Moving Forward: Implementation of the Affordable Care Act and

Farmworker Health

Jennifer Ng’andu

National Council of La Raza (NCLR)

Presentation Overview

• Farmworker Eligibility and the Affordable Care Act

• Overview of Supreme Court’s Decision on Medicaid

• Moving Forward: What Communities are Doing

Eligibility

Eligibility: Citizen

THREE MAJOR PATHWAYS TO COVERAGE • Employer-Sponsored Coverage

– Employers with more than 50 employees responsible for providing insurance options

• Medicaid – Current Medicaid program continues to operate – Blanket expansion for Medicaid for all persons with annual

income* under 133% of the federal poverty level ($30,700 per year for family of 4)

• New Health Insurance Marketplaces, “Exchanges” – Tax credits for individual coverage – SHOPS for small businesses

Eligibility: Lawfully Present

• Employer-Sponsored Coverage remains unrestricted – Seasonal workers are not counted towards employer

responsibility requirements

• New Health Insurance Marketplaces, “Exchanges” available to all defined as lawfully present – Protections for low-income immigrants ineligible for

Medicaid

• Medicaid – Unchanged, with continued legal immigrant restricted. – “Qualified” immigrants barred for five-years – “Not-Qualified” barred indefinitely unless status changes – Emergency Medicaid available to those who would

otherwise qualify

Eligibility: Undocumented

• Employer-Sponsored and Private Market Coverage Outside Exchanges – No explicit ban

• New Health Insurance Marketplaces, “Exchanges” are restricted to individuals – SHOPs have no explicit ban

• Medicaid – Explicit bar from full-scope Medicaid

– Emergency Medicaid available to those who would otherwise qualify

In Focus: H-2A Workers

• In most final regulations have been considered “lawfully present.” – Have individual responsibility to purchase

insurance if they can afford it and can access individual benefits for Exchanges.

• Employer rules to provide coverage apply, but: – Employer responsibility is not calculated based

upon seasonal employees working less than 120 days per year.

• Farm labor contractors treated as employers.

Getting Farmworkers Covered

KEY QUESTIONS

• What protections/incentives are in place to ensure responsible actions by employers?

• How will this work for mixed status and mixed coverage families?

• Will coverage plans really follow the person? Be consistent state to state?

• How will coverage be affordable for very poor workers?

Getting Farmworkers Covered

KEY QUESTIONS • How do we balance the varying standards eligibility for

legal/undocumented immigrants during application and enrollment?

• How do we shape enrollment systems and Health IT to be accessible for farmworkers?

• What is the verification process? Who runs it? How do we verify income?

• How will protections be enforced? • What outreach will be done to prepare farmworker

communities for coverage? How will it be done?

Alternatives

Emergency Medicaid

Basic Health Plans

Community Health Centers/Free Clinics

Charity Care

State-Funded Programs

SCOTUS

SCOTUS Ruling on Medicaid Expansion

• Ruled the funding of Medicaid expansion unconstitutional as written in law. – Opinion says that federal government cannot penalize

a state by taking away all funding for failure to implement the Medicaid coverage expansion in the ACA.

• States have a choice. – If they take that choice and the extra money, they

must abide by the rules of the expansion.

• All other Medicaid provisions apply

MEDICAID PROVISIONS

• FMAP for Medicaid expansion group

– Big dollars for states who chose to expand their programs.

• Increased provider rates for those who participate in coverage.

• Reduced Disproportionate Share Hospital (DSH) Medicaid payments.

Key Questions from the

Ruling

Are States Required to Meet the Maintenance

of Effort?

Can States Participate in the Expansion After

2014?

Who are the most vulnerable? What about immigrants?

Can States Implement Part of the Medicaid

Expansion?

WHAT’S NEXT?

Federal Rulemaking

• Federal Government is moving forward on rules in near future

– Single Streamlined Application Rule (Published on July 6, 2012)

– Expected rules on federal exchanges

– Expected rules on premium tax credits

– Limited guidance and communication about Medicaid

State Implementation Timelines

• Federal government must make decisions about what states are ready for Exchanges by January 2013.

• Federal government announced new funding opportunity to expand exchanges on June 29, 2012.

• States can expand Medicaid now, though FMAP is not quite as generous as at 2014 levels.

How are advocates preparing?

• Talking about the Medicaid program and why it’s needed for farmworker communities.

• Building alliances with hospitals and employers of farmworkers who would benefit from employees on Medicaid.

• Collecting stories to illustrate opportunities and challenges of system.

What can you do?

• Weigh in comments on proposed federal rules.

• Connect with your state implementers.

• Find state resources and contacts on: www.statereforum.org

My Contact Information

Jennifer Ng’andu

National Council of La Raza (NCLR)

Email: jngandu@nclr.org

Twitter: @NCLR

(202) 776-1762

www.nclr.org/healthcareforall