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In-Person Assister Program

In-Person Assister Program . Helping individuals learn about and apply for health coverage through the new Washington Healthplanfinder. Topics Covered. Who is CHOICE? Affordable Care Act (ACA) overview Implementation of the ACA in Washington State

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In-Person Assister Program

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  1. In-Person Assister Program Helping individuals learn about and apply for health coverage through the new Washington Healthplanfinder

  2. Topics Covered Who is CHOICE? Affordable Care Act (ACA) overview Implementation of the ACA in Washington State Health Benefit Exchange & In-Person Assistance Program overview In-Person Assisters and how they can help

  3. CHOICE Regional Health Network Non-profit, collaborative organization, established in 1995. Dedicated to improving health in Central Western Washington through collective planning and action of health care leaders.

  4. Emergency room visit reduction program Donated care programs for uninsured Dental access programs Collaborative health system improvements (focused on transitions of care, cardiac response) Headquarters in Olympia www.crhn.org

  5. Affordable Care Act (ACA) in Washington State • Washington Health Benefit Exchange:The “Exchange” created in 2011 • Medicaid Expansion: Included in 2013-2015 Biennial Budget signed by Governor Inslee on June 30, 2013

  6. After 100+ years, why now?

  7. Slows the rising health care costs on the Gross Domestic Product Expands health care coverage to 32 million uninsured Americans Expands Medicaid Offers affordable Qualified Health Plans Goals of ACA In our region, the number of uninsured is estimated at 80,000individuals.

  8. Kids can’t be denied coverage if they are sick Young adults can stay on parents policies until age 26 Eliminates “pre-existing conditions” exclusions Prohibits lifetime limits Closes Medicare prescription doughnut hole Expands coverage by expanding Medicaid and by offering Qualified Health Plans Impact of the ACA

  9. Ten Essential Health BenefitsTen essential Health benefits

  10. Individual Mandate • Requireall citizens and legal residents (there are some exceptions) to have health coverage by January 1, 2014. • There are a number of ways to meet the mandate. • There are also exceptions. • People will not go to jail if they do not meet the mandate!

  11. Satisfying the Mandate You are insured through a combination of any of the following sources: • Medicare • TRICARE or veteran’s health program • An employer-provided plan • Medicaid/Apple Health • Insurance you buy that is at least at the Bronze level • A grandfathered health plan in existence before the health reform law was enacted No Penalty

  12. Mandate Exemptions No penalty for being without health insurance. • Religious objections • Undocumented immigrant • Incarcerated • American Indians and Alaskan Natives • Income below the tax filing threshold • The lowest cost plan option exceeds 8 percent of an individual’s income

  13. Penalties

  14. Uninsured in WA Estimated impact of ACA in Washington Data Source: Office of Financial Management, State Population Survey; compiled by CHOICE

  15. *Urban Institute

  16. Medicaid: now expanded to cover individuals 19 – 65 with incomes up to 138% FPL, meet citizenship requirements, are not incarcerated, are not entitled to Medicare. Medicaid Standard CHIP Medicaid Standard Medicaid Alternative Benefit Plan Family Planning Extension Take Charge Family Planning CHIP BCCT Exchange with Subsidy ADATSA Basic Health Program Medicaid Expansion (WA Apple Health) 2014 Coverage Continuum through Insurance Affordability Programs (IAPs) 2013-15 Budgets Propose Various Eliminations Exchange without Subsidy Medical Care Services Program Presumptive SSI (aka DL-X)

  17. Classic Medicaid Auto-Converted • SSI • SSI-related (Aged, Blind, Disabled) • Medicare Savings Program • Healthcare for Workers with Disabilities • Nursing Homes • Waiver Services • Medical Care Services (+65 or immigration status) • MCS • ADATSA • Aged, Blind, Disabled cash program (the old GA-X/DL-X Program).

  18. Current Medicaid who need to Reapply through WA Healthplanfinder • Apple Health for Kids (Children’s Medicaid) • Pregnancy Medical

  19. Medicare • The new insurance marketplace does not effect those on Medicare. • There are also no Medicare supplemental plans for purchase in new marketplace.

  20. Washington Health Benefit Exchange • The ACA establishes an Exchange in each state, to organize the new insurance marketplace. • HBE responsible for: • Online enrollment tool development. • Contracting with organizations for customer support. • Determining eligibility and tax credits. • Aggregate premiums and send monthly payment to carriers. • Review and certify qualified health plans. To learn more: www.wahbexchange.org

  21. Qualified Health Plan (QHP): an insurance plan certified by the OIC/Exchange that provides 10 essential health benefits, follows rules on cost-sharing, and meets other requirements, like… Network adequacy Marketing Include certain providers that serve low-income, underserved communities Qualified Health Plan

  22. Qualified Health Plan - Metal Tiers Actuarial Value: The amount (%) of the bill that the insurer pays

  23. Approved Companies Offering Plans through WAHealthplanfinder.org • Bridgespan • Community Health Plan of Washington • Coordinated Care • Group Health Cooperative • Lifewise • Molina Healthcare • Premera Blue Cross • Kaiser Foundation Health Plan of the Northwest • Pediatric Dental: Dental Dental of WA, Kaiser Foundation, Lifewise, Premera

  24. Health Insurance Premium Tax Credits (HIPTC) • Designed to make premiums affordable for individuals and families with lower incomes • Only available to individuals and families with income up to 400% Federal Poverty Level (FPL) • Can be used to reduce monthly premiums • Can be claimed as a credit on annual tax return • Must apply through Washington Healthplanfinder

  25. Health Insurance Premium Tax Credit andCost Sharing Reductions Cost Sharing Reductions: Premium Tax Credits: *Of the second lowest cost Silver plan

  26. Health Care Coverage in 2014 New Continuum of Affordable Options *138% 185% 400% 300% % Federal Poverty Level 0%100%200%300%400% Medicaid (Adult Coverage) Medicaid (Pregnancy Coverage) Apple Health for Kids (Medicaid/CHIP) * Premium Tax Credits & Cost-Sharing Reductions for Exchange Health Plans Exchange Health Plans * The ACA’s “133% of the FPL” is effectively 138% of the FPL because of a 5% across-the-board income disregard 26

  27. How will people get coverage? www.WAHealthplanfinder.org

  28. Single point of entry for individual, families and small businesses to apply for coverage. Tool provides on-the-spot eligibility results: Interfaces with federal and state systems to verify info What if a user doesn’t have a computer or has questions about insurance coverage? WAHealthplanfinder.org Details

  29. In-Person Assister Program • Established to help consumers learn about, apply for and enroll in appropriate health insurance coverage. • Focused on reaching most vulnerable uninsured people who require assistance to enroll into the expanded health care options • Community awareness, outreach, and enrollment are program components. • HBE contracting with “Lead Organizations” to develop a network of In-Person Assisters and referral partners to carry out this program. • CHOICE was awarded contract in June.

  30. Clallam Grays Harbor Jefferson Lewis Mason Pacific Thurston CHOICE’s Seven County Region

  31. Build local network of community-based organizations Lead outreach and education activities for service area Train Assisters within the service area Financial agent for network partners Performance monitoring Reporting Lead Organization Responsibilities As defined by HBE

  32. In-Person Assisters (IPAs)

  33. Community awareness & outreach Help answer questions about the new law and insurance Provide application-enrollment assistance Using trained and certified staff Impartial, objective information Cannot offer QHPs outside of open enrollment Assist individuals to understand their benefits Provide effective follow-up services In-Person Assisters Responsibilities

  34. Important Things to Remember • If you are already insured, you don’t have to make any changes. • If you are uninsured, you need to apply for coverage for 2014 or face a penalty. • If you are uninsured and enroll, make sure to report your information accurately – you could qualify for different coverage depending on your reported income. If you enroll, and your income changes through the year, report it! • If you need help enrolling, there are organizations in your community who are available to help!

  35. Questions?

  36. Libby Weisdepp Program Manager CHOICE Regional Health Network weisdeppl@crhn.org | (360) 539-7576 x120

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