Albert Schweitzer Fellowship Monthly Meeting

September 11, 2013

The Affordable Care Act: How it will Affect the Patients

We Serve

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Topics Covered Today

• Overview of the Affordable Care Act

• Private Health Insurance

• Public Health Insurance

• Covered Services

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Implementation of the Affordable Care Act• Quick Overview!

http://kff.org/health-reform/video/youtoons-obamacare-video/

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The Marketplace: Private Health Insurance• What is a Health Insurance Marketplace? - A virtual portal available to consumers to figure out what insurance coverage

they are eligible for, review and compare insurance plans, and enroll in health

coverage.

• How will Illinois consumers apply for health coverage?

- Consumers in Illinois will apply for health coverage through the Illinois Health Insurance Marketplace, that is a partnership between the state and federal government.

- Marketplace will be accessible through a website, phone or paper application.

- Timeframe for enrollment: October 1, 2013- May 31, 20144

Medicaid: Public Health Insurance

• What is Medicaid?-A public health insurance option administered jointly by the states

and the federal government.

- Participation in the program is voluntary, Congress has instituted a number of eligibility and coverage requirements for states that wish to participate.

- States retain significant power in crafting coverage and eligibility provisions, which vary significantly from state to state.

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How is Medicaid Changing Under the Affordable Care Act?

Federal & Illinois Medicaid Policy- A national Medicaid minimum eligibility level of 133% of the

federal poverty level ($29,700 for a family of four in 2011/($14,484 for an individual in 2011) for nearly all Americans under age 65.

- New mandatory eligibility group consisting of non-pregnant adults between 19-65 with incomes at or below $133% FPL.

-This Medicaid eligibility expansion goes into effect on January 1, 2014 but states can choose to expand coverage with Federal support anytime before this date.

- Approximately 500, 000 to 800,000 Illinois residents will be covered under this restructured Medicaid program at little or no cost to individuals.

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New Eligibility Standards: Modified Adjusted Gross Income (MAGI)

• Federal Agency Regulation & Enforcement- Internal Revenue Service- Department of Health & Human Services- State Agency: Illinois Department of Healthcare and Family

Services

• Income Calculation- Countable Income + 5% Universal Income Deduction

- up to 138% FPL

• All other forms of income deductions formerly included will be disregarded.

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Traditional Medicaid and Medicaid Expansion Under the Affordable Care Act Traditional Medicaid Plans

- Eligibility based on individual’s aid category + State Financial Test

- Pregnant women, Children, Parents, Seniors, Individuals with Disabilities

- Medicaid beneficiaries receive wide range of benefits not covered in plans on the private market.

Alternative Benefit Plans (ABPs)- Medicaid Benchmark Equivalent Plans, must cover the Essential

Health Benefits (EHBs) specified in the ACA. - Newly Eligible Individuals will receive benefits through this plan.

Churning- Medicaid and Marketplace Eligibility standards will significantly

effect individuals with varying income levels. 8

Individuals Affected by Medicaid Expansion Women

- Pregnant Women: more women would qualify for Medicaid after pregnancy

- Non-Pregnant Women: Entitled to 22 Preventive Care Services without cost sharing or deductibles.

Children - All children between the ages of 0-19 are eligible for Medicaid as

long as they fall at or below the 133%-138% FPL.

Families (Parents/Caretaker Relatives)- All former income deductions will be disregarded to determine

eligibility.

Homeless Youths- Eligible for traditional Medicaid or newly eligible Medicaid,

depending on age.- Lack of awareness is the main concern.

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Services Required Under the Affordable Care Act

•Autism Screening•Behavioral Assessments•Depression Screening

•Developmental Screening• Iron Supplements

•Hematocrit or Hemoglobin Screening• Immunization Vaccines

•Height, Weight & BMI Measurements•Lead Screening

•Obesity Counseling•PKU Screening

•STI Prevention Counseling•Vision & Hearing Screening

•Well Women Visits•Breast Cancer Genetic Test and Mammography

Screening•Cervical Cancer Screening

•FDA approved Contraception•Domestic Violence Counseling•HIV Screening & Counseling

•HPV DNA Test•Osteoporosis Screening

•Rh Incompatibility Screening•Sexually Transmitted Infections Counseling

•Abdominal Aortic Aneurysm one-time screening

•Alcohol Misuse Counseling•Blood Pressure Screening•Cholesterol Screening

•Colorectal Cancer Screening•Depression Screening

•Diabetes (Type 2 Screening)•HIV Screening

• Immunization Vaccines•Obesity Counseling•Syphilis Screening

•Ambulatory patient services. • Emergency services.

•Hospitalization. •Maternity and newborn care.

• Mental health and substance use disorder•Prescription drugs.

•Rehabilitative & habilitative•Laboratory services.

•Preventive and wellness •chronic disease management.

•Pediatric services

Essential Health

Benefits (EHBs)

Preventive Care

Services - Adults

Preventive Care

Services – Children

Preventive Care

Services – Women

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Illinois Programs to Facilitate Implementation Illinois CountyCare (1115 State Waiver)

- CountyCare is a federally-funded demonstration project, waiving traditional Medicaid requirements for many uninsured adults in Cook County.

- Early implementation of the Medicaid Expansion under the Affordable Care Act for select patients and providers.

- Cook County HHS estimates that at least 115,000 and as many as 250,000 residents may be eligible for CountyCare.

ABE (Application for Benefits Eligibility)- Streamline Access to Enrollment Process: The client facing portal that

individuals can use to apply to several public benefits programs: TANF, SNAP and other medical benefits.

- Question/Answer format brings the applicant to the correct page for either the Health Insurance Marketplace or Medicaid.

- Not real time eligibility, but ABE will help to assess potential eligibility and provide guidance to the correct program. 11

Sources for Health Reform Information & Updates• United States Department of Health & Human Services

http://www.hhs.gov • Centers for Medicare & Medicaid Services

http://www.cms.gov • Medicaid.gov- Keeping America Healthy

http://www.medicaid.gov • American Public Health Association

http://www.apha.org • American College of Obstetricians & Gynecologists

http://www.acog.org/ • Illinois Department of Healthcare & Family Services http

://www2.illinois.gov/hfs

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Loyola University Chicago School of Law

Public Interest Law Reporter

Annual Law Journal Symposium

Increased Access to Healthcare: The Impact of the Affordable Care Act’s Medicaid

Expansion on Underserved Communities

November 8, 2013

9:30am- 4pm

Philip Corboy Law Center, 25 E. Pearson St., Chicago IL

Invitation!

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“In the Health Justice Project, doctors, social workers, lawyers and students of each profession are

partnering to address the social and environmental causes — like unhealthy housing conditions and

improperly denied food stamps — at the root of poor health.”

Emily A. Benfer, clinical professor of law, director of the Health Justice Project, Loyola University Chicago School of Law, Beazley Institute for Health Law & PolicyChicago Tribune, October 5, 2011

Health Justice Project

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