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

2. 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

3. 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)

4. 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

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

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

7. The Health Insurance Marketplace

8. Illinois Health Insurance Marketplace How Does It Work?
Create an account online: Starting 10/1/ 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?

9. 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?

10. 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*

11. 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

12. 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

15. Medicaid Coverage

16. 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

17. 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?

18. 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

25. 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

26. LTC Penalty Example Applicant transferred:
$5, /2007
$3, /2008
$5, /2009
$4, /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
= (2.52)
2 whole months of penalty - July & August
plus .52 days in September = 15.6 days
Eligible beginning 9/16/13
LTC Penalty Example

27. Resources Check out these websites:
Illinois’ Health Care Reform site
Federal Health Care Reform sites (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)