The Landscape of ACA Implementation in Florida

Sept. 13th, 2013Leah Barber-Heinz

Advocacy Director, Florida CHAIN

AGENDA

1. Implementation Timeline

2. Overview of the Marketplace and eligible Floridians

3. Enrollment help- Navigators, CACs, Health Centers

4. Medicaid Expansion

5. Resources

1. Timeline

• August 15th- Navigator funding announced

• mid-September- Navigator training began online

• September 23rd- Legislative committee weeks begin

• October 1st- Open enrollment begins (17 days)

• January 1st, 2014- Coverage begins

• March 31st- Open enrollment period ends

• October 1st, 2014- Open enrollment begins again

2. Marketplace Overview

• A new, transparent, and competitive insurance marketplace

• Individuals and small businesses can buy affordable and qualified health benefit plans

• Choices of health plans that meet benefits and cost standards

• Income between 100% to 400% of the Federal Poverty Level (FPL) ($23,550 – $94,200 for a family of four)

Health Insurance Affordability Programs in FloridaPost ACA

Who will enroll in the marketplace?Uninsured & under-insured (inadequate and/or unaffordable coverage)

Floridians with incomes between 100% and 400% of poverty level

• Currently about 2.7 million such Floridians

• Majority will not have had private insurance previously

• Compared with existing private insurance market:

- More racially diverse - Less likely to be English-proficient- Less formal education

• Others can buy, but below 100% and above 400% of poverty = no tax credits

% of poverty level Individual Family of 4

100% FPL $11,490 $45,960

400% FPL $23,550 $94,200

3. Enrollment help

Assistance that helps people choose the right health coverage option for themselves

& their families

4 sources for enrollment assistance

• Navigators• Certified Application

Counselors (CACs)• Health Centers (FQHCs)• Marketplace-

www.healthcare.gov, 1-800-318-2596

Navigators: What do they do?

• Provide unbiased help for people so they can buy coverage in Marketplace or connect with Medicaid and KidCare.

• Educate consumers on health coverage options

• Assist with eligibility, enrollment, and health plan selection

Navigators must:

• Prioritize serve low-income, disadvantaged, and hard-to-reach populations

• Help people understand how premium tax credits work and the potential impact on families’ finances

• Explain how health insurance, benefits, cost sharing, and appeals processes work

• Provide information that can be understood for those with limited English proficiency

Who are Florida Navigators?

University of South Florida: Florida Covering Kids & Families (FL-CKF) is a community and consumer-focused nonprofit initiative of The Lawton and Rhea Chiles Center for Healthy Mothers and Babies, based in the College of Public Health, at the University of South Florida (USF), located in Tampa, Florida. FL-CKF, in collaboration with a state-wide consortium of 10 partners, will assist consumers and small employers with the enrollment process and conducting public education activities to raise awareness about the Marketplace.

Epilepsy Foundation of Florida plans to utilize their existing partnerships with schools and universities, government agencies, hospitals, and faith-based entities to educate and help enroll consumers in the Marketplace.

Advanced Patient Advocacy, LLC for nearly 14 years has partnered with health care providers and state and local governments in 21 states to provide services to communities to help educate and enroll uninsured consumers. They will work with medical centers to identify uninsured individuals and provide education and assistance to help them make informed decisions about enrollment in the Marketplaces.

Who are Florida Navigators cont.

National Hispanic Council on Aging works closely with its Hispanic Aging Network composed of 39 community-based organizations across the continental U.S., D.C., and Puerto Rico. The NHCOA will deploy Navigators in Dade County, Florida, and Dallas County, Texas, to enroll the uninsured Hispanic population

Cardon Healthcare Network has over 20 years of experience providing in-person eligibility assistance to Medicaid enrollees in 33 states. Cardon Healthcare Network will use this experience to provide outreach and assistance with its existing robust infrastructure.

Mental Health America will target underserved individuals with behavioral health disorders who are uninsured or underinsured. The National Office of Mental Health America (MHA) will serve as the lead agency in the Initiative. The Mental Health America of East Central Florida (MHAECF) will serve Brevard, Flagler, Orange, Putnam, St. Johns, and Volusia counties in Florida.

Walton

Holmes

Washington

Wakulla

MadisonLeon

Gadsden

Jackson

Bay

SantaRosa

Okaloosa

Calhoun

Liberty

Gulf Franklin

Jeffe

rson

Taylor

Lafayette

Hamilton

Suwannee Col

umbi

a

Baker

Nassau

Duval

Union

Bradford

Flagler

Putnam

Clay

DixieGilchrist

Alachua

Levy

MarionVolusia

Citrus Lake

Sumter

Orange

SeminoleHernando B

revard

IndianRiver

OsceolaPolk

Pasco

Hillsborough

Pinellas

Manatee Hardee

Highlands

Okeechobee St. Lucie

SarasotaDe Soto

Charlotte Glades

Martin

LeeHendry

Palm Beach

CollierBroward

Monroe

Miami-Dade

Escambia

1. Families Count

2. PAEC

3. North Central Florida Health Planning Council, Inc. (WellFlorida Council, Inc.)

4. The Health Planning Council of NE FL

5. Treasure Coast Health Council

6. Health Planning Council of S.W. Florida, Inc.

7. Kids Healthcare Foundation

8. PCAN

9. United Way of Brevard

Florida CHAIN-Statewide

Other navigator entities

USF, Covering Kids and Families

What are Certified Application Counselors (CACs)?

• Provide information about full range about Marketplace plans, Medicaid and CHIP

• Help people apply and enroll in Marketplace, Medicaid and CHIP

• HHS provided training and certification• Federal funding not available

What Organizations Can Be CACs?

• Screen and certify that staff will protect information

• Have a track record of helping people enroll in public benefits programs or social services

Practically Speaking, CAC entities are likely to be:

• Community Health Centers (such as FQHCs)

• Hospitals

• Health Care Providers

• Indian Health Services and Providers

• Ryan White HIV/AIDS providers

• Behavioral or mental health providers

• Agencies with experience providing social services such as SNAP outreach, energy assistance, or tax assistance, which are:

• Non-federal government entities

• 501(c) nonprofits

• Local government agencies such as health departments, libraries

What is the difference between CACs and Navigators?

• CACs perform similar but more limited functions:

• CACs are not required (but may) do outreach

• CACs are not subject to same stringent conflict of interest standards but must disclose potential conflicts of interests

• CACs do not have to meet cultural and linguistically appropriate standards (CLAS) beyond other obligations they already have

• CAC may refer individuals with disabilities

• CACs do not have to refer consumers to ombudsman or other consumer assistance programs

How does an organization become a CAC?

• Apply on-line. http://marketplace.cms.gov/help-us/cac-apply.html

• If accepted, must enter into agreement with Marketplace

• Must screen and certify staff and volunteers

Federally Qualified Health Centers and Enrollment Assistance

Florida: Health Center Outreach & Enrollment Assistance

46 awards totaling $8,052,533

FL health centers expect to hire 163 new workers, who will assist 158,160 people with enrollment into affordable health insurance coverage.

http://www.hrsa.gov/about/news/2013tables/outreachandenrollment/fl.html

What is Outreach and Education?

• Informing people about coverage options

• Monitoring how things are going and report

• Working together to fix problems and highlight successes

• Identifying needed improvements in systems and policies- STORY BANK

• Up to 138% Federal Poverty Level • $26,951 for a Family of 3• 100% Federally funded through

2017, then tapers to 90% match 2020

• Effectively a State option due to Supreme Court decision

• Governor, State Senate, Hospitals, Business community and advocates support

4. Medicaid Expansion

Medicaid Expansion815,000 to 1,295,000

would gain coverage in Florida• Low income childless

adults- 58%

• Low income working parent (s)- 42%

• Persons with disabilities- 49,000

• Working adults- 46.4%

Medicaid Expansion cont.

Source: Florida CHAIN- http://floridachain.org/wp-content/uploads/2013/03/expansion-population-charts-as-of-03.21.13.pdf

Medicaid Expansion- Call to Action

Almost 3 million Floridians will be newly eligible

But we all need to make sure people know about the new benefits and programs and help

them enroll

5. Resources

To prepare for and enroll in Marketplace- www.healthcare.gov

Healthcare expansion advocacy and campaigns-

www.healthcareforflorida.org

Outreach/Enrollment materials-http://marketplace.cms.gov/getofficialresources/publications-and-articles/publications-and-articles.html (just google CMS/Outreach Enrollment Materials)

Share your story portal- http://floridachain.org/shareyourstory/

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