the affordable care act: present and future opportunities for coverage

Illinois Maternal & Child Health Coalition

The Affordable Care Act: Present and Future Opportunities for Coverage

Presented to Alliance for Healthy and Active Communities quarterly meeting

Kathy Chan, Associate Director and Director of Policy and AdvocacyIllinois Maternal and Child Health Coalition

Thursday, March 28, 2013

About IMCHCOur Projects and Initiatives:• Campaign to Save Our

Mothers and Babies• Chicago Area Immunization

Campaign• Cooking Matters, a program

of Share Our Strength• Illinois Coalition for School

Health Centers• Illinois Premature Infant

Health Network• text4baby

www.ilmaternal.org/

Healthcarereform

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http://www.ilmaternal.org/healthcarereform

http://www.ilmaternal.org/healthcarereform

Presentation Overview


• Understand major provisions of the Affordable Care Act

• Find out which policies/programs are currently in effect

• Learn about changes that will occur in the near future • Be aware of pending policy decisions at the state and

federal levels and opportunities for advocacy• Questions and answers• Brief demo of Visualizing Health Care Reform

Affordable Care Act Overview


• Signed into law on March 23, 2010• Establishes a floor, not a ceiling• States are largely responsible for implementation• Phases-in changes to private health insurance coverage and

expands public coverage • Enacts tax credits to help individuals and small businesses

access more affordable insurance options• Reforms Medicare, protects Medicaid and CHIP• Authorization of numerous grant programs and pilot projects• Imposes individual and employer responsibility provisions

Present Opportunities for Coverage


• All Kids – comprehensive health insurance coverage for kids <300% FPL

• FamilyCare – coverage for parents and relative caregivers <133% FPL

• Moms & Babies – coverage for pregnant women and infants up to 1 year of age <200% FPL

• Illinois Healthy Women – limited family planning coverage to women <200% FPL

• Illinois Breast and Cervical Cancer Program – for uninsured women 35-64 years, no income limit

Visit www.health.illinois.gov for more information

http://www.health.illinois.gov/

Present Opportunities for Access to Affordable Coverage and Care


• Expansion of young adult coverage to 26 years in private insurance plans

• No-cost preventive care in new private health insurance plans –Women-specific preventive services went into

effect on August 1, 2012

Present Opportunities for Access to Affordable Coverage and Care (cont'd)


• August 2012 – No-cost women’s preventive health services for new insurance plans• Well-women visits• Gestational diabetes screenings• HPV DNA testing (separate from pap smear results)• STI counseling, HIV screening and counseling• Contraceptives (i.e. birth control)• Breastfeeding support services and supplies• Domestic violence screenings



• CountyCare - 1115 “Cook County” Waiver for early implementation of “new Medicaid” – Coverage begins January 1, 2013– Eligibility criteria:

• 19-64 years of age• Income less than 133% FPL• Resident of Cook County• Ineligible for existing Medicaid programs or Medicare• US citizen or Legal Permanent Resident for at least five years

– Must use Cook County Health and Hospital Network and/or contracted providers

– To apply, phone 312-864-8200 or toll free at 855-671-8883– http://www.cookcountyhhs.org/patient-services/county-care/



• Elimination of lifetime limits and phasing out of annual limits• Elimination of pre-existing conditions for children• Tax credits to help qualifying small businesses and nonprofits

pay for private health insurance for their employees• Minimum medical loss ration (MLR)• Justifications of annual increased premium rates above 10%• New protections for breastfeeding women• Direct access to OB/GYNs• Grants for programs and demonstration projects, e.g.

Community Transformation GrantsVisit www.healthcare.gov for more information

Health Insurance Landscape in 2014


New options for coverage Competitive health insurance marketplace Tax credits – for those with incomes up to 400% FPL

(~$92,000/year for a family of four) Cost-sharing subsidies for those at or below 250% FPL

New Medicaid limits to cover newly eligible - 138% FPL (~$20,000/year for family of two) Medicaid currently only available to those who meet income

requirement AND categorical eligibility (child under 19 years, parent or relative caregiver, elderly, disabled)

Most single and childless adults ineligible

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Health Insurance MarketplaceEach state will establish a health insurance marketplace where

consumers can find and compare insurance plans

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Health Insurance Marketplace


Federal-state partnership in 2014 Intent for state-based Marketplace in 2015 –

requires state legislature to pass authorizing legislation. Must include: Establish governing board Financing mechanism – must be self-sufficient

Additional issues: Strong conflict-of-interest provisions Prioritize consumers Cost-control, quality-assurance, network adequacy

Health Insurance Landscape in 2014 (cont'd)


1.6M Illinois residents will have access to affordable coverage Over 1M will be eligible to use the Exchange 342,000 newly eligible for Medicaid

• Guaranteed issue – no more pre-existing condition exclusion or gender rating; limited age rating• Benchmark essential health benefits package –

will also determine coverage for "new Medicaid" – Likely to be identical to present FamilyCare coverage

What must be included in the Essential Health Benefits?

• Ambulatory Patient Services• Emergency Services• Hospitalization• Maternity and Newborn Care• Mental Health and Substance Abuse Services (including

Behavioral Health Treatment)• Prescription Drug Coverage• Rehabilitative and Habilitative Services and Devices• Laboratory Services• Preventive and Wellness Services• Chronic Disease Management• Pediatric Services, Including Oral and Vision Care


Individual and Employer Responsibility Provisions

• Nearly everyone will be required to purchase health insurance starting 2014 or face a penalty– Exceptions:

• Individuals who would have to pay more than 9.5% of their annual income for health care, even with tax credits and subsidies

• Undocumented individuals• Employers with >50FTEs will be required to provide affordable and adequate health insurance (many already do)– New tax credits for small businesses to help offset costs– Employers will only pay a shared responsibility fee if their

uninsured employees receive tax credits or subsidiesIllinois Maternal &

Child Health Coalition

ACA and Immigrants Immigrants “lawfully present” in U.S.

May buy health insurance in state exchanges May apply for tax credits for premiums & cost-

sharing reductions• Are eligible for the Illinois Pre-existing Condition Plan• Must buy health insurance under the individual mandate

(unless unaffordable or exempt) Undocumented Immigrants:

Unable to buy private health insurance in exchange (& ineligible for tax credits or cost-sharing reductions)

Exempt from individual mandate

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Pending Illinois Policy Decisions

• Benchmark EHB selection – BCBS Blue Advantage• Establishment of a Health Insurance Marketplace in Illinois

(aka “the Exchange”) – Single-entry point, simplified screening/application

process• Developing a Navigator/In-Person Assistor program• Ensure Illinois covers all of the newly eligible in Medicaid• Implementation of Medicaid reform legislation • State budget challenges - ongoing need to preserve

Medicaid and related programs


Pending Federal Policy Decisions

• Pending rules and regulations


Planning Questions

• Existing patient payer-mix?• Capacity?• Medicaid delivery system changes?• Partnership opportunities? • Community/patient education?


Advocacy Opportunities• SB26/HB106 – Medicaid Financing Act– www.ilmaternal.org/action.htm– AARP toll-free hotline: 1-888-616-3322

• Governor’s Health Care Reform Implementation Council: www.healthcarereform.illinois.gov

• Illinois Department of Healthcare and Family Services: www.hfs.illinois.gov – Public Involvement – Boards and Commissions

• Medicaid Advisory Council: http://www2.illinois.gov/hfs/PublicInvolvement/BoardsandCommisions/MAC/Pages/default.aspx


What You Can Do! • Connect with your legislators!• Spread the word• Consider becoming an ACA Ambassador• Subscribe to IMCHC’s newsletter and action alert,

Facebook, Twitter (@ILMaternal)• Download and share our factsheets and toolkit• Subscribe to our podcast• Invite us to present and suggest future topics• Bookmark www.illinoishealthmatters.org


Additional Resources

• www.ilmaternal.org • www.illinoishealthmatters.org• www.healthcare.gov• www.familiesusa.org• www.heathreform.kff.org


Questions?


Kathy [email protected]

312-491-8161x24www.ilmaternal.org

Visualizing Health Care Reform in 2014

•Who will be eligible for Medicaid in the community my pharmacy serves? •Who will be eligible for subsidies in the Exchange in 2014 in the community we serve?

www.illinoishealthmatters.org

Local Interactive Health Insurance Data by Community Area

so you can answer the following questions:

• Grant Proposals• Education & Outreach• Advocacy• Board Education• Operational Decisions

Data Example


Data Example


Lyons and Stickney – Cook CountyIn 2014, 20,022 people (13% of the population) will have affordable health insurance available to them. Below are the types of coverage that will be available to them based on their income:

• 5,512: Newly eligible for Medicaid (income up to 138% FPL, $15,400/year for a single person)• 9,565: Eligible for tax credits to help pay for private coverage on the Health Insurance Exchange (income ranging from139 - 400% FPL, between $32,000 - $92,000/year for a family of four)• 4,945 Ineligible for tax credits, but will have access to Exchange (incomes above 400% FPL, above $92,000/year for a family of four)

Data Example


Cook CountyIn 2014, 855,413 people (16.4% of the population) will have affordable health insurance available to them. Below are the types of coverage that will be available to them based on their income:

• 330,923: Newly eligible for Medicaid (income up to 138% FPL, $15,400/year for a single person)• 394,135: Eligible for tax credits to help pay for private coverage on the Health Insurance Exchange (income ranging from139 - 400% FPL, between $32,000 - $92,000/year for a family of four)• 130,355: Ineligible for tax credits, but will have access to Exchange (incomes above 400% FPL, above $92,000/year for a family of four)

Resources


the affordable care act: present and future opportunities for coverage

Documents

child health coalitionthursday

affordable coverage

preventive health services

advocacyillinois maternal

affordable care actfind

public coverage

future opportunities

kids present opportunities