special needs work group july 18, 2013 the affordable care act: an update
TRANSCRIPT
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)
2
What does the ACA do?
GOOD News!!!Real insurance that provides real coverage
10 Essential benefit areasAffordable – to fit your budget
premium and cost-sharing subsidies
Choice of plans – Simple language, no fine print
You can get help signing up
4
The Work Ahead
GOOD News!!!Most Important Information to share
Web site – www.healthcare.govTelephone numberLocal Help
5
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
6
What Does This Mean for CYSHCN?
Changes in Medicaid
Access to insurance for other family members
Help in applying and renewing
7
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
8
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.
9
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.)
10
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
11
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
12
Changes in Medicaid - Applying
Help in applying and renewing Web site for the Marketplace
www.healthcare.gov
Phone number for the Marketplace800-318-2596
(with language access)TTY 855-889-4325
Materials in English, Spanish, Chinese, French Creole, Korean, Polish, Portuguese, Vietnamese
13
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
14
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
15
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
16
Insurance through the Marketplace
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.
17
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
18
Don’t Forget!
Help in applying and renewing Web site for the Marketplace
www.healthcare.gov
Phone number for the Marketplace800-318-2596
(with language access)
TTY 855-889-4325
19