Health Reform and Health Coverage: Changes Ahead for Kids and Families Kim VanPelt St. Luke’s Health Initiatives September 16, 2013

Coverage Expansion Employer-based coverage Medicaid The “Exchange” 2

Medicaid Expansion Over 300,000 Arizonans will benefit Provides coverage up to 138% of the federal poverty level (approximately $32,500 for a family of four) Supported by the Governor, passed by the Legislature Restores the will of the voters Approximately 60 percent of voters support restoration or expansion Eligibility screening begins in October, coverage begins on January 1, 2014

Improvements to Coverage Prevents discrimination in pricing based on pre- existing conditions Essential benefits chosen by Arizona allows for coverage of many services Those who have self-insured or grandfathered plans will not benefit from essential benefits, elimination of cost-sharing

Essential Benefits Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services Prescription drugs; Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services Chronic disease management Pediatric services, including oral and vision care

Essential Benefits Arizona picked state employee plan, administered by United Health Care, as benchmark Resources/Downloads/arizona-ehb- benchmark-plan.pdf

The Marketplace Exchange now called the Marketplace Arizona deferring to the federal government to run Online site for individuals and small businesses to compare and purchase health coverage Intended to simplify and structure health insurance choices for individuals, families and small businesses Exclusive mechanism for receiving federal subsidies and plans with cost-sharing limits

The Marketplace Open enrollment begins October 1 Open enrollment will occur through the end of March 1.3 million Arizonans predicted to eventually receive coverage through the marketplace

The Marketplace Expected Enrollment by Type Individual Exchange: 496,000 AHCCCS (assuming Medicaid expansion): 343,000

Plan Levels of Coverage Level of CoveragePlan Pays on AverageEnrollees Pay on Average (In addition to the monthly plan premiums) Bronze60%40% Silver70%30% Gold80%20% Platinum90%10%

Catastrophic Plans Eligible to adults under 30 years of age Also available to those who obtain a hardship waiver from the marketplace Includes plans with high deductibles, lower premiums Includes coverage or three primary care visits and preventive services

Premium Subsidies Tax credit is advanceable or refundable Eligibility is based on – Projected household income and family size – 100 – 400% FPL ($23,550 -$94,200 for a family of four in 2013) – Obtaining qualified coverage through the marketplace – Ineligible for government-sponsored coverage, affordable- sponsored insurance, or certain other minimum essential coverage Tax credits available to immigrants who are lawfully present

Cost Sharing Reduction Eligibility for reduced cost sharing is based on – Incomes at or below 250% of FPL ($58,875 annually for a family of four in 2013) – Receiving the new premium tax credit – Enrolling in a marketplace silver-level plan – No cost sharing for members of Tribes

Individual Mandate Beginning in 2014, most people must have health coverage or pay a fee when you file your tax return Some people may qualify for an exemption

Cover Arizona Builds off of the successful outreach efforts for the Pre-Existing Conditions Insurance Pool More than 300 members Two goals: – Maximize enrollment of individuals and families in the new insurance marketplace and Medicaid – Identify and assess outreach efforts so that we can build on our successes

Local Action Needed to Ensure Success Awareness Outreach Enrollment Assistance

Navigators Certified Application Counselors Toll Free Hotline Brokers

Special Issues for Kids and Families Members of the same family may qualify for different programs KidsCare II disappears in 2014 Businesses may begin dropping family coverage

Two Doors Health E Arizona Plus Marketplace

Timeline August – Navigator grants awarded August – September – Navigators and certified enrollment assisters trained October – Determination of which plans will participate in the exchange October - Open enrollment in the exchange begins October - Media campaign begins, driving people to Healthcare.gov January 1, 2014 – Coverage purchased through exchanges takes effect

Need more information Marketplace Call Center (Consumers) - 24/7 English and Spanish and 150 Languages , (TTY)