The Affordable Care Act: An Update

1. The Affordable Care Act: An Update Special needs work group July 18, 2013

2. What does the ACA do? GOOD News!!! People will be able to get insurance!! (It may be a little complicated – it may be confusing at first)

3. What does the ACA do? GOOD News!!! People will be able to get insurance!!

4. What does the ACA do? GOOD News!!! • Real insurance that provides real coverage 10 Essential benefit areas • Affordable – to fit your budget • premium and cost-sharing subsidies • Choice of plans – Simple language, no fine print • You can get help signing up

5. The Work Ahead GOOD News!!! • Most Important Information to share • Web site – www.healthcare.gov • Telephone number • Local Help

6. The Work Ahead Not as GOOD News!!! People don’t know this is coming. According to a survey by Enroll America: • 78% of uninsured adults don’t know about these changes. • 72% of people eligible for the affordability programs don’t know

7. What Does This Mean for CYSHCN? • Changes in Medicaid • Access to insurance for other family members • Help in applying and renewing

8. Changes in Medicaid • PH-95 (children with disabilities) category stays as it is • This is a disability category and is not affected by the other changes in Medicaid • PHLP has not heard of any new plans to impose co-pays • Be aware of the changes to non-disability Medicaid • May be incorrectly applied • May make it easier for other family members to obtain coverage

9. Changes in Medicaid - Household • Uses tax-filing standards • Self plus dependents • If someone else claims a dependent, that person doesn’t count in the household • Biggest impact will be on complex households where a child lives with a non-parent, with one parent but is claimed by the other, etc.

10. Changes in Medicaid - Renewal • Renewal of coverage – once a year • Based on electronic data sources as the primary means • Agency will send a pre-populated form with available information to the head of household. If no corrections, will automatically renew coverage • Eliminates six-month reporting, unless client reports substantial change in circumstances (income, household, residence, etc.)

11. Changes in Medicaid - Applying • No wrong door • Eligibility for tax credits and subsidies is based on ineligibility for Medicaid or CHIP • Marketplace must screen for Medicaid and CHIP • If not eligible for Medicaid or CHIP, DPW or PID must send application to the Marketplace • Electronic records as primary source of information • Search federal and state databases for income and citizenship info • Not ask client for paper proof as a first step

12. Changes in Medicaid - Applying • Single streamlined application • Apply online, over the phone, in-person, by mail • Paper application is fixed but online is dynamic, asking only the necessary questions • Asks the questions for Medicaid, CHIP and the tax credits and subsidies • Does not require submission of verification documents at point of application • Can provide real time eligibility determination for Marketplace products

13. Changes in Medicaid - Applying • Help in applying and renewing • Web site for the Marketplace www.healthcare.gov • Phone number for the Marketplace 800-318-2596 (with language access) TTY 855-889-4325 • Materials in English, Spanish, Chinese, French Creole, Korean, Polish, Portuguese, Vietnamese

16. Changes in Medicaid - Applying • Help in applying and renewing • Navigators • Paid, trained, and certified by the federal government • Responsible for public education, outreach and application and renewal assistance • Have to be culturally and linguistically competent and accessible for people with disabilities • Certified Application Counselors • No federal funding • Can do some or all of Navigator activities • Will be trained and certified by the federal government

17. Insurance through the Marketplace • Similar to Medicaid • Same, single streamlined application • Same web site and phone number • Uses MAGI income and household size • Electronic data sources • Provides Essential Health Benefits • Renewal once a year

18. Insurance through the Marketplace • Differences • Income tax credit and subsidies available • Reconciliation at tax time • So if not filing a tax return now, will have to in 2015 for 2014 • May owe money back to IRS if subsidy was overpaid • Four levels of cost sharing • Bronze, Silver, Gold and Platinum • Subsidies and tax credits only for silver (80%) • Able to compare and choose from an array of plans • Real-time enrollment

19. How You Can Help • Most Important Facts to share: • All insurance plans will have to cover doctor visits, hospitalizations, maternity care, emergency room care, and prescriptions. • You might be able to get financial help to pay for a health insurance plan.

20. How You Can Help • Most Important Facts to share: • If you have a pre-existing condition, insurance plans cannot deny you coverage. • All insurance plans will have to show the costs and what is covered in simple language with no fine print

21. Don’t Forget! • Help in applying and renewing • Web site for the Marketplace www.healthcare.gov • Phone number for the Marketplace 800-318-2596 (with language access) TTY 855-889-4325

22. Where to go for help PA Health Law Project Ann Bacharach – 215-625-3596 Helpline – 1-800-274-3258 • For advice on applying, enrolling, renewal, obtaining services • For clients who need a lawyer to represent them at hearings and appeals