Take the Extended Health Coverage Fight to the Ohio Senate:What Advocates Can Do Now – 4/26/13

Medicaid Expansion in OhioHow it Impacts Hispanic Communities

Nita Carter, Health Equity Director UHCAN Ohio Chair UHCAN Ohio Statewide Health Equity Committee

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Take the Extended Health Coverage Fight to the Ohio Senate:What Advocates Can Do Now – 4/26/13

What I Will Cover Today

• Mediciad Expansion• Status of Medicaid

Expansion• What this means for

Hispanics in Ohio• The Exchange and

Hispanics in Ohio

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Take the Extended Health Coverage Fight to the Ohio Senate:What Advocates Can Do Now – 4/26/13

What is Medicaid?

• Federal/State program providing comprehensive health coverage

• Covers certain groups: kids, pregnant women, parents, totally disabled, and older adults needing long term care

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Take the Extended Health Coverage Fight to the Ohio Senate:What Advocates Can Do Now – 4/26/13

Affordable Care Act (ACA) and Medicaid Expansion

• Expansion of Medicaid is one way the ACA expands coverage.

• Under the Medicaid Expansion, ALL adults under age 65 who make under 138% Federal Poverty Level are newly eligible for Medicaid. 4

Take the Extended Health Coverage Fight to the Ohio Senate:What Advocates Can Do Now – 4/26/13

People Who Will Be Newly Eligible for Medicaid

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Over 275,000 Ohioans in the next two years!

Take the Extended Health Coverage Fight to the Ohio Senate:What Advocates Can Do Now – 4/26/13

Who Would be Covered?

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• Parents with incomes 91-138% FPL• People working in low-wage jobs that

don’t offer health insurance – personal care aides, child care workers, food service workers, etc.

• People suffering from serious mental health and addictions, other serious health issues

• 26,000 Ohio veterans• Retirees under 65 on fixed incomes

Take the Extended Health Coverage Fight to the Ohio Senate:What Advocates Can Do Now – 4/26/13

Who Would be Covered?

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Affordable Care Act expands Medicaid coverage to ANYONE under age 65 with incomes below 138% Federal Poverty Level (FPL)

Take the Extended Health Coverage Fight to the Ohio Senate:What Advocates Can Do Now – 4/26/13

Medicaid Expansion is Up in the Air

• Unprecedented support– Ohio Alliance for

Health Transformation– Regional Medicaid

Expansion coalitions– Every imaginable

stakeholder group• But, Ohio General

Assembly left it out of state budget

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Take the Extended Health Coverage Fight to the Ohio Senate:What Advocates Can Do Now – 4/26/13

Who Pays for Current Ohio Medicaid?

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Year Ohio’s Cost

Federal Government’s Cost

2007 40.34%

59.66%

2008 39.21%

60.79%

2009 27.66%

72.34%

2010 26.53%

73.47%

2011 36.31%

63.69%

2012 35.85%

64.15%

2013 36.42%

63.58%

Year Ohio’s Cost

Federal Government’s Cost

2014 0% 100%2015 0% 100%2016 0% 100%2017 5% 95%2018 6% 94%2019 7% 93%2020+

10% 90%

Who Pays for Medicaid Expansion?

Take the Extended Health Coverage Fight to the Ohio Senate:What Advocates Can Do Now – 4/26/13

Benefits of Medicaid Expansion

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Boosts Ohio’s economy- And state revenues

Creates jobs

Promotes healthier Ohioans

Take the Extended Health Coverage Fight to the Ohio Senate:What Advocates Can Do Now – 4/26/13

Consequences of Not Expanding Medicaid

• Over 500,000 Ohioans remain uninsured – no option for people under 100% FPL

–Untreated mental illness and addiction

•Lose federal funds – over $13 billion in 6 years

•Forego up to 27,000 new jobs

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Take the Extended Health Coverage Fight to the Ohio Senate:What Advocates Can Do Now – 4/26/13

Medicaid for Immigrants - General Rule• Citizens are eligible for Medicaid if they meet the

eligibility requirements. For non-citizens:

– If you arrived in US before 8/22/96 and are lawfully here, you’re eligible for Medicaid (if you meet the other eligibility requirements)

– If you arrived in US on or after 8/22/96, most “qualified aliens” are barred from Medicaid, except refugees and asylees

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Take the Extended Health Coverage Fight to the Ohio Senate:What Advocates Can Do Now – 4/26/13

Immigrants Eligible for Medicaid who entered after 8/22/96• Refugees, asylees (after date asylum

granted); Deportees; battered spouse & her children; most Cubans, Haitians, others*

Eligible for 7 years from date of entry

After 7 years, must be US citizen or meet work/US veteran or active duty requirement. 13

Take the Extended Health Coverage Fight to the Ohio Senate:What Advocates Can Do Now – 4/26/13

Immigrants entering after 8/22/96: special Ohio problem• US law bars most immigrants entering US after 8/22/96

from Medicaid for five years unless they meet one of two requirements during the first 5 years

• 40 work quarters under social security or• Veteran or active duty in US armed forces or• Become a citizen

• Ohio bars them forever – unless they meet one of the requirements above

• Sponsor affidavits of support signed after 12/97 (I-864) create additional barrier.

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Take the Extended Health Coverage Fight to the Ohio Senate:What Advocates Can Do Now – 4/26/13

Immigrants not eligible for Medicaid (except Alien Emergency Medical Assistance)

• Non-immigrants such as students and foreign visitors

• Undocumented immigrants

• Other categories

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Take the Extended Health Coverage Fight to the Ohio Senate:What Advocates Can Do Now – 4/26/13

Immigrant Kids Eligible for Medicaid

• U.S. born children are U.S. citizens, eligible for MA, regardless of parents’ status

• But citizen children w/ non-citizen parents have less MA than citizen children w/ citizen parents

• All legal immigrant children in U.S. before 8/22/96 =ok

• Children entering U.S. after 8/22/96 face same barriers as adults.

• NOTE: Sponsor is not responsible for benefits used by citizen children of sponsored immigrants.

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Take the Extended Health Coverage Fight to the Ohio Senate:What Advocates Can Do Now – 4/26/13

All Low-Income Newborns Receive Equal Access to Medicaid• All babies born in the US whose deliveries are

covered by Medicaid may remain eligible for Medicaid for up to a year after their birth.

• Child must remain living with mother.

• At one year, child verifies citizenship.

• This deeming applies to all children whose delivery is paid by Medicaid, regardless of mother’s immigration status

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Take the Extended Health Coverage Fight to the Ohio Senate:What Advocates Can Do Now – 4/26/13

AEMA - Alien Emergency Medical Assistance Ohio Administrative Code 5101:1-41-20, effective 3/15/05

• Special category of Medicaid for people not meeting Medicaid citizenship requirement

• Must be state resident

• Must be financially and categorically eligible for Medicaid

• For non-citizens, regardless of immigration status, including legal residents, undocumented and visa holders (Caution: Visa holders should consult immigration attorney)

• Must have had an “emergency medical condition”

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Take the Extended Health Coverage Fight to the Ohio Senate:What Advocates Can Do Now – 4/26/13

Enrolling for Insurance in the Exchange/Marketplace

• If you don’t have coverage through Medicaid, Medicare or employer sponsored coverage, you go to the new marketplace, the “Exchange”– Tax subsidies are available for people

138-400% FPL ( around 15,000-44,000)– Small businesses purchase through

Exchange – better coverage at lower cost

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Take the Extended Health Coverage Fight to the Ohio Senate:What Advocates Can Do Now – 4/26/13

Federal Poverty Levels for 2013

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Group Size 100% 138% 150% 200% 300% 400%

One $11,490 $15,856 $17,235 $22,980 $34,470 $45,960

Two 15,510 21,404 23,265 31,020 46,530 $62,040

Three 19,530 26,951 29,295 39,060 58,590 $78,120

Four 23,550 32,499 35,325 47,100 70,650 $94,200

Five 27,570 38,047 41,355 55,140 82,710 $110,280

Six 31,590 43,594 47,385 63,180 94,770 $126,360

21Take the Extended Health Coverage Fight to the Ohio Senate:What Advocates Can Do Now – 4/26/13

www.healthcare.gov• Get Ready to Enroll• Enrollment in the Marketplace starts in October 2013.• Whether you’re uninsured, need insurance for your small

business, or just want to explore your choices, the Health Insurance Marketplace can help you find a plan that’s right for you.

• Checklist for individuals & families• Learn 7 things you can do NOW to get ready for

enrollment through the Marketplace in October.• Checklist for small businesses• If you’re a small business owner, you’ll be able to offer

your employees new health plan choices through the Small Business Health Options Program (SHOP).

Take the Extended Health Coverage Fight to the Ohio Senate:What Advocates Can Do Now – 4/26/13

Proponents Escalate the Campaign – What Can you do?

• Letters to Editor• Stories in Media• Participate in our webinar to learn more• Events around state• Set up Community Forum

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Take the Extended Health Coverage Fight to the Ohio Senate:What Advocates Can Do Now – 4/26/13

For more information:

Visit our Medicaid Expansion Center “Like” Ohioans Support MedicaidExpansion on FacebookJoin our email list• Email rdillow@uhcanohio.org to join Ohio

Consumers for Health Coverage’s email list

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http://bit.ly/MECenter