal for insurance companies to deny or restrict insurance to children because of pre-existing condition

27. Timeline: In Progress Now Ban on Discriminating Against Kids with PEC When: • Applies to health plan years starting after September 23, 2010 How: • As with any group plan, insurance companies may decide to restrict enrollment to specific enrollment periods • Department of Health and Human Services is responsible for regulation and enforcement details

28. Timeline: In Progress Now Expanded Coverage for Young Adults Who: • Adult children up to age 26 Why: • Before ACA, children were often dropped from parents’ insurance plans when they turned 18 or finished college • Many young people have difficulty finding jobs with employer-sponsored coverage and can’t afford to buy individual coverage, so they often would go without insurance

29. Timeline: In Progress Now Expanded Coverage for Young Adults What: • Children can stay on (or be added to) their parents’ insurance until they turn 26 • Applies to plans that offer dependent coverage When: • Open enrollment for coverage started on September 23, 2010 and was required by law to continue for at least 30 days, with annual open enrollment periods • Finding Insurance Options

30. Timeline: In Progress Now Ban on Lifetime Coverage Limits Who: • Anyone who has insurance or will ever use insurance Why: • In the past, insurance companies have used lifetime coverage limits to limit amount of money they will pay out for a customer’s health care needs • If someone got sick and reached their lifetime coverage limit during treatment, the insurance company could just stop paying for treatment

31. Timeline: In Progress Now Ban on Lifetime Coverage Limits What: • Insurance companies not allowed to put caps on amount they will spend on lifetime coverage costs for essential benefits • Essential benefits include things like hospital stays, doctor visits, and prescription drugs

32. Timeline: In Progress Now Ban on Lifetime Coverage Limits When: • Ban started September 23, 2010, for all new individual insurance plans and all group plans • Annual limits are restricted in all group plans and new individual plans, until 2014, when banned completely How: • The law includes a detailed list of essential benefits that must be covered without limit

33. Timeline: In Progress Now Free Preventive Services - Private Coverage Who: •  Anyone who has private insurance Why: • Before ACA, many health plans charged for preventive services, so people often chose to skip them • Preventive services can help avoid many costly health problems down the road

34. Timeline: In Progress Now Free Preventive Services - Private Coverage What: • Private insurance plans have to cover certain recommended preventive services, like cancer screenings • Insurance companies are required to offer these services free to patient - without deductible, coinsurance, or copayment charges •  Law ensures many free preventive health services for children, including many vaccines

35. Timeline: In Progress Now Free Preventive Services - Private Coverage When: • All new individual and group plans after September 23, 2010 How: • Coverage for these services is offered through existing private insurance plans

36. Timeline: In Progress Now Improvements to Medicaid HCBS Who: • People who use Medicaid’s Home and Community-Based Services (HCBS) Why: • In 2005, 1915(i) was added to Social Security Act • Gave state Medicaid programs option to provide HCBS to people with disabilities before they need institutional care •  Many states did not choose to provide these services

37. Timeline: In Progress Now Improvements to Medicaid HCBS What: • ACA changes and adds to Section 1915(i) • Removes many barriers to states to offering these services • Allows states to amend their plans instead of having to apply for waiver • Improves quality of services and access to HCBS for people with disabilities • Expands services that state can offer as part of HCBS • Allows states to extend full Medicaid benefits to people using HCBS

38. Timeline: In Progress Now Improvements to Medicaid HCBS When: • Changes went into effect on October 1, 2010 How: • As long as people meet a state’s eligibility requirements, HCBS have to be offered to every eligible person in the state •  States can now provide services to people with incomes up to 300% of the Supplemental Security Income (SSI) Federal Benefit Rate ($2,022 per month in 2011)

39. Timeline: In Progress Now Drug Discounts for People in Donut Hole Who: • People who fall in Medicare’s donut hole

40. Timeline: In Progress Now Drug Discounts for People in Donut Hole Why: • Under Medicare Part D, when person’s prescription drug costs reach a certain amount ($2,840 in 2011): • Medicare stops paying for any prescription drug costs • They have to pay for 100% of their drugs out-of-pocket, until they reach the maximum out-of-pocket amount • Once they reach this maximum ($4,550.00), they are out of the donut hole - Catastrophic Coverage begins, and Medicare starts to help cover the costs again

41. Timeline: In Progress Now Drug Discounts for People in Donut Hole What: • People in donut hole get up to 50% discount on brand name drugs, 7% discount on generics for 2011 and 14% for 2012 • People who qualify for Extra Help, and join a Medicare drug plan, will have no coverage gap. When: • Discount started January 1, 2011 • Will grow until 2020, when donut hole is closed completely How: • Full cost of drugs (rather than discounted amount) still counts towards person’s out-of-pocket maximum

42. Timeline: In Progress Now More Preventive Services Under Medicare Who: • Anyone on Medicare Why: • Preventive services can help avoid many costly health problems down the road

43. Timeline: In Progress Now More Preventive Services Under Medicare What: • People on Medicare can get a free wellness visit and personalized prevention plan each year • Must have had Part B for longer than 12 months • No copayment, deductible, or coinsurance charges for recommended preventive services

44. Timeline: In Progress Now More Preventive Services Under Medicare When: • Started January 1, 2011 How: • Coverage for these services are offered through existing Medicare plans

45. Timeline: In Progress Now Medicaid Community First Choice Option Who: • People with disabilities who are on Medicaid with income less than or equal to 150% of Federal Poverty Level, or if greater, meet an institutional level of care Why: • People with disabilities have the right to choose to live in and receive services in their homes and communities whenever possible

46. Timeline: In Progress Now Medicaid Community First Choice Option What: • Provides HCBS such as attendant services and supports to increase a person’s ability to live in the community • Allows Medicaid plans to choose HCBS as a rule, rather than the exception When: • CFC Option will be effective October 1, 2011

47. Timeline: In Progress Now Medicaid Community First Choice Option How: • ACA provides a 6 percentage point increase in federal Medicaid match for states that choose the CFC Option

48. Timeline: by 2012

49. Timeline: By 2012CLASS Act Who: • Everyone Why: • Paying for long-term care is expensive • Many people can’t afford it and don’t budget for it • People need options that give them more choice and flexibility about long-term care

50. Timeline: By 2012CLASS Act What: • The Community Living Assistance Services and Support Act (CLASS Act) provides for voluntary, self-funded, long-term care insurance through the workplace • Insurance will help pay for long-term care costs for people with disabilities and elderly people • People will be able to use cash benefit to pay for their choice of variety of long-term care services, including home health care workers, assistive technology, adult day care, transportation, or assisted living