The Affordable Care Act:The Future is NowDolores AlvaradoChief Executive Officer

Affordable Care Act Town HallIndia Community CenterOctober 24, 2013

Community Health Partnership

Founded in 1993 - Consortium organization composed of 11 community health organizations, with a total of 42 sites in Santa Clara and San Mateo Counties

Health Care Safety Net for over 166,000 patients Low-Income Majority of patients have

incomes < 200% FPL

Health Center Patients in 2012 Rate of unsponsored/uninsured

is 5-60% 451,883 Total Encounters

Community Health Partnership

Community Health Partnership Our mission is to

advocate for affordable and accessible health services for our diverse and multicultural communities regardless of background, and to support our members in achieving these goals.

Community Health Partnership

Preparing for 2014 Health Care

Coverage Quality Improvement Patient Centered

Health Home Electronic Health

Record Systems and Data Analytics

Workforce Models Advocacy

The Affordable Care Act (ACA)

Mandates consumer protection from the health insurance industry

Improves health care quality while lowering costs Demonstration Projects

Accountable Care Organizations

Patient Centered Medical Home

Payment Reform Expands health coverage

and access Medicaid/Medi-Cal New Health Insurance

Markets/Covered California Individual Mandate

ACA- Consumer Protections

No more annual or lifetime caps on health insurance No rescinding of coverage due to chronic health conditions No discrimination for pre-existing conditions

Children-began in 2010 Adults and Gender-1/1/2014

Provides no-cost preventive care and prescription discounts New plans must cover preventive services without

deductible or co-pay MediCare rebates and free preventive care

Young adults can stay on parents’ coverage until age 26 All individual and small group plans both inside and outside

the health insurance marketplaces must cover mental health treatment at the same level as other types of care.

MediCal Expansion

MediCal (MediCaid) is a Government sponsored health insurance program for low income individuals. However, up until now, many people who met the income requirements did not qualify for MediCal*

• The ACA, expands MediCal eligibility to childless adults (19-64) who make less than 138% FPL Individuals making up to $15,400/year Family of four making up to $32,500/year In CA, lawfully present immigrants that meet MediCal

income eligibility will be transferred to Covered CA with benefits and costs similar to being in MediCal

Covered California (Health Benefit Exchange)

An on-line “market-place” that will offer a variety of approved health plans at various prices and benefit levels

Assistance available online, over the phone, and in-person through Covered California Certified Enrollment Entities and Counselors

Open enrollment (October 1, 2013-March 31, 2014) Four types of plans will be offered: Bronze, Silver, Gold and

Platinum* Subsidies will be available to individuals whose income is

between 138%-400% of FPL** Family of four:

• Covered California Website: www.coveredca.com

Percent of FPL

Annual Income

Unsubsidized monthly premium

Monthly premium after subsidy

150% $35,137 $1187 $117

399% $93,700 $1187 $742

Changes in 2014 for Californians with no Health Insurance

Individual Family of Four Coverage Options Cost

Up to $15,856 Up to $32,499 Eligible for Medi-Cal.Low-income Californians, who are U.S. citizens as well as most legally present immigrants can enroll in Medi-Cal.

Small co-payments for selected services.

Up to $45,960 Up to $94,200 Eligible to buy subsidized private coverage through Covered California.

The portion of a premium that an individual or family will have to pay will not exceed a specified percentage of income. Yearly limits on out-of-pocket costs also apply.

$45,961 and above

$94,201 and above

Required to buy private coverage.Consumers in this income category are ineligible for a subsidy.

Individuals who remain uninsured will be liable for penalties unless they qualify for certain exemptions.

ACA Coverage Expansion in Santa Clara County

Medi-Cal Covered California Remaining Uninsured

28,000 92,000 140,000

Remaining Uninsured in Santa Clara County, Regional and County Estimates, UC Berkeley Labor Center and UCLA Center for Health Policy Research

Beginning in January 2014, Santa Clara County uninsured individuals will benefit from new low-cost health insurance programs

20,000 Low Income Health Program participants will transition to MediCal

28,000 New MediCal enrollees92,000 Covered CA eligible

The ACA and Immigrants

Undocumented Immigrants Not able to buy health insurance in the individual

market of the state insurance exchange Not able to apply for tax credits for premiums or

co-payments Not eligible for federal Medicaid, CHIP, or Medicare

Exception: Eligible for Emergency Medicaid (“Restricted Medi-Cal)

Eligible family members of undocumented family can apply for these federal health programs

States can still choose to cover a broader group of immigrants in their state-funded health programs

Can seek care at community health centers

Community Health Centers

Certified Enrollment Counselors

Offer team-based care as Patient Centered Health Homes

Community based and led (Patient Majority Boards)

Sliding scale fees for uninsured

System Impact

Individuals and families with health insurance/coverage are more likely to seek preventive care Chronic disease management Early detection

Decrease in costly emergency room use Uncompensated care drives up the hospital and health

insurance costs Larger, diverse pool of participants (including young

and healthy) will eventually bring down health insurance costs

Patient Centered Medical Home, Accountable Care Organizations, Payment Reform will promote efficiencies in the health care delivery system

Healthier workforce

References

Alameda Health Consortium California Department of Health Care Services California Mental Health Directors Association California Primary Care Association Community Clinic Consortium CoveredCA.com Healthcare.gov Health Access Insure the Uninsured Project (ITUP) Kaiser Family Foundation National Alliance on Mental Illness (NAMI) National Association of Community Health Centers National Immigration Law Center Robert Wood Johnson Foundation Substance Abuse and Mental Health Services Administration (SAMHSA) Western Center on Law & Poverty

Thank You!

Dolores Alvarado(408) 556-6605www.chpscc.org dolores@chpscc.org