“Affordable Care Act in California: Its Impact on BMoC ”

1. “Affordable Care Act in California: Its Impact on BMoC” Gilbert Ojeda, Director, CPAC Warren Institute Webinar (In Cooperation with the CA Program on Access to Care): An Introduction to Health Reform and Its Impact on Boys and Young Men of Color November 20, 2012

2. Background • * BMoC are hard-to-reach, hardly reached & can be difficult to serve, for non-linguistically and culturally competent health plans and providers. • * By definition BMoC reside in low-income households, are likely uninsured or underinsured & often live in medically underserved areas (MUA) • * Uncovered & underserved BMoC can/will , as with many low income uninsured and underinsured, will have their health coverage improved under CA’s ACA programs • * Yet, BMoC are not at this time “on the radar screen” for either Medi-Cal or CA Health Exchange (Covered CA)

3. Key Considerations for BMoC under ACA Coverage Expansion • * The design of new ACA coverage system is moving rapidly to completion, but has not yet incorporated sufficient linkages to certain vulnerable populations, including BMoC, rural low income uninsured, & immigrants who are otherwise eligible. • * The full implementation will proceed rapidly starting in January 2013 including plan selection, outreach & enrollment, & the selection of community, regional & provider partners. • * The next four to six months will be critical for focusing the attention of all BMoC advocates, including legislators & other State decisionmakers to ensure inclusion of BMoC policies & programs into all elements of ACA implementation.

4. ACA Components for BMoC • * Medi-Cal Expansion to cover Childless Adults over age 19 (disproportionally males) • * Healthy Families Program transition of 900,000 children & youth into Medi-Cal by 2014 • * Expansion thru Exchange (Covered CA) to cover persons > age 19 with federal subsidies • * Coverage thru the SHOP Exchange for small business employees who are often not covered by health benefits

5. Childless Adult Medi-Cal • BMoC ages 19-26 who meet income requirements of less than 133% FPL & are citizens or in US more than 5 years as legal residents are eligible • These Childless Adults will be eligible for so-called “benchmark plan” which is mandated by ACA. • For those BMoC who have employer coverage, State must offer premium assistance if it more effective than enrolling in Medi-Cal and/or “wrap around” benefits, such as substance abuse care, if not provided by employer plan. • The State can not charge premiums & coverage can be retroactive up to three months if BMoC would have been eligible for that period • Will particularly impact BMoC unemployed which in CA approaches 40% in some inner city and low income rural areas. • Recent bills signed by Governor will also expand Medi-Cal coverage to post-incarceration & for young men aging out of State foster care. • It is estimated that 190,000 BMoC will become eligible for and enroll in this program in 2014.

6. Coverage thru Exchange • It’s projected that over 400,000 persons ages 18-26 will enroll in Covered CA with about 165,000 to be BMoC or 40% of total. • Federal subsidies will be available thru Covered CA for all persons, including BMoC, up to income levels of 400 FPL. • Citizen and residency requirements are identical to the Medi-Cal Expansion to participate in Exchange. • There will be 4 tiers of plans, plus catastrophic plans; only persons less than age 30 will be eligible for catastrophic plans; cost of coverage to not exceed 8% of household income at highest income levels. • There will be sliding-scale subsidy in form of tax credit. For BMoC under 200% FPL cost, premiums will not exceed 6.3% of income adjusted retroactively at tax time. • Due to projected coverage of over 2 million persons thru Covered CA, premium costs will be substantially less than market cost, even prior to subsidies.

7. Healthy Families (HF) Transition • HF program is a federal program in place since 1998 & covers 880,000 children & youth ages 5 to 19. • It is estimated that 140,000 BMoC, ages 16-18, will transition from HF into Medi-Cal by the end of 2013. • Program has a modest sliding scale premium & provides medical care, dental & behavioral health coverage thru private & public health plans. • Legal resident children & youth under the 5 year legal resident “bar” are covered thru a State-funded option. • Unlike Medi-Cal, HF is subject to enrollment limits, waiting lists & cuts to services, which have been imposed a few times during tight State budgets over last 8 years. • Physician, dental & clinic rates are somewhat higher than Medi-Cal raising concern about provider acceptance after transition to Medi-Cal. • HF will begin transition of 400,000 HF enrollees into Medi-Cal effective January 2013 to be completed by end of 2013. • Advocates from provider community, children’s groups and BMoC groups have tried to “slow down” transition due to perceived need to better communicate changes to enrollee families, participating providers and health plans. Medi-Cal has so far indicated its plans to move ahead.

8. Coverage thru SHOP (small businesses) • Small Business Health Options Program (SHOP) will be operated thru Exchange to cover small business employees (of less than 50). • BMoC are disproportionally employed and (at times) underemployed by small businesses. Such businesses are most often the target of high annual rate increases when they do provide health benefits & most liable to not provide coverage due to lack of “affordable” private health plans. • A significant number of small businesses in CA are minority owned & large portions of their employees are BMoC. • Traditional role of insurance brokers & agents for small businesses will be enhanced by SHOP and overall Exchange thru use of navigators & Assistors who are culturally & linguistically competent. • It is estimated that more than 20% of the potentially eligible employee population thru SHOP small businesses are BMoC.

9. Key Areas for Action for BMoC in ACA in CA • Maximize use by California State agencies & provider groups of federal support, including for CHCs and School based Health Centers • Develop expanded knowledge base for addressing use of “health homes” for BMoC population groups to address consequences of trauma induced conditions in communities, including violence and income disparities • Ensure that the Exchange and Medi-Cal design into their outreach and enrollment programs interventions appropriate to vulnerable populations, including BMoC. • Ensure that transition of Healthy Families program into Medi-Cal is addressed in a manner that fully takes into account the successful and trust-based relationships with enrollees, providers and health plans that have been built over the last 14 years of its existence. • Ensure that the inclusion of entry level jobs for BMoC in the expanding health care arena is built into health workforce planning being carried out by the State. • With continued prospects for reduced State based funding for public programs directed at all vulnerable populations in CA, implementation of the federal Health Reform program (under ACA) offers the best short term prospect for positively addressing the health issues of Boys and Young Men of Color. Literally billions of dollars will flow into CA because of it. CA and the Alliance of BMoC Advocates must be positioned to make the best of it.

10. Acknowledgements • CPAC would like to acknowledge The California Endowment for their support. • CPAC would like to acknowledge Jerry Kominski and Ken Jacobs with the UC Berkeley/UCLA Labor and Educational Center for the use of their data.

11. Contact Information Gilbert Ojeda, Director California Program on Access to Care 1950 Addison St., Ste. 203 Berkeley, CA 94704 510-643-3141 gilbert.ojeda@berkeley.edu http://cpac.berkeley.edu/