+ connecting communities to coverage: the affordable care act in il october 1, 2013 connecting...

+ Connecting Communities to Coverage:

The Affordable Care Act in ILOctober 1, 2013

Connecting Communities to Coverage: The Affordable Care Act in Illinois

About EverThrive Illinois

Formally known as Illinois Maternal and Child Health Coalition

Our Projects and Initiatives: Health Reform Projects School Health Project Immunization Project Health Disparities Project Premature Birth Project Cooking Matters Project

www.ilmaternal.org

@EverThriveIL

#NASWIL

Kathy Waligora, M.S.W

Manager, Health Reform Initiatives

kwaligora@ilmaternal.org

Learning Objectives

Understand the basic provisions of the law likely to impact clients

Get an introduction to the new enrollment systems, including the Marketplace.

Understand the role of social workers in connecting communities to coverage

Gain access to tools and resources which will help you to connect with other enrollment specialists and stakeholders

ACA 101

The Affordable Care Act puts in place comprehensive reforms that: Ensure that all insurance is high quality, Protect consumers from insurance industry practices which

limited access to coverage for many, and Improve access to affordable health coverage.

If you are already insured, the only changes you will see are new benefits, better consumer protections, and more value for every dollar you spend on care. If you like your plan you can keep it and don’t need to do anything differently.

If you are uninsured, new pathways to coverage will make it easier than ever to get covered and stay covered. Financial assistance will be available to guarantee you can pay for coverage and health care.

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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Essential Health Benefits

Individual Responsibility

The individual mandate requires most Americans to purchase health insurance starting January 1, 2014 or pay the shared responsibility payment if they do not comply

People are exempt from the shared responsibility payment if: They would have to spend more than 8% of household income on

the cheapest qualifying health insurance plan even after tax credits and subsidies

Their income falls below the threshold for filing federal income tax

They are undocumented or not a lawfully permanent resident

People already meet this requirement if: They have insurance through an employer or purchase individual

insurance. They have insurance through Medicaid, Medicare, CHIP, Veteran’s

Administration and/or Tricare for active duty and retire military, Indian Health Services

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+Cost & Financial Assistance

Cost of Health Insurance

There are three factors that can determine an individual’s premium: Age

Up to 3x more for older adults Tobacco Use

Up to 1.5 times for tobacco users Where you live

IL recently released premium rates and they were 25% lower than expected and much lower than other states

Limits on Cost Sharing

“First-dollar” (no deductible/cost-sharing) coverage on preventive health

Limit small group health plan deductibles in 2014 to $2,000 for single, or $4,000 for family (adjusted annually)

Limit out-of-pocket amount in 2014 to $6,350 for single and $12,700 for family (adjusted annually)

Maximum out-of-pocket limits are reduced further for individuals and families below 250% FPL

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Financial Assistance

Premium Tax

Credits

•Helps you pay the monthly cost to have a plan

Cost-Sharing

Reductions

•Decrease the charges (e.g., copays, deductibles) you must pay when receiving health care services covered by the plan

Premium Tax Credit

Take It Now! (Advanced) Taking It Later! (Tax Time)

October 2013 – March 2014

• Enroll in health plan on Marketplace

• Choose to take all your credit in advance

– or just part of it

• Enroll in health plan on Marketplace

During 2014 • Pay a lower premium each month in 2014

– and now you are covered

• Pay full premium each month in 2014

– and now you are covered

January 2015 – April 2015

• Get a statement from Marketplace showing how much credit you received in 2014

• File your 2014 taxes, including information about tax credit already taken

• File your 2014 taxes• Either subtract the amount of

tax credit from the taxes you owe – or if you don’t owe anything IRS may give you a refund

IL Submitted Rates (non smoker)

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The REAL cost of Coverage in Illinois

Kaiser Family Foundation: kff.org

+Access to Coverage

Getting Insurance in 2014

Medicaid Expansion

The ACA expands Medicaid to cover all people under 138% of the federal poverty level Must be US Citizen or

Legal Permanent Resident of 5 years or more to qualify

Coverage begins January 1, 2014

100% federally funded in the first three years, gradually reduces to 90% by 2020

CountyCare: A New Medicaid Program for Cook County Who?

Live in Cook County Be 19-64 years old Have income at or below 133% of the

Federal Poverty Level ($14,856 individual, $20,123 couple – annually)

Be a legal immigrant for five years or more or a US citizen

Have a Social Security number or have applied for one

Access services at Cook County Health and Hospital System locations and some participating federally qualified health centers

It is important to continue enrolling eligible individuals into CountyCare as they can be enrolled and back bill for services BEFORE January 1, 2014

Existing Medicaid Programs

You might not need to wait until January to enroll in Medicaid:1.All Kids covers children under a

certain income regardless of immigration status

2.FamilyCare covers parents of children under 19 under a certain income

3.Moms and Babies covers pregnant women under a certain income regardless of immigration status

4.Medicaid for the Aged, Blind, and Disabled provides coverage for older adults and disabled people under a certain income

Get Connected TODAY1-800-843-6154

1-800-447-6404 TTY

The Marketplace

Enroll between Oct 1- March 31 for private insurance; by Dec 15 for coverage beginning Jan 1, 2014

Enroll year round for Medicaid

Three ways to get connected:1. On the web www.GetCoveredIllinois.gov

2. On the phone 1-866-311-1119

3. In Person Work with a Navigator to get

support and advice

The Marketplace in IL

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Get Covered Illinois

Healthcare.gov

SHOPIndividual

MarketplaceAssess

Medicaid/CHIP

EligibilityApplication for APTC/C

SR

Eligibility

Determinat

ion for

APTC/CSR

ABE

Application available to state office

State worker Processes

Application

Eligibility Determination

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111111111111111111111111111111111111

1111

If potentially eligible referred to Medicaid/CHIP

111111111111111111111111111111111111

1111

The Marketplace

Open Enrollment Period

Enrollment Date/Period Effective Coverage Begins

Oct. 1 – Dec. 15, 2013 Jan. 1, 2014

1st – 15th of month (Jan. – March)

1st of following month

16th – last day of month(Dec. – March)

1st of second following month

Initial Open Enrollment Ends March 31, 2014

Changes can be made within 30 or 60 days of triggering event (marriage, birth, move) that allows

for a change

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***Those who are eligible for Medicaid can apply for coverage any day of the year!

+Role for Social Workers

The Role for Social Workers

Educate clients on health insurance

Educate clients on the Affordable Care Act

Connect uninsured clients to Assisters

Become a Certified Enrollment Specialist

Connect to larger campaigns to elevate messages or even volunteer to canvass your community, host/participate in phone banks, and support events

Connect with other stakeholders across Illinois, using IHM HelpHub

Education: Barriers 29

Healthcare system

Lack of knowledge/information

Financial

Attitudes and perceptions

Culture

Communication

Professional Bias

Physical and social environment

Physical proximity

Politics and Policy

All insurance plans will have to cover doctor

visits, hospitalizations, maternity care,

emergency room care, and prescriptions.

You might be able to get financial help to pay for a health insurance plan.

If you have a pre-existing condition, insurance

plans cannot deny you coverage.

All insurance plans will have to show the costs and what is covered in simple language with

no fine print.

Key Messages30

One of these = top

message for 89% of

population

Source: Enroll America, November 2012

Certified Application Counselors

Who? Community based organization that wants to help by training your staff to assist people applying for coverage through the Marketplace

What? Help people understand, apply, and enroll for health coverage through the Marketplace. Your organization must agree to make sure that designated individuals complete required training, and that they comply with privacy and security laws, and other program standards.

How? Complete a brief application and access training at: http://marketplace.cms.gov/help-us/cac.html

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Major Campaigns

Get Covered Illinois

BeCovered Illinois

Enroll America-Get Covered America

Many other groups will run campaigns, so

there will be no shortage of graphics, materials, resources,

or ideas.

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Illinois Health Matters HelpHub

An online community where enrollment and outreach stakeholders in Illinois can share their experiences and get access to resources related to the ACA

To request an invite, email helphub@illinoishealthmatters.org with the name of your organization, lead agency (if part of IPC or Navigator grant) and /or details of your ACA involvement.

Resources

Illinois Health Matters

http://www.illinoishealthmatters.org

EverThrive Illinois ACA

http://www.ilmaternal.org/hcr

Kaiser Family Foundation

http://healthreform.kff.org/

www.GetCoveredIllinois.gov

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Questions?

Kathy Waligora, M.S.W.ManagerHealth Reform InitiativesEverThrive Illinois

kwaligora@ilmaternal.org312-491-8161 x29

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