aca and vets & families

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+ ACA and Vets & Families NASW IL Conference Oct 28 2013

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ACA and Vets & Families. NASW IL Conference Oct 28 2013. ACA 101. ACA 101. ACA 101: Key Components. Available Now…. 2014 and Beyond…. Extended dependent coverage to age 26 No pre-existing condition exclusion for children Preventive services without cost sharing - PowerPoint PPT Presentation

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Page 1: ACA and Vets & Families

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ACA and Vets & Families

NASW IL ConferenceOct 28 2013

Page 2: ACA and Vets & Families

+ ACA 101

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Page 3: ACA and Vets & Families

ACA 101

ACA signed into law on March 23, 2010 with major provisions to start January 1, 2014

“Health Insurance Marketplaces” have been established and will open October 1, 2013

Individuals are responsible to obtain health coverage through an employer, directly from an insurance company or through the Marketplace

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Page 4: ACA and Vets & Families

ACA 101: Key Components

Extended dependent coverage to age 26

No pre-existing condition exclusion for children

Preventive services without cost sharing

CountyCare-the early expansion of Medicaid in Cook County

No lifetime limits on care Small business tax credits No insurance rescissions except in

cases of fraud/intentional misrepresentation

New Marketplace to buy insurance and receive financial help to pay for it

New Medicaid Adult Group available to adults under 138% FPL

Financial Assistance to purchase private insurance

Medicaid available to former foster children up to age 26 at any income level

No pre-existing condition exclusion for adults All plans must cover Essential Health Benefits No annual limits on care No gender rating Closing Medicare Part D donut hole Individual and Employer Responsibility

Available Now… 2014 and Beyond…

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ACA 101: Preventive Care

No Cost Sharing for certain preventive services, if provided in-network. However, there may still be some costs for the doctor’s visit if the visit includes other services besides the preventive service.

List of covered services the same for all plans and includes immunizations, cancer screenings, access to birth control, and a range of other services.

The full list is available at healthcare.gov/prevention

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26 Covered Preventive Services-- HighlightsAlcohol & Drug Use Assessments Behavioral Health Assessments

Depression for adolescents Developmental Screening & Surveillance

Immunizations – birth to age 18 Obesity screening & counseling

Hearing, Vision screenings STI – screening & counseling

Oral health screening & assessment for birth – 10

HIV screening -- adolescents

Autism screening at 18 & 24 months Blood Pressure screening for children

www.healthcare.gov for full list and more details

ACA 101: Highlights of Preventive Care 6

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ACA 101: Essential Health Benefits

Federal VIP for vision for children

Supplemented by All Kids for dental

for children

BCBS Blue Advantage

• Ambulatory patient services• Emergency services• Hospitalization• Maternity and newborn care• Mental health and substance use

disorder services• Prescription drugs• Rehabilitative and habilitative

services and devices• Laboratory services• Preventive and wellness services

including chronic disease management

• Pediatric services including oral and vision care

All health plans in the Marketplace, individual & small group, are qualified

health plans (QHP).

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Illinois’Benchmark

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8ACA 101: New Pathways to Coverage

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+ Healthcare Coverage Pathwaysfor Veterans and their Families

VA

Tricare

Marketplace and Medicaid

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Important Dates

OCTOBER 1, 2013- Open Enrollment in the Marketplace/New Medicaid Begins.

DECEMBER 15, 2013

- Must be enrolled by this date for Marketplace health coverage to begin by 1/1/14

JANUARY 1, 2014

- New Medicaid Adult Group Coverage begins. (No backdating before this date.)

MARCH 31, 2014

- Open Enrollment for Marketplace ends (Medicaid is always open).

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Page 11: ACA and Vets & Families

+ Marketplace in IL

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Marketplace in IL: Overview 12

Web shopping tool for individuals and small business to purchase private and public health insurance.

Gives consumers the tools and power to have control over their insurance decisions Apples-to-apples comparison of plans Find the right fit!

www.getcoveredillinois.gov

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Marketplace in IL: Eligibility & ApplicationThe applications for Medicaid and Financial

Assistance in the Marketplace will ask for information about:

Illinois ResidencyCitizenship/immigration status Income/Tax filing status Dependents and household composition

Information will be electronically verified.

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+Eligibility: Income

Modified adjusted gross income (MAGI) guides paths to health coverage

Why MAGI? It will standardize the calculation of income across all insurance

affordability programs It is used both by the Marketplace and Medicaid to determine

eligibility.

Income is compared to program limits to determine source of health coverage

MAGI is an income counting methodology, it is not a number on a tax form

When using MAGI, resources/assets are not a consideration Veterans benefits are not counted

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+Application: Household Composition

How a household is determined is different

for the Marketplace and Medicaid

The information collected affects the

person’s benefits so it must be entered

correctly.

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+Application: Household Composition

Household information is provided to the Marketplace based on whether a person files taxes, plans to file taxes or is claimed as a dependent

Tax information is used to determine the group size to compare income to the FPL and determine eligibility and amount of tax credits and subsidy

Application for health coverage can be for all persons who file taxes together

Medicaid programs use tax information to determine the group size and income eligibility for Medicaid benefits

Eligibility for Medicaid is determined by income limits for the type of Medicaid program considered

Application for health coverage is generally for persons living in the house together

Marketplace Medicaid

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+ Veterans and their Families

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+VA Health Care Information

Veterans who obtain health care through the USVA meet the requirements for minimum essential health benefits

Veterans may be able to blend other health coverage with USVA coverage to increase access to providers

• Veterans enrolled in USVA health coverage are eligible to enroll in Medicaid if the individual qualifies for the benefit

• Veterans enrolled in USVA health coverage are able to access this benefit as well as Medicare if the individual qualifies for Medicare

• Veterans who have private insurance through an employer can be enrolled in USVA health coverage as well as private insurance

If enrolled in USVA healthcare coverage the veteran is not eligible for tax credits and subsidy through the Marketplace

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+ VA and Families

Families members of Vets enrolled in VA health care cannot receive VA health benefits

Exception: Civilian Health and Medical Program (CHAMPVA); Spina Bifida Health Care Program

Options for families: Tricare, Marketplace (Medicaid)

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+ CHAMPVA Eligibility Definitions

Term Definition

Beneficiary A CHAMPVA-eligible spouse, widow(er), or child.

Child Includes birth, adopted, stepchild, or helpless child as determined by a VA regional office (see the “Rules that Impact CHAMPVA Eligibility” section of the CHAMVPA handbook).

Dependents A child, spouse, or widow(er) of a qualifying sponsor.

Qualifying Sponsor A Veteran who is permanently and totally disabled from a service-connected condition, died as a result of a service-connected condition, was rated permanently and totally disabled from a service-connected condition at the time of death, or died on active duty and whose dependents are not otherwise entitled to DoD TRICARE benefits.

Service-Connected A VA regional office determination that a Veteran's illness or injury is related to military service.

Spouse The wife or husband of a qualifying sponsor.

Widow(er) The surviving spouse of a qualifying sponsor.

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Page 21: ACA and Vets & Families

+ Tricare and ACA

Two Beneficiary categories: Sponsor (SM) and Dependents (family members)

Some Tricare Plans qualify for Minimum Essential Coverage (MEC) and others don’t Tricare Prime; Reserve Select; Young Adult = yes Tricare for dependent parents and in-laws = no

If electing Tricare, then no tax credit or subsidy through the marketplace

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+ Tricare Eligibility

Eligibility depends on military status

Active Duty

Reserve/National Guard SMs and Families are eligible so long as the SM is attending drills

Families

Survivors’ remaining eligible when a sponsor dies depends on If the sponsor was AD or not If the survivor is a spouse or child

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+ Tricare’s differences

Tricare Young Adult Tricare’s current age limit for children: 21 or age 23 if in

school full-time Young Adult is a Tricare option that the child (or parent)

may purchase for additional coverage

Mental health and substance use disorder coverage limits may not meet the requirements for parity

Other costs

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+ Medicaid Expansion in 2014• In 2014, anyone up to 138% (133% plus 5% income

disregard) FPL is eligible for Medicaid, called “newly eligible” Medicaid.• No disability requirement.• Must be under 65, not entitled to or enrolled in

Medicare A or enrolled in Part B.• Modified gross income (MAGI) and no asset test,

which is different from current Medicaid and All Kids Programs.

• Federal government pays for much greater percentage of this expansion.

• Veterans Benefits are not countable income

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+ Additional information and Resources

Visit http://getcoveredillinois.gov

Talk to a navigator: http://getcoveredillinois.gov/get-help/

http://tricare.mil

www.va.gov

www.Illinoishealthmatters.org

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