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The Affordable Care Act: Overview and Update on Wisconsin Implementation

The Affordable Care Act: Overview and Update on Wisconsin Implementation. What have you heard about the Affordable Care Act?. What is the ACA?. Stands for “Affordable Care Act”, otherwise known as the health care law or “ Obamacare ” Health insurance reform Became law on March 23, 2010

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The Affordable Care Act: Overview and Update on Wisconsin Implementation

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  1. The Affordable Care Act: Overview and Update on Wisconsin Implementation

  2. What have you heard about the Affordable Care Act?

  3. What is the ACA? • Stands for “Affordable Care Act”, otherwise known as the health care law or “Obamacare” • Health insurance reform • Became law on March 23, 2010 • Different parts affect different groups of people, two main stages • Stage 1 focuses on patient protections (now) • Stage 2 focuses on expanding coverage (2014)

  4. Things that aren’t likely to help you in your work, but that I want you to know anyway

  5. Stage 1 (now) • Allows young adults to stay on parents’ policies until they are 26 • Eliminates lifetime limits • Phases out annual limits (gone in 2014) • Can’t drop coverage after a person gets sick or for an honest mistake on your insurance application

  6. Stage 1 (now) • Many preventive care services must now also be offered by private insurance without co-pay or deductible. • Over 1.1 million Wisconsinites already benefiting • Includes things such as: • Mammograms, blood pressure screenings, many cancer screenings, immunizations, diet & losing weight, quitting smoking, etc. • Full list at www.healthcare.gov

  7. Things that will definitely help you in your work

  8. Stage 2 The bulk of the health care law goes into effect on January 1, 2014 to help expand coverage

  9. Choices for States • Medicaid expansion • Marketplace design • Basic health plans (we wont talk about this)

  10. Current BadgerCare Health Plans

  11. BadgerCare & Marketplace - 2014

  12. How will it impact my work? • Insurance coverage for low-income adults may be changing • Becoming eligible for the first time • Losing eligibility • Becoming eligible for something different • Will affect roughly 500,000 Wisconsinites

  13. Choices for States • Medicaid expansion • Marketplace design • Basic health plans (we wont talk about this)

  14. What’s in there? • Medicaid Plans • Qualified Health Plans • Advanced Premium Tax Credits and Cost Sharing Subsidies

  15. How does it work?

  16. What’s in there? • Medicaid Plans • Qualified Health Plans • Advanced Premium Tax Credits and Cost Sharing Subsidies

  17. Essential Health Benefits • Ambulatory patient services • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance use disorder services, including behavioral health treatment • Prescription drugs • Rehabilitative and habilitative services and devices • Laboratory services • Preventive and wellness services and chronic disease management • Pediatric Services, including oral and vision care

  18. What’s in there? • Medicaid Plans • Qualified Health Plans • Advanced Premium Tax Credits and Cost Sharing Subsidies

  19. Advance Premium… wha? • Individuals who use Marketplace to buy insurance must pay premiums = % of their income based on the Federal Poverty Level. Source: Adapted from Kaiser Family Foundation, http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7962-02.pdf

  20. Cost Sharing? Low-Income Cost-Sharing Subsidies C ACA cost-sharing subsidies, which reduce what low income people must pay for deductibles and co-pays (capped at approximately $2,000 for an individual and $4,000 for a family), further “stretch” the value of their insurance. Source: Adapted from Kaiser Family Foundation, http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7962-02.pdf

  21. Individual Tax Credit • Must be used within new competitive health marketplace • Credit calculator:healthreform.kff.org/SubsidyCalculator.aspx • Calculator estimates that a 40 year old with family of four, making $60,000 would: • Have a premium of $10,539 for the year • With a tax credit of $5,626 • Leaving the family with $4,913 to pay ($409/month)

  22. This sounds confusing… why would anyone do this?

  23. Individual Mandate • Do any of the following apply? • You are part of a religion opposed to acceptance of benefits from a health insurance policy • You are an undocumented immigrant • You are incarcerated • You are a member of an Indian tribe • Your family income is below the threshold for filing a tax return ($10,000 for an individual, $20,000 for a family in 2013) • You have to pay more than 8% of your income for health insurance, after taking into account any employer contributions or tax credits There is no penalty for being without health insurance YES NO Adapted from the Kaiser Family Foundation: http://kff.org/infographic/the-requirement-to-buy-coverage-under-the-affordable-care-act/

  24. Individual Mandate, continued • Were you insured for the whole year through a combination of any of the following sources? • Medicare • Medicaid or the Children’s Health Insurance Program (CHIP) • TRICARE (for service members, retirees, and their families) • A plan offered by an employer • Insurance bought on your own that is at least at the Bronze level • A grandfathered health plan in existence before the ACA was enacted The requirement to have health insurance is satisfied and no penalty is assessed YES NO Adapted from the Kaiser Family Foundation: http://kff.org/infographic/the-requirement-to-buy-coverage-under-the-affordable-care-act/

  25. There IS a penalty for being without health insurance 2014 Penalty is $95 per adult and $47.50 per child (up to $385 for a family) or 10% of family income, whichever is greater 2015 Penalty is $325 per adult and $162.50 per child (up to $975 for a family) or 2% of family income, whichever is greater 2016 and beyond Penalty is $695 per adult and $347.50 per child (up to $2,085 for a family) or 2.5% of family income, whichever is greater Adapted from the Kaiser Family Foundation: http://kff.org/infographic/the-requirement-to-buy-coverage-under-the-affordable-care-act/

  26. How do we help?

  27. Opportunities (AKA challenges) • Lack of knowledge • Vulnerable populations likely to benefit are used to a different system • Current lack of coordination

  28. Limited Public Awareness of the uninsured don’t know about the new health insurance marketplace 78% Enroll America Research, November 2012

  29. Four Key Messages to Reach Most Uninsured One of these = top message for 89% of population Source: Enroll America, November 2012

  30. DHS plans for individual BadgerCare member outreach • September 20 • BadgerCare letters will be sent to: • Basic Plan members • BC Extension (TMA) members • Core Waitlist • Those looking to be above 100% • October 1 • Individual phone calls • Priority 1: Individuals likely to be losing coverage • Priority 2: Individuals on Core waitlist

  31. What’s the message? • www.healthcare.gov • November 18th caveat • When in doubt, always refer to healthcare.gov • December 15th last day to apply for coverage starting on Jan. 1 • Federal call line: • 800-318-2596 • Refer to access.wi.gov for: • Foodshare, family planning, childcare, etc.

  32. Opportunities (AKA challenges) • Lack of knowledge • Vulnerable populations likely to benefit are used to a different system • Current lack of coordination

  33. Opportunities (AKA challenges) • Lack of knowledge • Vulnerable populations likely to benefit are used to a different system • Current lack of coordination

  34. Regional Enrollment Networks • Asset-Based Community Development model • Lets coordinate our resources instead of re-inventing the wheel! • Determine how every interested organization in Wisconsin can play a role in getting people covered • Coordinate training and resource needs

  35. Current Enrollment Assistance A few examples: • AmeriCorps members • Agents and Brokers • Hospital/Clinic enrollment staff • Community-based organization enrollment staff • Aging and Disability Resource Centers • Public Health • Veterans • Income Maintenance Agencies

  36. New categories of “Enrollment Support” created by ACA • Certified Application Counselors • CMS certification of CAC Organizations • OCI training • Government entities and tribes exempt! • Navigators • Federal grant • OCI licensure

  37. Mobilizers! Mobilizers

  38. In-Person Assistance • Wisconsin Enrollment Directory • E4HealthWI.org • Navigator awardees: • Partners for Community Development • Northwest CEP • Legal Action of Wisconsin/Senior LAW • National Council of Urban Indian Health • National Healthy Start Association • R&B Solutions • Community Health Centers

  39. Order Materials Online www.marketplace.cms.gov

  40. Questions/Follow-Up Lisa Olson lolson@wphca.org 608-443-2946

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