The Patient Protection and Affordable Care Act Young Adult Outreach and Education

Who Doesn’t Have Insurance?  19.7% of residents in California lack insurance  32.3% of year olds in California lack insurance  15.7% of residents in the U.S. lack insurance  26.9% of year olds in the US lack insurance

Who are Young Invincibles?

 What’s already in place  What’s coming  Health care and undocumented immigrants  Young adult outreach Overview

ACA Provisions Already in Effect that Help Young Adults

 Dependent Coverage  Free Preventive Care  No denial for pre-existing condition for under 19  Student Health Plans  Women’s Health  Domestic Violence Support  Contraception  Community Health Centers What’s Already in Effect

 Under 26 can stay on parent’s plan  Under 19 – no denial for pre- existing conditions  Free Preventive Care – no co-pays on screenings and check-ups Dependent Coverage and Preventive Care

 Previously limited regulations  Now subject to standardized ACA requirements  Must include preventive care benefits  80/20 Ratio Student Health Plans

Women’s Health Benefits  Well-women visits  Support for breastfeeding  Domestic violence screening and counseling  Mammograms and cancer screenings

Domestic Violence Provisions in the ACA  Aug. 2012: New plans must cover screenings and counseling for domestic violence with no cost-sharing  Jan. 2014: No denial of coverage for victims of domestic or sexual assault  Law provides $1.5 billion over 5 years for home visitation models  Funds for youth and teen programs on violence prevention and healthy relationship training

Contraception  As of Aug 2012, new health insurance plans must cover contraception with no co-pay  Religious institutions exempt  Religiously-affiliated institutions get 1 year delay  After Aug. 2013, employees and students get coverage directly from insurance companies

 Currently 8,000 CHCs provide care to 20 million individuals  In June 2012 grants went to 219 CHCs around the country  Increased number of patients served by 1.25 million Growth of Community Health Centers (CHCs)

What Changes Will Come in 2014?

 Medicaid Expansion  Subsidies  Exchanges/Marketplaces  Individual Mandate Changes to Come

California and Medi-Cal Currently may be eligible:  Enrollees of SSI/SSP, CalWorks (AFDC), Refugee Assistance, Foster Care or Adoption Assistance Program  Certain individuals under 21, 65 or older  Blind or disabled individuals  Pregnant women Eligible in 2014:  EVERYONE at or below 133% of FPL

Changes for Americans with Disabilities  Expands and supports the Money Follows the Person program through 2016  Helps states create home and community- based services through improved Medicaid  Improves data collection on health disparities and improved training and culture competency for health care providers  In 2014, no annual limits, no denying coverage for pre-existing conditions

 Those making % of the federal poverty level (FPL) will qualify for subsidies (tax credits) to buy insurance on the exchange  133% of FPL for 1 person is $14,900  400% of FPL for 1 person is $44,000 Subsidies/Tax Credits

How Much of a Subsidy? FPLIncomePremiumTax CreditActual Cost 133%$1,275$283$244$39 250%$2,397$283$90$193 Four tiers of plans – Bronze, Silver, Gold, and Platinum Subsidies are calculated based on Silver plan Individuals can use subsidy for any plan

 Shop for insurance  Each state is different, some will have federally-facilitated exchanges (FFEs)  Subsidies applied directly Ex-cha-cha-cha-Changes

 Catastrophic plans  Young adults (under 30) and those with financial hardship eligible  No Annual Limits in 2014 (already phasing out)  Tax Credit for employers (already started) Other important parts of the ACA Picture Source:

How many young people in California could get health insurance? Source: Census Bureau, CPS 2010

Exchanges in the States Picture Source: Kaiser Family Foundation, Last updated November 14, 2012

 Created in 2010  Five-member board unaffiliated with other interest groups  Minimum requirements for insurance providers to join the exchange  Must offer at least one choice at each of the four levels  Carriers that do not participate in the exchange may not sell catastrophic-only plans. California Health Benefit Exchange

 Individuals must have qualifying health insurance  If not, penalties  $95 the first year  Rises in 2016, ex. $695  Exemptions Individual Mandate and Penalties Picture Source:

Jessica, 23 years old  Part-time student, part-time job  $10,000/year before taxes ~ 87% of poverty  Qualifies for Medi-Cal

Jeff, 22 years old  Part-time student, full-time construction worker  Earns $23,000/year  Takes home: $1,438/month  Total health premium: $283/month  With tax credits he pays: $121/month

 Young adults have high rates of uninsurance  Many provisions in the ACA that help young adults  Dependent Coverage  Student Health Plans  Contraception and Women’s Health  Changes to come  Expanded Medicaid  Subsidies  Exchanges  Individual Mandate Summary: ACA and Young Adults

Health Care for Undocumented Immigrants

Medi-Cal for Undocumented Immigrants  Undocumented immigrants who are not eligible for full scope Medi-Cal can qualify for Emergency Medi-Cal as long as they meet requirements  Services include:  Breast and cervical cancer treatment  Kidney dialysis  Family Planning, access, care and treatment  Child health and disability prevention  Access for infants and mothers

 The ACA does not cover undocumented immigrants  Medi-Cal could expand by 30% in the next few years  The state expects to enroll 1.5 million or more adults in Medi-Cal as 2014 reforms occur  There are concerns over cuts in the reimbursement rates for providers ACA Expansion and Medi-Cal

Outreach and Education for Young Adults in California

 Health Care Outreach  Mobile Technology  Social Media  Challenges  Navigators  Timeline Overview

 Traditional Outreach  Tabling  Group presentations  Hosting events  New Outreach Strategies Health Care Outreach

 Your Healthcare Finder  Find doctors in the area  For Android and iPhoneAndroidiPhone  Mobile Website  Text Message Services  QR Codes  Can be scanned and direct users to your website Mobile Outreach

 Find doctors and Community Health Centers in your area  Search by location with GPS or zip code  Search by name or category  Shows user ratings of doctors in the area Find a Doctor

 Explains how to find health insurance for different people (students, chronic conditions, buying your own plan)  Explains the health care law  Defines common health insurance terms Healthcare FAQ

Fun game for people to play while passing time in the waiting room Waiting Room Game

 Facebook  Create events  Send news updates  Twitter  Connect with new people  Coordinate plans  Retweet  Be fun! Using Social Media Picture Source: Wikimedia Commons

 It’s expensive  ACA offers new options  I’m young and healthy  Injuries can happen to anyone  Make it personal  Why do I need health insurance?  Uninsured drives up health care costs  Individual mandate requires insurance Challenges

 State exchanges – formal “Navigator” program  Funded through State’s Exchange  Aids with outreach and enrollment  States with federal exchanges – Assisters will provide help on outreach Navigators & Assisters

California’s Assisters Program Certified Enrollment Assisters (Navigators)  Compensated by the Exchange  Non-profit organizations, community clinics, County Social Services offices employing Eligibility Workers, and labor unions. Direct Benefit Assistors  Not be paid by the Exchange  Health insurance agents, hospitals, and providers. Recommendations:

 Present – end of 2012:  Educate young adults about ACA  Ensure eligible young adults are on dependent coverage  Jan 2013 – Oct 2013:  Educate young adults about the upcoming Exchanges.  Oct 1 st, 2013 – March 31 st, 2014  Open enrollment for exchanges  Ensure young adults are getting subsidies and Medicaid, if possible Timeline: What to Look For

 ACA is phasing in, some changes already underway  Outreach and education  Traditional outreach  Social media and mobile technology  Big changes in 2013  Like us on Facebook  Follow us on Twitter Key