The Patient Protection and Affordable Care Act

1. The Patient Protection and Affordable Care Act Young Adult Outreach and Education

2. Who Doesn’t Have Insurance? 15.7% of residents in the U.S. lack insurance 26.9% of 18-34 year olds in the US lack insurance • 19.7% of residents in California lack insurance • 32.3% of 18-34 year olds in California lack insurance

3. Who are Young Invincibles?

4. Overview What’s already in place What’s coming Health care and undocumented immigrants Young adult outreach

5. ACA Provisions Already in Effect that Help Young Adults

6. What’s Already in Effect Dependent Coverage Free Preventive Care No denial for pre-existing condition for under 19 Student Health Plans Women’s Health Domestic Violence Support Contraception Community Health Centers

7. Dependent Coverage and Preventive Care Under 26 can stay on parent’s plan Under 19 – no denial for pre-existing conditions Free Preventive Care – no co-pays on screenings and check-ups

8. Student Health Plans • Previously limited regulations • Now subject to standardized ACA requirements • Must include preventive care benefits • 80/20 Ratio

9. Women’s Health Benefits • Well-women visits • Support for breastfeeding • Domestic violence screening and counseling • Mammograms and cancer screenings

10. Domestic Violence Provisions in the ACA • Aug. 2012: New plans must cover screenings and counseling for domestic violence with no cost-sharing • Jan. 2014: No denial of coverage for victims of domestic or sexual assault • Law provides $1.5 billion over 5 years for home visitation models • Funds for youth and teen programs on violence prevention and healthy relationship training

11. Contraception • As of Aug 2012, new health insurance plans must cover contraception with no co-pay • Religious institutions exempt • Religiously-affiliated institutions get 1 year delay • After Aug. 2013, employees and students get coverage directly from insurance companies

12. Growth of Community Health Centers (CHCs) • Currently 8,000 CHCs provide care to 20 million individuals • In June 2012 grants went to 219 CHCs around the country • Increased number of patients served by 1.25 million

13. What Changes Will Come in 2014?

14. Changes to Come Medicaid Expansion Subsidies Exchanges/Marketplaces Individual Mandate

15. California and Medi-Cal Currently may be eligible: • Enrollees of SSI/SSP, CalWorks(AFDC), Refugee Assistance, Foster Care or Adoption Assistance Program • Certain individuals under 21, 65 or older • Blind or disabled individuals • Pregnant women Eligible in 2014: • EVERYONE at or below 133% of FPL

16. Changes for Americans with Disabilities • Expands and supports the Money Follows the Person program through 2016 • Helps states create home and community-based services through improved Medicaid • Improves data collection on health disparities and improved training and culture competency for health care providers • In 2014, no annual limits, no denying coverage for pre-existing conditions

17. Subsidies/Tax Credits • Those making 133-400 % of the federal poverty level (FPL) will qualify for subsidies (tax credits) to buy insurance on the exchange • 133% of FPL for 1 person is $14,900 • 400% of FPL for 1 person is $44,000

18. How Much of a Subsidy? • Four tiers of plans – Bronze, Silver, Gold, and Platinum • Subsidies are calculated based on Silver plan • Individuals can use subsidy for any plan

19. Ex-cha-cha-cha-Changes Shop for insurance Each state is different, some will have federally-facilitated exchanges (FFEs) Subsidies applied directly

20. Other important parts of the ACA • Catastrophic plans • Young adults (under 30) and those with financial hardship eligible • No Annual Limits in 2014 (already phasing out) • Tax Credit for employers (already started) Picture Source: http://wymancenter.org/the-importance-of-bulking-up-the-muscle-of-perseverance/

21. How many young people in California could get health insurance? Source: Census Bureau, CPS 2010

22. Exchanges in the States Picture Source: Kaiser Family Foundation, Last updated November 14, 2012

23. California Health Benefit Exchange • Created in 2010 • Five-member board unaffiliated with other interest groups • Minimum requirements for insurance providers to join the exchange • Must offer at least one choice at each of the four levels • Carriers that do not participate in the exchange may not sell catastrophic-only plans.

24. Individual Mandate and Penalties • Individuals must have qualifying health insurance • If not, penalties • $95 the first year • Rises in 2016, ex. $695 • Exemptions Picture Source: http://thepinkleague.com/2012/08/30/so-whats-the-lowdown-the-basics-of-football-part-2/

25. Jessica, 23 years old Part-time student, part-time job $10,000/year before taxes~ 87% of poverty Qualifies for Medi-Cal

26. Jeff, 22 years old Part-time student, full-time construction worker Earns $23,000/year Takes home: $1,438/month Total health premium: $283/month With tax credits he pays: $121/month

27. Summary: ACA and Young Adults • Young adults have high rates of uninsurance • Many provisions in the ACA that help young adults • Dependent Coverage • Student Health Plans • Contraception and Women’s Health • Changes to come • Expanded Medicaid • Subsidies • Exchanges • Individual Mandate

28. Health Care for Undocumented Immigrants

29. Medi-Cal for Undocumented Immigrants • Undocumented immigrants who are not eligible for full scope Medi-Cal can qualify for Emergency Medi-Cal as long as they meet requirements • Services include: • Breast and cervical cancer treatment • Kidney dialysis • Family Planning, access, care and treatment • Child health and disability prevention • Access for infants and mothers

30. ACA Expansion and Medi-Cal The ACA does not cover undocumented immigrants Medi-Cal could expand by 30% in the next few years The state expects to enroll 1.5 million or more adults in Medi-Cal as 2014 reforms occur There are concerns over cuts in the reimbursement rates for providers

31. Outreach and Education for Young Adults in California

32. Overview Health Care Outreach Mobile Technology Social Media Challenges Navigators Timeline

33. Health Care Outreach • Traditional Outreach • Tabling • Group presentations • Hosting events • New Outreach Strategies

34. Mobile Outreach • Your Healthcare Finder • Find doctors in the area • For Android and iPhone • Mobile Website • Text Message Services • QR Codes • Can be scanned and direct users to your website

35. Find a Doctor • Find doctors and Community Health Centers in your area • Search by location with GPS or zip code • Search by name or category • Shows user ratings of doctors in the area

36. Healthcare FAQ Explains how to find health insurance for different people (students, chronic conditions, buying your own plan) Explains the health care law Defines common health insurance terms

37. Waiting Room Game Fun game for people to play while passing time in the waiting room

38. Using Social Media • Facebook • Create events • Send news updates • Twitter • Connect with new people • Coordinate plans • Retweet • Be fun! Picture Source: Wikimedia Commons

39. Challenges • It’s expensive • ACA offers new options • I’m young and healthy • Injuries can happen to anyone • Make it personal • Why do I need health insurance? • Uninsured drives up health care costs • Individual mandate requires insurance

40. Navigators & Assisters • State exchanges – formal “Navigator” program • Funded through State’s Exchange • Aids with outreach and enrollment • States with federal exchanges – Assisters will provide help on outreach

41. California’s Assisters Program Recommendations: Direct Benefit Assistors Not be paid by the Exchange Health insurance agents, hospitals, and providers. Certified Enrollment Assisters (Navigators) • Compensated by the Exchange • Non-profit organizations, community clinics, County Social Services offices employing Eligibility Workers, and labor unions.

42. Timeline: What to Look For • Present – end of 2012: • Educate young adults about ACA • Ensure eligible young adults are on dependent coverage • Jan 2013 – Oct 2013: • Educate young adults about the upcoming Exchanges. • Oct 1st, 2013 – March 31st, 2014 • Open enrollment for exchanges • Ensure young adults are getting subsidies and Medicaid, if possible

43. Key Takeaways @YI_Care • ACA is phasing in, some changes already underway • Outreach and education • Traditional outreach • Social media and mobile technology • Big changes in 2013 • Like us on Facebook • Follow us on Twitter