Patient Access and the Healthcare Exchange Buddy Holt Eligibility Consultants, Inc. 2013-November.

Slides:



Advertisements
Similar presentations
Health Insurance Exchanges under the Affordable Care Act Deborah Chollet, Ph.D. Senior Fellow.
Advertisements

Nebraska Medicaid and the Impact of the Affordable Care Act on Eligibility Nebraska Association of Health Underwriters February 18,
The Arizona Health Insurance Exchange and Medicaid Expansion Linda Skinner Director Health Care Innovation Infrastructure Management.
Medicaid expansion in sc. today’s talk  Background  Politics of expansion  Impact on People  Impact on Business  Impact on the Economy  Final Thoughts.
Affordable Care Act: Implementation in Illinois Implications for Low Income Populations and Legal Services Attorneys.
What does it mean for our families and communities?
TAX-AIDE Patient Protection and Affordable Care Act (PPACA) Better known as ACA.
Changes under the Healthcare Reform 1. 2 First there were two choices Under the Affordable Care Act every individual must have Minimum Essential Healthcare.
Affordable Care Act & You: What every consumer should know
Changes under the Healthcare Reform 1. 2 First there were two choices Under the Affordable Care Act every individual must have Minimum Essential Health.
SCAODA June 7th, 2013 Governor Walker’s Entitlement Reform & Patient Protection And Affordable Care Act (PPACA) 1.
1 HOBBS STRAUS DEAN & WALKER, LLP WASHINGTON, DC | PORTLAND, OR | OKLAHOMA CITY, OK | SACRAMENTO, CA To Insure or Not to Insure Opportunities for Tribes.
The Health Law: It’s Working! About 10 million more people have insurance this year as a result of the Affordable Care Act The biggest winners from the.
GIOVANNI GOMEZ REGIONAL COORDINATOR OF OUTREACH The Affordable Care Act: Illinois Health Insurance Marketplace.
What do I Need to Know about the Affordable Care Act & The Health Insurance Marketplace?
Understanding The Affordable Care Act (ACA) Time to learn your…
What is the Affordable Care Act? The Patient Protection and Affordable Care Act (PPACA),commonly called the Affordable Care Act (ACA) or Obamacare,is.
Health Insurance Marketplaces Presented by Cobbs Allen © 2013 Zywave, Inc. All rights reserved.
2014 Affordable Care Act Provisions for Individuals, Families, and Small Business Main Line Association for Continuing Education Penn State Great Valley.
Patient Protection and Affordable Care Act (PPACA) Better known as ACA
COPS/Metro Workshop on the Health Insurance Marketplace An Organizing Strategy.
The Affordable Care Act What It Means for You Marcia H. Salkin Managing Director, Legislative Policy NAR Government Affairs.
 You pay a premium into an insurance pool. In the event that you are sick or injured, the insurance policy pays all or part of your medical expenses.
What Does Health Care Reform Mean for You? Presented by Alliance 360° Insurance Solutions © 2013 Zywave, Inc. All rights reserved.
Affordable Care Act and Small Businesses Jon Bailey, Director Rural Research and Analysis Program Center for Rural Affairs.
Oklahoma SoonerCare and the Affordable Care Act: Changes on the Horizon Buffy Heater, MPH Director of Planning & Development October 12,
The Patient Protection and Affordable Care Act Young Adult Outreach and Education.
Introduction to Health Insurance Exchanges. Affordable Care Act (ACA) Insurance Reforms – No lifetime limits, annual limits – Pre-existing conditions.
1. Help your constituents gain the most from the Affordable Care Act Quick refresher course on Covered California: your destination for affordable, quality.
John C. Godsoe, Esq.John J. Cureo Bond, Schoeneck & King, PLLCLawley Benefits Group LLC.
The Artists Health Insurance Resource Center A program of The Actors Fund Center for Emerging.
1 Healthcare Reform and Employee Benefit Trends: What’s the Latest in Both?
TOM TAYLOR NANCY MERRIMAN Oral Health & the ACA. Many Uninsured Patients Will Become Eligible for Affordable Coverage in 2014 Two new opportunities for.
Affordable Care Act (ACA) The Affordable Care Act
Health Reform: What It Means to Our Community. Health Reform: Key Provisions o Provides coverage to 32 million uninsured people by o Changes insurance.
Affordable Care Act Overview Session 1 Presented by Tokie Moriel & John Tvedt 1DHS/DFO/IMTA/
Presented by Deb Polun Director of Government Affairs/Media Relations Community Health Center Association of Connecticut.
A Trail Guide to Health Care Reform Roberta Rifkin, Vice President for Government Affairs.
March /21/2014  The Affordable Care Act establishes a new Health Insurance Marketplace. People who need health insurance can go to the Marketplace,
+ The Affordable Care Act. + Outcomes Participants will: Gain knowledge of the history of the Affordable Care Act; Understand the benefits for children.
Health Insurance Exchanges
1 The Affordable Care Act and Texas Implementation Texas Statewide Independent Living Conference April 5, 2011 Stacey Pogue, Senior Policy Analyst,
Center on Budget and Policy Priorities cbpp.org ACA Health Coverage Enrollment Overview Center on Budget and Policy Priorities September 24, 2013.
THE COMMONWEALTH FUND The Patient Protection and Affordable Care Act: Health Insurance Exchanges Sara R. Collins, Ph.D. Vice President, Affordable Health.
Health Care Reform and its Impact on Michigan Janet Olszewski, Director Michigan Department of Community Health Senate Health Policy Committee May 5, 2010.
HEALTH IN COLORADO GOVERNOR HICKENLOOPER’S VISION.
Health Care Reform: The Top 10 Things You Need to Know.
Spotlight on the Federal Health Care Reform Law. 2. The Health Care and Education Affordability Reconciliation Act of 2010 was signed March 30, 2010.
Medicare, Medicaid, and Health Care Reform Todd Gilmer, PhD Professor of Health Policy and Economics Department of Family and Preventive Medicine 1.
Under the data-hood of the “Patient Protection and Affordable Care Act, 2010” (this presentation based solely on publicly-available data and reports)
Healthcare Reform Overview May 12, What We’ll Discuss Today  Overview of what the new healthcare system will look like  Review of key addiction.
Health Care Reform: How Will it Change the Delivery System? SOUTH CAROLINA HOSPITAL ASSOCIATION 4/1/2010.
Commonwealth of Massachusetts Executive Office of Health and Human Services Implementing the Affordable Care Act in Massachusetts 2013 Legislative Package.
Session 3: Insurance Bonus. What we will cover An explanation of the Healthcare Reform Bill. How you will know if you will have to provide insurance to.
Montana Medicaid & Expansion 101. What is Medicaid ? Federal and State program that pays medical costs for people with limited income and assets. 2.
"Immigrants & the Safety Net: Challenges from Health Care Reform” California Program on Access to Care Presented by: Monica Blanco-Etheridge Latino Coalition.
Reporting Health Insurance Coverage for Individuals and Families: Individual Shared Responsibility Provision & Premium Tax Credit Ley Mills, Stakeholder.
The Patient Protection and Affordable Care Act. The Affordable Care Act Signed into law on March 23, 2010 Implemented incrementally You can keep your.
UNDERSTANDING THE AFFORDABLE CARE ACT & HOW IT CHANGED HEALTHCARE.
Affordable Care Act Red group Luke, Trevor, Noah, Sarah.
Health Reform: An Overview Unit 4 Seminar. The Decision The opinions spanned 193 pages, upholding the individual insurance mandate while reflecting a.
Reporting Health Insurance Coverage for Individuals and Families: Individual Shared Responsibility Provision & Premium Tax Credit Jerrie Muir, Tax Consultant.
THE AFFORDABLE CARE ACT: WHAT’S NEXT? Presented by: Michael O’Connor, RHU.
The Individual Mandate Presented by Cobbs Allen © 2013 Zywave, Inc. All rights reserved.
WHAT EVERY FAMILY LAW PRACTITIONER SHOULD KNOW THE AFFORDABLE CARE ACT 1.
Chapter 5 Healthcare Reform. Objectives After studying this chapter the student should be able to: Describe the expansion of healthcare insurance under.
An Overview Name Certified Navigator Phone Number
HEALTH CARE POLICY.
Health Coverage Enrollment in Michigan
Health Care Reform: What It Means for You Jewish Family Service Austin Alamo Breast Cancer Foundation December 16, 2010 Stacey Pogue, Senior Policy.
Presentation transcript:

Patient Access and the Healthcare Exchange Buddy Holt Eligibility Consultants, Inc November

What is Medicaid? Government run health coverage program for low-income individuals and families since 1965 It is jointly administered and funded by the federal government and the states The federal government sets basic guidelines, and the states have broad authority to modify their Medicaid programs respective to the needs of their state

Who is Eligible? A person has to satisfy two tests: 1) Belong to a "categorically" eligible group (generally: children, pregnant women, blind or disabled persons, and the elderly) 2)Meet the financial test set by the state for that group The federal government mandates eligibility levels for children and pregnant women be at least percent Eligibility levels for parents can be much lower States are not required to cover adults without dependent children

The Current Medicaid Eligibility Levels

Key Provisions of the ACA Maintains an employer based system with employer requirements Maintains a private insurance market Enacts an “Individual Mandate” requiring most people to have insurance Allows coverage for young adults on their parent’s policy Enacts health insurance reforms (i.e. No preexisting condition exclusions) Requires creation of health insurance exchanges Expands Medicaid significantly (138% FPIL)

Medicaid Expansion Eligibility based on Modified Adjusted Gross Income (MAGI) New categories of Medicaid eligibles: Single, childless adults, not disabled Parents Former foster children (aged out up to 26) All “newly eligible” adults will receive a benefit package or benchmark-equivalent that meets the minimum essential health benefits available in the Exchange.

What does this look like pragmatically? Jan to Mar 2013, ECI screened 16,427 individuals Under the current rules 5384 of these were sponsorship eligible Applying the new rules of the Affordable Care Act to this same population would have resulted in 13,162 being potentially eligible for Medicaid Under the new rules the remaining portion of these individuals, unless claiming an exemption, would be mandated to obtain coverage through an employer or an exchange or pay an additional tax (a.k.a. penalty)

The Reimbursement Shift Avg Discharge Bal. $10, Avg Paid to Hospital $ 2, Avg Discharge Bal. $ 2, Avg Paid to Hospital $

The undetermined future of CHIP Extends the current CHIP authorization through 9/30/2015 CHIP-eligible children, who cannot enroll in CHIP due to federal allotment caps, will be deemed ineligible and will then be eligible for tax credits in the exchange. ACA provides that after FY2015 states may enroll targeted low- income children in qualified health plans via the exchanges Much of what will happen with CHIP still remains to be determined by the consensus which must be reached between the state and the federal HHSC

Changes in funding Increase Medicaid payments for primary care to 100% of the Medicare rates for 2013 and 2014 with 100% federal funding Reduces Disproportionate Share Hospital (DSH) payments by $14 billion through 2019 “New eligibles” will be covered through federal funds at 100% for new agencies are being created to resolve underfunding and provider participation issues (i.e. CMI)

Expansion and the June 2012 Ruling The Supreme Court upheld the Medicaid expansion of the Affordable Care Act as constitutional It limited the federal government’s ability to penalize states that don’t implement the expansion ACA assumed all states would comply with setting up exchanges and made no provision legally or economically for the 17 states electing not to set up the exchanges Heavy funding from the federal government is being used to entice the state’s cooperation. The next legislative session will significantly shape future Texas Medicaid

Making the ACA Work 47 major changes to the revenue code 2,000 new IRS agents just for the ACA Office The Federal Data Services Hub (Wall Street Journal, 5/15/13) – IRS records for income and employment status – Social Security records for identity – Homeland Security records for citizenship – Justice records for criminal history – HHS records for enrollment in entitlement programs and medical claims data – State Government records for residency

Pathways to Enrollment Navigators: Funded through grants; provide outreach and assistance in addition to help consumers identify tax credits. Certified Application Counselors: Certifies application counselors which educate consumer and assist in the completion of applications for coverage. Champions for change: Educates consumers in general and make referrals to Navigators, CACs and the Healthcare Marketplace Self Application: Via Healthcare.gov, paper application, or call center State Assistance Application:

ACA Exchanges (a.k.a. Healthcare Marketplace) Anyone can shop for insurance through an exchange Plans are offered on 4 tiers: Bronze Plan Silver Plan Gold Plan Platinum Plan Tax subsidies are offered for applicants who fall between 133% to 400% of FPIL Open enrollment began October 1, 2013

Exchanges – Premium Assistance To qualify for premium assistance credit, you must: Not be eligible for employer-sponsored plan Have a household income between 100% and 400% FPIL Not receive Medicare, Medicaid, CHIP, Tricare, or VA benefits Be a citizen of legal permanent resident Be a resident of a state where a state exchange is available Not an dependent on someone else’s tax return Purchase a non-catastrophic plan through the Exchange

Exchanges – Premium Assistance The amount of the tax credit is based on the premium for the cost of the silver plan in the exchange area where the applicant lives. The amount varies with income so that the premium will not exceed a specified percentage of their income (adjusted for family size): FPILIncome RangeApplicable Portion Level 1<133%2.00%-2.00% Level 2133%-150%3.00%-4.00% Level 3150%-200%4.00%-6.30% Level 4200%-250%6.30%-8.05% Level 5250%-300%8.05%-9.50% Level 6300%-400%9.50%-9.50%

What’s a Poor State to Do? Texas has a 133% to 185% FPIL window for potential Marketplace enrollees who can still be on Medicaid All Marketplace eligible Medicaid applicants are being forward to the fed Jan 1, 2014 for outreach. Texas has a designated unit in Austin to receive application referrals through the Healthcare marketplace New training is being made available to State HHSC workers in mid-December along with a new Medicaid application. Texas will be moving to the MAGI calculation method

What’s in the Future? The employer mandate has been pushed to 2015 and given the current problems the potential of pushing the individual mandate is gaining traction The fed has set a goal of 700,000 enrollees to meet their numbers 400,000 have lost insurance so far and a reversal would require at least 6 months with state insurance commissions No provisions for undocumented aliens, prisoners, income exempt (8%), religiously exempt, non-filers, Native Americans, lapsed policies of less than 3 months, or individuals below tax filing threshold. 40% increase in insurance policies Lots of new individual TAXES!!! Decreased levels of hospital and provider reimbursement