Healthcare Reform Overview May 12, 2010

2 What We’ll Discuss Today  Overview of what the new healthcare system will look like  Review of key addiction related- provisions  Timeline for implementation  Next steps

3 National Healthcare Reform After more than a year of work, missed deadlines, and compromises, the healthcare reform bill was passed and signed into law on March 23, 2010 Some provisions take effect immediately but most will take effect in 2014, with full implementation by 2019 Once fully implemented, CBO estimates that 95 percent of the legal population will have health insurance

4 Key Things to Keep in Mind Preliminary discussion Statute provides framework, lots of remaining questions/ambiguity Scope of services/continuum of care not defined Years of regulations expected Enormous need for education and outreach

5 What does healthcare reform do? Creates health exchanges for individuals and small employers to pool risk and purchase insurance  Requires transparency, mandated benefits and other consumer protections Provides sliding scale subsidies for individuals and families up to 400% FPL to purchase or take up offers of health coverage Prohibits insurers from denying coverage to people with pre-existing conditions, charging higher premiums based on gender or health status, and placing annual or lifetime caps on insurance coverage Requires individuals to carry health insurance or pay a financial penalty

6 What else does healthcare reform do? Expands Medicaid eligibility to all Americans below 133% FPL  Mandates newly-eligible childless adults be enrolled in generally less-comprehensive “benchmark” plan  To finance the expansion, states will receive 100% FFP for , 95% FFP for , and 90% FFP after 2019 for expansion population Allows adult children to remain on their parent’s insurance until their 27 th birthday Creates a national high-risk pool for adults with preexisting conditions to buy into until implementation

7 Key SUD/MH provisions in the new law SUD/MH services included in the basic benefits package required in the exchange All plans in the exchange must adhere to the provisions of the Wellstone/Domenici parity act  The parity act already applies to large group plans that would exist outside the exchange Requires that newly-eligible Medicaid enrollees, including childless adults, receive adequate health coverage that includes SUD/MH coverage

8 Other key SUD/MH provisions in the new law Includes SUD/MH in chronic disease prevention initiatives Includes SUD/MH workforce in health workforce development initiatives Makes SUD prevention, treatment, and MH service providers eligible for community health team grants aimed at supporting medical homes

9 Timeline for implementation Some provisions take effect immediately or in the next several months. Biggest changes take effect on January 1, 2014, with full implementation by 2019.

10 Key provisions that take effect in 2010 Young adults can remain on their parent’s health plan until they turn 27 Preexisting condition exclusions prohibited for children Group or individual market plans are prohibited from rescinding coverage once an enrollee is covered under a plan, except for cases of fraud Prohibition against lifetime benefit caps and “unreasonable” annual limits National high-risk pool for people with preexisting conditions created; includes limited federal subsidies States now have option to extend Medicaid coverage to childless adults up to 133% FPL and receive current FFP Eliminates cost-sharing for preventive care in Medicare and private plans

11 Key provisions that take effect in 2014 All other insurance market reforms, including:  Guaranteed issue and renewability, prohibition of rating based on health status  Elimination of all annual and lifetime limits State insurance exchanges become effective for individuals and small employers with up to 50 or 100 employees. After 2017 states have option to open exchange to large employers. Exchange subsidies for those up to 400% FPL become available Essential benefit requirements become effective

12 More key provisions that take effect in 2014 States are required to extend Medicaid coverage to all up to 133% FPL Individual mandate becomes effective  Individuals that cannot demonstrate that they have qualifying coverage or are exempt will have to pay $95 or 1% of taxable income in 2014, increasing to $695 or 2.5% of taxable income in 2016 Limited employer responsibility requirement implemented Quality improvement provisions take effect

13 Next steps 2014 will be here before we know it. Implementation will be fast and furious. Federal agencies are already beginning to draft regulations Most important regulations related to SUD/MH include:  Benefit design  Continued guidance on parity  Changes within Medicaid  Healthcare delivery system—medical home and other models of care  Workforce  Chronic disease prevention

14 Questions? Gabrielle de la Gueronniere and Dan Belnap Legal Action Center