Time to Get Insured: Learn the Who, What, Why, and How to Enroll in Health Insurance through the Medicaid Expansion or

1. Time to Get Insured: Learn the Who, What, Why, and How to Enroll in Health Insurance through the Medicaid Expansion or the State or Federal Marketplace February 12, 2014

2. Archive This Training Teleconference will be recorded. The PowerPoint presentation, PDF version, video archive including closed captioning, and a written transcript will be posted to the ADS Center Web site athttp://www.promoteacceptance.samhsa.gov/teleconferences/archive/default.aspx.

3. Disclaimer The views expressed in this training event do not necessarily represent the views, policies, and positions of the Center for Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA), or the U.S. Department of Health and Human Services (HHS).

4. Questions At the end of the speaker presentations, you will be able to ask questions. You may submit your question by pressing “*1” on your telephone keypad. You will enter a queue and be allowed to ask your question in the order in which it is received. On hearing the conference operator announce your first name, you may proceed with your question.

5. Seeking Health Insurance under the Affordable Care Act Ron Manderscheid, Ph.D. Executive Director, National Association of County Behavioral Health and Developmental Disability Directors Adjunct Professor, Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health

6. The Affordable Care Act (ACA) Is Moving Ahead! • Insurance coverage for up to 19 million poor and 20 million near-poor citizens • Health benefits for up to 11 million persons with behavioral health conditions (“Statement from HHS Secretary,” 2012) • Safe Harbor for those with severe illnesses • New focus on prevention and promotion, not just disease care

7. The ABCs of the ACA • Medicaid Expansion • Marketplaces • Enrollment Process • More information on these topics available at http://www.behavioral.net.

8. Presentation Focus The ACA is about... coverage and access.

9. ACA Principles • Person-centered care—Consumer is the “true north.” • Shared decision making—Care plans and goals are jointly developed by consumer and provider. • Whole health—The person’s entire health picture is considered.

10. Role of Parity • Essential Health Benefit (EHB)for new private insurance must be at parity. • Medicaid Benchmark Benefit must be at parity. • Parity does extend to allindividual and most small group plans after January 1, 2014. • No individual plans will be grandfathered; private self-insured small group plans can be grandfathered, and non-Federal governmental small group plans can opt out.

11. Quick ACA Overview • Insurance Reform—Getting health insurance • Coverage Reform—Getting better health insurance benefits

12. ACA Medicaid Expansion • For States that have chosen this option (now 26 + the District of Columbia), enrollment began on October 1, 2013, with coverage beginning on January 1, 2014. • The expansion is designed for all uninsured adults up to 133 percent of the Federal poverty level (plus discounted 5 percent of income). • Upper income limit is about $15,282, or $1,273 per month for individuals. • Enrollment process will operate continuously.

13. ACA Affordable Health Insurance Marketplace • Enrollment began in ALL STATES on October 1, 2013. Initial insurance coverage became effective on January 1, 2014. Scope is all uninsured adults above 133 percent of the Federal poverty level (plus discounted 5 percent of income). • Lower income limit is about $15,282, or $1,273 per month for individuals. • Enrollment process will close on March 31, 2014. • The three types of State exchanges are Federally Facilitated Exchanges, State Partnership Exchanges, and State-Operated Exchanges.

14. A Very Important Distinction If your State is NOT CURRENTLY DOING the Medicaid expansion, then persons between 100 percent of the Federal poverty level and 133 percent of the Federal poverty level (plus discounted 5 percent of income) can enroll in MARKETPLACE insurance plans. This income range is from about $11,490 to $15,282 per year, or $957 to $1,273 per monthfor individuals.

15. Picture of State Medicaid Expansion

16. ACA New Coverage Mandates • Certain prevention and promotion services now have no copays or deductibles. • Guaranteed issue means insurance is available to people regardless of pre-existing conditions or age. • Those up to age 26 can now remain covered by family policies. • Insurance no longer has an annual or lifetime limit.

17. Who Can Help You to Enroll? Health Insurance Navigators Federally Qualified Health Centers Peers in Your Community Certified Application Counselors Authorized Representatives In-Person Assisters All will be unbiased and impartial. To find help in your area, call 1–800–318–2596 or TTY: 1–855–889–4325 or visit https://localhelp.healthcare.gov.

18. Resources • ACA Overview Article • Manderscheid, R. (in press). The Affordable Care Act: Overview and implications for county and city behavioral health and intellectual/developmental disability programs. Journal of Social Work in Disability and Rehabilitation. Accessible from http://nacbhdd.trilogyir.com/content/ACA%20Article%2011-18-12.pdf[PDF 103 Kb]We begin by reviewing the five key intended actions of the ACA—insurance reform, coverage reform, quality reform, performance reform, and information technology reform. This framework provides a basis for examining how populations served and service programs will change at the county and city level as a result of the ACA, and how provider staff also will change over time as a result of these developments. We conclude by outlining immediate next steps for county and city programs. • Statement from HHS Secretary Kathleen Sebelius on Mental Health Month [News release]. (2012, May 11). HHS Newsroom. Retrieved from http://www.hhs.gov/news/press/2012pres/05/20120511b.html

19. Contact Information Ron Manderscheid, Ph.D. Executive Director, National Association of County Behavioral Health and Developmental Disability Directors (NACBHDD) Adjunct Professor, Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University http://www.nacbhdd.org NACBHDD The Voice of Local Authorities in the Nation’s Capital! 25 Massachusetts Ave., NW, Suite 500 Washington, DC 20001 Office: 202–942–4296; Cell: 202–553–1827 Email: rmanderscheid@nacbhd.org

20. Adela Flores-Brennan, J.D. Assistance Network Manager Connect for Health Colorado Connecting to Coverage in Colorado

21. Colorado’s State-Based Marketplace Connect for Health Colorado is a State-based Marketplace. Authorizing legislation passed in 2011 150 health plan and 22 dental plan options More than 60,000 people enrolled as of January 15, 2014 http://www.connectforhealthco.com Colorado approved and implemented the Medicaid expansion.

22. How to Get Help • 855–PLANS–4–YOU (855–752–6749) • Certified Brokers or Certified Health Coverage Guides Located in Communities around the State • Certified Application Counselors • Online Chat with a Service Representative

23. What to Bring • Contact information • Social Security numbers (document numbers for lawfully present immigrants) for each applicant • Birth dates • Employer information and employer coverage information • Income information (tax returns, pay stubs, W-2s) • Preferred healthcare providers

24. Getting Started Shop and compare plans anonymously. Estimate eligibility for financial assistance. Use online tools to learn more.

25. Advanced Premium Tax Credit (APTC) • This credit offsets the cost of the monthly premium. • Bob from Denver, age 35, makes $22,000 per year. • He qualifies for an APTC of $131 per month. • He finds a Colorado HealthOp Bronze plan for $194 per month. • With the APTC applied, Bob pays about $63 per month.

26. Cost Sharing Reduction • This reduction comes in the form of an upgraded health plan that has lower deductibles and copays. • Individuals are eligible at up to 250 percent of poverty ($28,725 per year). • A Silver level plan must be purchased. • In Bob’s example, he is at about 200 percent of the Federal poverty level. With an ordinary Silver plan he would have to pay about 30 percent of the cost sharing, but with the Cost Sharing Reduction plan he pays about 13 percent.

27. Application Process

28. How to Apply • From homepage click “Shop Now” and create an account. • Want help paying for health insurance? • If yes, customers will be directed into the State’s Medicaid application.

29. How to Apply (cont.) • In the online Medicaid application, create an account and answer questions. • If denied Medicaid, then customers are directed back into the Marketplace. • Answer a few more questions, and see eligibility results for the Advanced Premium Tax Credit and Cost Sharing Reduction.

30. How to Apply (cont.) • Shop for a health plan. • Use the provider search tool. • Filter and sort on cost, coverage level, quality. • Select and compare.

31. Important Deadlines Open enrollment ends Signup deadline to have coverage by 5/1 Coverage began Signup deadline to have coverage by 3/1 Open enrollment began Signup deadline to have coverage by 4/1 Signup deadline to have coverage by 2/1 10/1/13 1/1/14 1/15/14 2/15/14 3/15/14 3/31/14 Open enrollment continues through March 31, 2014. Individuals must enroll by March 31 to avoid penalties but can enroll after April 1 with a qualifying life change event.

32. Connect for Health Colorado, http://www.connectforhealthco.com Searchable Frequently Asked Questions, https://connectforhealthco.custhelp.com/app/home/portal/individual Insurance Basics, http://connectforhealthco.com/insurance-basics Resources

33. Contact Information Adela Flores-Brennan, J.D. Assistance Network Manager Connect for Health Colorado 3773 Cherry Creek N. Dr., Suite 1025 Denver, CO 80209 Office: 720–496–2545 Email: afbrennan@connectforhealthco.com

34. Nyi Myint, M.S.W., M.B.A. Program Manager Alcohol/Drug Council of North Carolina Implementing the Affordable Care Act in North Carolina: Reaching out to Substance Abuse and Mental Health Services Consumers

35. About ADCNC Who we are: • The Alcohol/Drug Council of North Carolina (ADCNC) is a 501(c)(3) nonprofit agency that provides information and referral for alcohol and drug treatment. ADCNC was established in 1955. • Via Project Jumpstart, ADCNC provides official Navigator assistance for enrolling and applying for Affordable Care Act (ACA) health insurance coverage to the recovery community. • ADCNC is one of the four ACA grantees in North Carolina and one of a few grantees in the nation to serve the recovery community. Project Jumpstart’s mission: • Educate 110,000 North Carolina consumers about the ACA • Enroll 5,800 targeted North Carolina substance abuse and mental health consumers into the Marketplace • Be poised to advance substance abuse services within North Carolina through expansion of provider panels Our goal is to assist people in recovery by educating them about the value of health care and to help to enroll them in the Marketplace for affordable healthcare insurance.

36. Why Enrolling Is Important Health insurance gives you access to treatment. Access to treatment gives you a better chance of recovery.

37. Outreach Strategies

38. Communication Strategies • Targeted Messaging • Specific Communication and Messaging Targeted to People in Recovery • Emphasis of the Importance of Health Care to “Enroll for Health Insurance. Increase Your Chance of Recovery” • Dedicated Resources • http://healthcarencnow.org • https://www.facebook.com/HealthCareNC • https://twitter.com/HealthCareNCNow

39. North Carolina did not expand Medicaid. As a result, there is a “gap” in coverage for certain North Carolinians. North Carolina does not have a centralized State-run ACA point of entry. Block grants, which fund much of the public substance abuse and mental health treatment, are limited. Subsidies help those within 100 to 400 percent of the Federal poverty level (FPL). Enrollment in a Non-Expansion State

40. Non-Expansion States

41. Subsidies in a Non-Expansion State • These subsidies are designed for income levels of 100 to 400 percent of the FPL. • If you make less than $11,490 you are not eligible for a subsidy, nor are you eligible for Medicaid (because North Carolina did not expand Medicaid) services. • There are two kinds of subsidies: • Advanced Premium Tax Credits (APTCs) reduce premiums. • Cost Sharing Reductions (CSRs) help pay for copayments, deductibles, and coinsurance (100 to 250 percent of the FPL).

42. How Do I Enroll? You can apply online, in person, by phone, or through the mail. • Online: http://www.healthcare.gov • Phone: 1–800–318–2596 or TTY: 1–855–889–4325 • Mail: Health Insurance Marketplace, Dept. of Health and Human Services, 465 Industrial Blvd., London, KY 40750-0001 • In person: Find out about Local Enrollment Assistance, https://localhelp.healthcare.gov How to Apply In North Carolina • ADCNC offers official Navigator assistance for enrolling and applying for ACA individual and family health insurance coverage. • Navigators can assist with both online and paper applications. Call us at 1–855–726–2559 (toll free) for help or to set up an appointment. We offer both day and evening appointments.

43. What Do I Need to Apply? • Social Security number (or document numbers for legal residents) for everyone in your household who needs coverage • Employer and income information (pay stubs, W-2 forms) • Detailed information about your employer’s insurance (if offered) • Providing accurate and complete information is very important to avoid delays in processing your application

44. What Healthcare Plans Are Available? • Platinum: Insurance pays 90 percent of covered medical expenses. • Gold: Insurance pays 80 percent of covered medical expenses. • Silver: Insurance pays 70 percent of covered medical expenses. • Bronze: Insurance pays 60 percent of covered medical expenses.

45. What if I Don’t Qualify for Medicaid? How Can I Get Help? • Programs vary from State to State. • Resources in North Carolina include the following: • Medicaid/Children’s Health Insurance Program (CHIP) • Integrated Payment and Reporting System (IPRS) • Division of Social Services • Division of Public Health • Charity Care Program of the University of North Carolina Hospitals Reach out to your State’s public health department to find out what programs are available to you.

46. Process and Timeline for Getting Insured • Step 1: Set up an account on http://www.HealthCare.gov. First you'll provide some basic information. Then choose a user name, password, and security questions. • Step 2: Fill out the online application. You'll provide information about you and your family, like income, household members, current health coverage information, and more. This will help the Marketplace find options that meet your needs. • Step 3: Review your application results. You will receive a response back from the Health Insurance Marketplace explaining the results of your application, including any tax credits that can be used to lower your monthly premium. • Step 4: Go to the Health Insurance Marketplace at http://www.HealthCare.govto review the plan options and compare rates. • Step 5: Choose a health plan. • Step 6: Make your first month’s payment.

47. Challenges for North Carolina Subsidies/Getting Help with Coverage When Your Income Is under $11,490 • Because North Carolina did not expand Medicaid, there are a number of people who fall into the “gap” where there is neither subsidy nor Medicaid coverage. • Identifying the number of people who fall into the “gap” is important. • The subsidies program was designed to help people with income levels between 100 and 400 percent of the FPL. • Medicaid was supposed to help the people who fell below the 100 percent level. If you report less than $11,490 you will not receive a subsidy, nor will you have access to Medicaid. • Estimating income accurately is critical. What Can You Do? • Report any and all income (babysitting, mowing lawns, eBay sales, etc.). In order to receive a subsidy, you must report an income of $11,490 or more. If it is less you will not receive a subsidy. Report your income accurately.

48. Challenges for North Carolina (cont.) Expanding Provider Panels in North Carolina—Why Is This Important? • North Carolina has 100 counties and only two insurance providers under the ACA Marketplace. • Blue Cross Blue Shield has 26 plans in 100 counties. • Coventry has 25 plans in 39 counties. • If you live in a rural part of North Carolina, you may not have access to a local provider and may need to drive a far distance to get medical care. • The availability of multiple providers, including those who have addiction-specific training, is important to preserve consumer choice and increase the likelihood of successful treatment outcomes. Outreach as Case Management in North Carolina—Why Is This Important? • Integration of outreach into case management is the new standard of care for access to resources.

49. Defining Parity • Federal parity law is defined by the Mental Health Parity and Addictions Equity Act (MHPAEA), the Affordable Care Act, and the final rule to implement MHPAEA. • Insurance companies each have the duty to ensure that they structure their benefit packages in compliance with parity. • Oversight for parity compliance is shared by State insurance commissioners, the U.S. Department of Labor, and the U.S. Department of Health and Human Services. • Lawsuits have been filed over certain aspects, and further litigation may be expected.

50. Faces & Voices of Recovery (Producer), and Williams, G. D. (Director). (2013). The anonymous people: Official trailer [Motion picture]. Available fromhttp://www.youtube.com/watch?v=bqoEtUn0Agw Healthcare NC Now, http://healthcarencnow.org Local Enrollment Assistance, https://localhelp.healthcare.gov Resources