Presented to: Medical Associations and Societies – Group Meeting

1. Affordable Care Act (ACA) Update Presented to: Medical Associations and Societies – Group Meeting Presented by: Blake Fulenwider, Deputy Commissioner, DCH June 12, 2013

2. ACA Update Agenda • DCH & The Affordable Care Act (ACA) • Medicaid Expansion • Health Insurance Exchange

3. DCH & The Affordable Care Act What’s DCH’s Role in all of this? • Medicaid Expansion • CHIP to Medicaid Transfer • Federal Premium Tax • Medicaid and CHIP Eligibility Determination • Health Insurance Exchange • State Health Benefit Plan Other State Entities Involved: • Governor’s Office • OPB • Dept. of Insurance • Dept. of Human Services

4. Medicaid Expansion • Eliminate categorical eligibility for Low Income Medicaid (LIM) • Make eligible and enroll virtually all individuals at or below 138% FPL • In Georgia, primarily childless adults • New eligibility categories match with substantial FFP • Currently eligible but not enrolled match with standard FFP

5. Who is Eligible?

6. Who Are Our Members? Expansion 5

7. Medicaid Expansion • Enrollment • Additional 620,000 enrollees in Medicaid in 2014 • Grows to 695,000 enrollees by 2023 • Cost • 10-year Total Estimate • $4.5 Billion in additional state expenditure • $40.8 Billion (State + Federal)

8. Medicaid Expansion DecisionsBy State

9. DCH: Health Insurance Exchange (HIX) • Federally-subsidized coverage in a U.S. HHS-approved health plan • that meets Minimum Essential Benefits (MEB) and is certified as a Qualified Health Plan (QHP) able to be offered on the exchange in a state or on the Federally Facilitated Exchange (FFE) • Advance Premium Tax Credits (APTC) and Cost Sharing Reductions (CSR) • for families with household income between 138% FPL to 400% FPL. Family expected contribution a percentage of household income, not to exceed 9.5%. • Includes Plan Management, Consumer Outreach and Assistance • as well as ‘assisting in enrollment’ into a QHP • Major IT infrastructure required

10. Health Insurance Exchange (HIX) Options • HHS Providing states with three options

11. Health Insurance Exchange Decisions By State 18 State-Based; 7 Partnership; 26 Federally-Facilitated Exchanges Source: Kaiser Family Foundation; statehealthfacts.org; 5/07/2013.

12. Health Insurance Exchange DecisionsMap View By State Source: Kaiser Family Foundation; statehealthfacts.org; 1/14/2013

13. AHBE and SHOP AHBE (Individual Exchange) SHOP (Small Business Exchange) Focus: Employers Eligible Users: Full Time Equivalent Employees of small businesses with 1 to 100 workers Options: State option to limit to businesses of 1-50 or less until 2016 State may expand to 100+ as of 2017, with approval of US HHS Subsidies: Limited 2-year employer tax credit Section 125 “Cafeteria Plan” Pre-Tax Treatment • Focus: Individuals • Eligible Users: • Resident of state in which exchange is based • Not incarcerated • U.S. Citizen or legal alien • Restrictions: To access Premium Tax Credits and Cost-Sharing Subsidies, must be: • Between 138 – 400% FPL • Not offered AHBE-qualified coverage through employer or government program • No Cafeteria Plan Pre-Tax Treatment

14. Individual Applies Through FFE (FFE makes Medicaid/CHIP Assessment) DRAFT

15. HIX: A Regulatory Mechanism • HHS using state-based exchanges, state partnership and Federally Facilitated Exchanges as regulatory mechanism • Minimum Essential Benefits • Employer and Employee Mandate • Premium Subsidies • Assessment for Medicaid and CHIP • A gatekeeper to health insurers in the marketplace

16. Georgia’s Response • Georgia will not expand Medicaid eligibility • Lack of flexibility in management of the program • Uncertainty about cost and budget implications • Georgia will utilize the Federally-Facilitated Exchange (FFE) • FFE will manage all exchange functions • DCH will continue to make final determination for Medicaid eligibility

17. Title or Chapter Slide (use as needed; feel free to delete) Thank You