Leni Preston, Chair leni@mdchcr.org 301.530.8153

© 2013 Maryland Women’s Coalition For Health Care Reform Today’s Objectives: Introductions and Overview of Coalition ACA Overview and Key Provisions Maryland Health Care Reform Implementation Update Resources and Handouts “Health Reform Hits Main Street” Video – Kaiser Family Foundation Q&A © 2013 Maryland Women’s Coalition For Health Care Reform

© 2013 Maryland Women’s Coalition For Health Care Reform About the Coalition Nonpartisan alliance of individuals and 90 state-wide organizations working together to ensure that all Marylanders have the health care they need and deserve. National Partners Raising Women’s Voices National Women’s Law Center Open Society Institute - Baltimore [ © 2013 Maryland Women’s Coalition For Health Care Reform

How We Achieve Our Mission Work collaboratively with our members and partners to seek solutions and advance reforms to ensure that every resident of Maryland has access to affordable, comprehensive & high quality health care that is always there. © 2013 Maryland Women’s Coalition For Health Care Reform

How We Achieve Our Mission Educate our members and supporters, elected officials and the public Reach out to all potential allies of reform Engage our members in the reform issues and debates Advocate and take action, as a Coalition and as individuals, to bring quality, affordable health care to every resident in Maryland.  © 2013 Maryland Women’s Coalition For Health Care Reform

Why Health Care Reform Is Important to Women & Families 80% of health care decisions are made by women (Department of Labor). In 2008, 1 in 4 women went without necessary health care services. Only 13% of plans in individual market included comprehensive maternity care. Women have historically been charged more than men for health insurance. © 2013 Maryland Women’s Coalition For Health Care Reform

Why It Matters to Maryland Women 15% (280,000) are uninsured in Maryland 56% are currently employed A majority are under 200% FPL 38.7% are Hispanic/Latino 17.7% are African American 10.4% are Caucasian © 2013 Maryland Women’s Coalition For Health Care Reform

Prevention, Prevention, Prevention Women’s preventive care without co-pays and deductibles Well woman visit Breast feeding support Family planning services, including contraception Screenings for HIV, STI, and domestic violence Mammograms and cervical cancer screenings HPV testing © 2013 Maryland Women’s Coalition For Health Care Reform

Patient Protections: What We Have Gained to Date By 2011: 51,868 young adults can stay on their parents’ health plans 52,234 seniors got help paying for their prescription drugs 1,153,000 individuals gained preventive care coverage without co-pays or deductibles 2,251,000 no longer have to worry about lifetime limits for their care © 2013 Maryland Women’s Coalition For Health Care Reform

The Patient Protection and Affordable Care Act A 3-Legged Stool: Everyone is “in” Medicaid Expansion Qualified Health Plans at Maryland Health Connection Personal responsibility Affordability © 2013 Maryland Women’s Coalition For Health Care Reform

Affordability in the ACA Expand Medicaid program: individuals with incomes up to 138% FPL. Tax-credits to individuals with incomes between 138% & 400% FPL. Tax credits for small businesses. Creates Individual and Small Business Health Options Exchanges. Qualified health plans – 4 “metal” levels © 2013 Maryland Women’s Coalition For Health Care Reform

Individual Responsibility Individuals must obtain health insurance coverage When fully phased in penalty is 2.5 percent of income if coverage is not purchased Exceptions for: Financial hardship, religious objections, incarcerated individuals, undocumented immigrants, those for whom the lowest cost plan is 8 percent of annual income, and those whose income is below the tax filing threshold © 2013 Maryland Women’s Coalition For Health Care Reform

Employer Responsibility Penalties for employers with more than 50 FTEs Employer does not offer coverage and one FTE obtains coverage in the Exchange Employer offers coverage and one FTE obtains coverage in the Exchange No penalties for employers with less than 50 employees For low-wage very small employers there is a new tax credit for providing health insurance to employees - 66,000 eligible in Maryland. © 2013 Maryland Women’s Coalition For Health Care Reform

The Health Benefit Exchange: Maryland Health Connection Exchange will describe each plan in a standard format Monthly cost and co-pays Plan performance on quality measures Plan ratings by quality and price Compare Apples to Apples Can’t decide between a Fuji and a Rome? Get help! Website Telephone hotline Navigators © 2013 Maryland Women’s Coalition For Health Care Reform

Maryland: A National Leader Commitment and Leadership Effective Process: Health Care Reform Coordinating Council; Office of Health Care Reform; & Health Benefit Exchange Board Medicaid Expansion © 2013 Maryland Women’s Coalition For Health Care Reform

Health Care Reform Coordinating Council (HCRCC) Administrative and Legislative Body Create a Roadmap Report as basis for 2011 Legislation State Health Improvement Process Medicaid Expansion Determine Essential Health Benefit Benchmark Plan Determine Financing Mechanism © 2013 Maryland Women’s Coalition For Health Care Reform

Essential Health Benefits (EHB) HHS: States to Select Benchmark Plan with 10 Categories of Services Ambulatory patient services Emergency services Hospitalization Maternity & newborn care Mental health & substance use disorder services Prescription drugs Rehabilitative & habilitative services & devices Laboratory services Preventive & wellness services & chronic disease management Pediatric, including oral & vision care © 2013 Maryland Women’s Coalition For Health Care Reform

Medicaid Expansion: Up to 138% FPL Approximately 101,000 new enrollees in 2014 Benefit package remains the same Simplified enrollment process “No Wrong Door” © 2013 Maryland Women’s Coalition For Health Care Reform

© 2013 Maryland Women’s Coalition For Health Care Reform SHOP – What is It? Marketplace where small employers & nonprofits (under 50 employees) can purchase insurance. Tax credit available through 2016 © 2013 Maryland Women’s Coalition For Health Care Reform

Health Benefit Exchange Timeline Landmark ACA Legislation signed into Law 3/23/2010 by President Obama 4/12/2011 Governor O’Malley Signed Health Benefit Exchange Act into Law 6/3/2011 Exchange Board 1st Meeting 9-11/2011 Advisory Committees Met 1/1/2013 Exchange Must be Certified by Federal Government 10/1/2013 Individuals and Groups Begin Enrolling in Exchange 1/1/2014 Maryland Health Benefit Exchange will be Operational Source: A Report to the Governor and Maryland General Assembly Maryland Health Benefit Exchange, December 23, 2011, p. 1 © 2013 Maryland Women’s Coalition For Health Care Reform

© 2013 Maryland Women’s Coalition For Health Care Reform Legislation Maryland Health Benefit Exchange Act of 2011 Maryland Health Benefit Exchange Act of 2012 Maryland Health Progress Act of 2013 SB274/HB228 © 2013 Maryland Women’s Coalition For Health Care Reform

Health Progress Act of 2013: SB274/HB228 Medicaid Expansion MHBE financing MHIP Enrollees State reinsurance program Continuity of Care Final federal certification © 2013 Maryland Women’s Coalition For Health Care Reform

The Next Big Thing: Outreach and Enrollment © 2013 Maryland Women’s Coalition For Health Care Reform

Connector Entities: Who Are They? Navigators Assisters Application Counselors Call Center Captive Producers Producers © 2013 Maryland Women’s Coalition For Health Care Reform

Training and Certification Areas General knowledge of the ACA and Uninsured in Maryland Working knowledge of the new HIX eligibility and enrollment system Cultural Competency and Health Literacy Medical Assistance Programs Advanced Premium Tax Credits Qualified Health Plan Selection © 2013 Maryland Women’s Coalition For Health Care Reform

Maryland’s Implementation: Issues Currently Being Tracked Affordability Continuity of Care – including women (138-250% poverty) who become pregnant Network Adequacy & Essential Community Providers Stand-Alone Dental Plans/Pediatric Dental Coverage © 2013 Maryland Women’s Coalition For Health Care Reform

More Issue Areas To Track Effective Communications, Outreach & Enrollment Performance Measures & Data Collection QHP Quality Ratings Health Disparities © 2013 Maryland Women’s Coalition For Health Care Reform

Stay Informed & Get Involved Join the Coalition Newsletters, Alerts, Member Calls & Webinars 2013 educational forums; April 22nd Webinar: Leveraging Health Care Reform: Cultural Competency and Health Literacy Strategies Facebook and Twitter Encourage others to join Learn more about SHIP and your local health action coalition – www.dhmh.maryland.gov/ship Share your stories MDHealthCareReform.org © 2013 Maryland Women’s Coalition For Health Care Reform

© 2013 Maryland Women’s Coalition For Health Care Reform Resources You Can Use National Partners Raising Women’s Voices (RWV) http://www.raisingwomensvoices.net/ National Women’s Law Center (NWLC) http://www.nwlc.org/ Open Society Institute -Baltimore http://www.opensocietyfoundations.org/about/offices-foundations/open-society-institute-baltimore © 2013 Maryland Women’s Coalition For Health Care Reform

© 2013 Maryland Women’s Coalition For Health Care Reform Resources You Can Use Maryland Health Benefit Exchange http://marylandhbe.com/ Maryland Health Connection http://www.marylandhealthconnection.gov/ Maryland Health Insurance Plan (MHIP) http://getmdhealthcare.com/ Governor’s Office of Health Care Reform http://www.healthreform.maryland.gov/ Federal Department of Health & Human Services www.healthcare.gov © 2013 Maryland Women’s Coalition For Health Care Reform

Kaiser Family Foundation Health Reform Hits Main Street http://healthreform.kff.org/the-animation.aspx © 2013 Maryland Women’s Coalition For Health Care Reform

© 2013 Maryland Women’s Coalition For Health Care Reform Leni Preston, Chair, leni@mdchcr.org Website: www.MDHealthCareReform.org © 2013 Maryland Women’s Coalition For Health Care Reform