NEW WAYS TO USE THE AFFORDABLE CARE ACT

TO CLOSE WORKERS COMPENSATION

CASES

(c) Teddy Snyder 2013

Teddy Snyder mediates Workers Compensation cases throughout California. Parties on both sides of the table rely on her in-depth knowledge and creativity in crafting settlements.

An attorney since 1977, she has concentrated on claim settlement for over 19 years.

Teddy was in the first group LEXIS-NEXIS named as notable persons in Workers Compensation in 2008. She is a nationally recognized expert on Medicare Secondary Payer and Affordable Care Act issues affecting settlement, having written and spoken extensively on these subjects.

THE ISSUE OF ONGOING MEDICAL CARE

WHAT’S THE BIGGEST OBSTACLE TO CLOSING WORKERS COMPENSATION CLAIMS ?

THE AFFORDABLE CARE ACT PROVIDES

2 SAFETY NETS TO ASSURE CLAIMANTS

ONGOING MEDICAL CARE

MAKING SURE THE INJURED WORKER CAN GET NEEDED MEDICAL CARE IS KEY TO CLOSING

WORKERS COMPENSATION CLAIMS

HEALTH INSURANCE EXCHANGES

SAFETY NET #1

ACA CREATES A VIRTUAL SHOPPING MALL FOR PRIVATE HEALTH INSURANCE

ACA IS THE MALL– NOT THE STORE

ACA GUARANTEES THE INJURED WORKER WILL BE ABLE TO BUY

PRIVATE HEALTH INSURANCE REGARDLESS OF PRE-EXISTING CONDITION–

BUT DOES NOT REGULATE WHAT INSURERS CAN CHARGE THOUGH SOME STATES DO

CALIFORNIA DOES

SUBSIDIES ARE CALCULATED BASED ON “MODIFIED ADJUSTED GROSS INCOME”

NOT ASSETS

SO EVEN IF THE INJURED WORKER RECEIVES A LARGE SETTLEMENT, SUBSIDIES MAY STILL BE AVAILABLE

SUBSIDIES LOWER THE PREMIUM COST FOR THOSE WHO QUALIFY

EXPANDED MEDICAID

SAFETY NET #2

CALLED “MEDI-CAL” IN CALIFORNIA MAY BE A SOURCE

OF ONGOING MEDICAL CARE WHICH WILL ALLOW YOU TO SETTLE THE CASE

ACA CREATES A SECOND FORM OF MEDICAID/MEDI-CAL:

E X P A N D E D MEDICAID/MEDI-CAL

THERE ARE NO RESOURCE/ASSET LIMITS FOR

EXPANDED MEDI-CAL

MODIFIED ADJUSTED GROSS INCOME (“MAGI”) CANNOT EXCEED 138% OF FEDERAL POVERTY LEVEL

FOR A SINGLE PERSON, THAT’S CURRENTLY $15,856

THERE ARE NO ASSET LIMITS

SO EVEN IF THE INJURED WORKER RECEIVES A LARGE SETTLEMENT,

MEDICAID/MEDI-CAL MAY STILL BE AVAILABLE TO PAY

FOR ONGOING MEDICAL EXPENSES

OTHER QUALIFIERS FOR EXPANDED MEDICAID/MEDI-CAL

MUST BE AGED 19-64

NOT PREGNANT NOT INCARCERATED

MEET CITIZENSHIP RULES NOT BE MEDICARE-ELIGIBLE

YOU CAN REACH TEDDY SNYDER AT

TSnyder@WCMediator.com

Phone 310/889-8165