Affordable Care Act in Illinois Oct 2013 CCU Training John Spears IL Dept of Healthcare & Family Services

The Affordable Care Act (ACA) Principal Goal Everyone Gets Health Coverage (it’s the law) Everyone Can Get the Healthcare Services They Need When They Need Them (preventing poor health) Illinois is a Healthier State (people live better and longer) The Affordable Care Act (ACA) Principal Goal

The Affordable Care Act (ACA) Establishes Health Insurance Marketplace - A place to compare and pick a private health insurance plan with financial help available to help make coverage more affordable. Encourages States to expand Medicaid Encourages States to create better, more convenient systems for signing up - Illinois’ ABE (Application for Benefits Eligibility) The Affordable Care Act (ACA)

If you have Medicare or Medicaid, you are covered! You do not need to do anything. (Nor can you get a better deal by applying.) Existing Coverage

How to Apply ABE or Marketplace Navigators & Assistors Certified Application Counselors Telephone application Paper application In-Person application for Medicaid How to Apply

State or Federal – No Wrong Door Marketplace Eligible Medicaid Eligible State Intake Eligibility System Federal Marketplace State or Federal – No Wrong Door

The Health Insurance Marketplace

Illinois Health Insurance Marketplace How Does It Work? Create an account online: Starting 10/1/2013 enter information about you & your family, including your income, household size, and more. Pick a plan: Next you’ll see all the plans and programs you’re eligible for and can compare them side-by-side. You’ll also see if you get financial help with premiums and out-of-pocket costs. Enroll: Choose a plan that meets your needs and enroll! First open Enrollment is 10/1/13 - 3/31/14. Coverage starts on 1/1/2014 if you enroll by 12/15/2013. Illinois Health Insurance Marketplace How Does It Work?

Illinois Health Insurance Marketplace What Benefits Do You Get? Every Plan must cover: doctor visits emergency services hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services, including oral and vision care. Illinois Health Insurance Marketplace What Benefits Do You Get?

Health Insurance through the Marketplace – Actuarial Value* Bronze 60% Silver – 70% Gold – 80% Platinum – 90% *Average costs paid by plan for an average person. Remainder paid by individual Health Insurance through the Marketplace – Actuarial Value*

Marketplace Subsidies Eligibility is based on Household income, and family size (at end of year) Income between 100% to 400% of the Federal Poverty Level (FPL) Ineligibility for government-sponsored coverage, affordable employer-sponsored insurance, or other minimum essential coverage Family Size 100 – 400% FPL Monthly Income 2 $1,261 - $5,044 3 $1,591 - $6,364 4 $1,921 - $7,684 Marketplace Subsidies

The amount of the Premium Tax Credit depends on actual household income as a percentage of the (FPL) and family size A sliding scale that increases the taxpayer’s own contribution towards the premium cost as household income as a percentage of the FPL increases Advance payments are paid directly to the insurer on your behalf Reconciled at tax time against the actual Premium Tax Credit amount you are eligible for Premium Tax Credits

Medicaid Coverage

Medicaid Eligibility Changes for 2014 New ACA Eligible Adults Adults, age 19-64, not receiving Medicare Individuals under 138% will be eligible in a new Medicaid group ($1,321 per month or about $15,850 annual for 1) Former Foster Care - children under 26 who were on Medicaid when they aged-out of foster care. Medicaid Eligibility Changes for 2014

AABD or ACA Adult? AABD Group ACA Adult Group Any Age Covers Longterm care services Access to Waiver services Asset test Lower income standard Supplements Medicare Spenddown if over 100% FPL Waiver services apply to spenddown Disability test required Age 19-64 Higher income standard No asset test No ability to spenddown AABD or ACA Adult?

Monthly Income Standards Program 1 person 2 in family Family Care $1,321 $1,784 Aged, Blind or Disabled* $958 $1,293 Health Benefits for Workers with Disabilities** $3,351 $4,524 Medicare Savings Program*** $1,292 $1,744 ACA Adults Marketplace Insurance Subsidy $3,832 $5,172 *$2,000 resource test for 1, $3,000 for 2 **$25,0000 resource test, retirement accts exempt ***$7,080 resource test for 1, $10,620 for 2 Monthly Income Standards 11/7/2018

MAJOR CHANGES for LTC Transfer lookback increased to 60 months Expanded role for HFS OIG’s LTC-ADI New hardship waiver process Spousal Impoverishment amounts changed LTC spouses required to cooperate For LTC cases, only medical bills/receipts from the last 6 months for spenddown Home equity limited to $525,000 for LTC cases Must be asset eligible for each backdate month Self-employment resources limited to $6,000 Annuities and loans must make IL the beneficiary LTC Only MAJOR CHANGES for LTC LTC & Community AABD

LTC Penalty Example Applicant transferred: $5,100 6/2007 $3,600 8/2008 $5,800 12/2009 $4,200 10/2011 Client applies 7/1/13 and none of the transfers are considered allowable. - $13,600 (6/2007 transfer over 60 months) / $5400 private pay rate for the facility = 2.518 (2.52) 2 whole months of penalty - July & August plus .52 days in September = 15.6 days Eligible beginning 9/16/13 LTC Penalty Example

Resources Check out these websites: Illinois’ Health Care Reform site www.healthcarereform.illinois.gov Federal Health Care Reform sites www.HealthCare.gov (Health Insurance Marketplace info) Marketplace.cms.gov/help-us/cac.html (to begin federal process of signing up to be a Certified Application Counselor (CAC)) Marketplace.cms.gov/training/get-training.html (to access federal computer based training even if not registering to be a CAC)