1. + Connecting Communities to Coverage: The Affordable Care Act in IL October 1, 2013 Connecting Communities to Coverage: The Affordable Care Act in Illinois

2. About EverThrive Illinois Formally known as Illinois Maternal and Child Health Coalition Our Projects and Initiatives: Health Reform Projects School Health Project Immunization Project Health Disparities Project Premature Birth Project Cooking Matters Project www.ilmaternal.org @EverThriveIL #NASWIL Kathy Waligora, M.S.W Manager, Health Reform Initiatives kwaligora@ilmaternal.org

3. Learning Objectives Understand the basic provisions of the law likely to impact clients Get an introduction to the new enrollment systems, including the Marketplace. Understand the role of social workers in connecting communities to coverage Gain access to tools and resources which will help you to connect with other enrollment specialists and stakeholders

4. ACA 101 The Affordable Care Act puts in place comprehensive reforms that: Ensure that all insurance is high quality, Protect consumers from insurance industry practices which limited access to coverage for many, and Improve access to affordable health coverage. If you are already insured, the only changes you will see are new benefits, better consumer protections, and more value for every dollar you spend on care. If you like your plan you can keep it and don’t need to do anything differently. If you are uninsured, new pathways to coverage will make it easier than ever to get covered and stay covered. Financial assistance will be available to guarantee you can pay for coverage and health care.

5. Key Components Extended dependent coverage to age 26 No pre-existing condition exclusion for children Preventive services without cost sharing CountyCare-the early expansion of Medicaid in Cook County No lifetime limits on care Small business tax credits No insurance rescissions except in cases of fraud/intentional misrepresentation New Marketplace to buy insurance and receive financial help to pay for it New Medicaid Adult Group available to adults under 138% FPL Financial Assistance to purchase private insurance Medicaid available to former foster children up to age 26 at any income level No pre-existing condition exclusion for adults All plans must cover Essential Health Benefits No annual limits on care No gender rating Closing Medicare Part D donut hole Individual and Employer Responsibility Available Now…2014 and Beyond… Connecting Communities to Coverage 2013 5

6. Essential Health Benefits

7. Individual Responsibility The individual mandate requires most Americans to purchase health insurance starting January 1, 2014 or pay the shared responsibility payment if they do not comply People are exempt from the shared responsibility payment if: They would have to spend more than 8% of household income on the cheapest qualifying health insurance plan even after tax credits and subsidies Their income falls below the threshold for filing federal income tax They are undocumented or not a lawfully permanent resident People already meet this requirement if: They have insurance through an employer or purchase individual insurance. They have insurance through Medicaid, Medicare, CHIP, Veteran’s Administration and/or Tricare for active duty and retire military, Indian Health Services

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9. + Cost & Financial Assistance

10. Cost of Health Insurance There are three factors that can determine an individual’s premium: Age Up to 3x more for older adults Tobacco Use Up to 1.5 times for tobacco users Where you live IL recently released premium rates and they were 25% lower than expected and much lower than other states

11. Limits on Cost Sharing “First-dollar” (no deductible/cost-sharing) coverage on preventive health Limit small group health plan deductibles in 2014 to $2,000 for single, or $4,000 for family (adjusted annually) Limit out-of-pocket amount in 2014 to $6,350 for single and $12,700 for family (adjusted annually) Maximum out-of-pocket limits are reduced further for individuals and families below 250% FPL 11

12. Financial Assistance Helps you pay the monthly cost to have a plan Premium Tax Credits Decrease the charges (e.g., copays, deductibles) you must pay when receiving health care services covered by the plan Cost- Sharing Reductions

13. Premium Tax Credit Take It Now! (Advanced)Taking It Later! (Tax Time) October 2013 – March 2014 Enroll in health plan on Marketplace Choose to take all your credit in advance – or just part of it Enroll in health plan on Marketplace During 2014 Pay a lower premium each month in 2014 – and now you are covered Pay full premium each month in 2014 – and now you are covered January 2015 – April 2015 Get a statement from Marketplace showing how much credit you received in 2014 File your 2014 taxes, including information about tax credit already taken File your 2014 taxes Either subtract the amount of tax credit from the taxes you owe – or if you don’t owe anything IRS may give you a refund

15. IL Submitted Rates (non smoker) Connecting Communities to Coverage 2013 15

16. The REAL cost of Coverage in Illinois Kaiser Family Foundation: kff.org

17. + Access to Coverage

18. Getting Insurance in 2014

19. Medicaid Expansion The ACA expands Medicaid to cover all people under 138% of the federal poverty level Must be US Citizen or Legal Permanent Resident of 5 years or more to qualify Coverage begins January 1, 2014 100% federally funded in the first three years, gradually reduces to 90% by 2020

20. CountyCare: A New Medicaid Program for Cook County Who? Live in Cook County Be 19-64 years old Have income at or below 133% of the Federal Poverty Level ($14,856 individual, $20,123 couple – annually) Be a legal immigrant for five years or more or a US citizen Have a Social Security number or have applied for one Access services at Cook County Health and Hospital System locations and some participating federally qualified health centers It is important to continue enrolling eligible individuals into CountyCare as they can be enrolled and back bill for services BEFORE January 1, 2014

21. Existing Medicaid Programs You might not need to wait until January to enroll in Medicaid: 1.All Kids covers children under a certain income regardless of immigration status 2.FamilyCare covers parents of children under 19 under a certain income 3.Moms and Babies covers pregnant women under a certain income regardless of immigration status 4.Medicaid for the Aged, Blind, and Disabled provides coverage for older adults and disabled people under a certain income Get Connected TODAY 1-800-843-6154 1-800-447-6404 TTY

22. The Marketplace Enroll between Oct 1- March 31 for private insurance; by Dec 15 for coverage beginning Jan 1, 2014 Enroll year round for Medicaid

23. Three ways to get connected: 1. On the web www.GetCoveredIllinois.gov 2. On the phone 1-866-311-1119 3. In Person Work with a Navigator to get support and advice

24. The Marketplace in IL Connecting Communities to Coverage 2013 24

25. Get Covered Illinois Healthcare.gov SHOP Individual Marketplace Assess Medicaid/CHIP Eligibility Application for APTC/CSR Eligibility Determination for APTC/CSR Select and enroll in QHP without APTC/CSR Select and enroll in QHP with APTC/CSR ABE Application available to state office State worker Processes Application Eligibility Determinatio n If denied for Medicaid/CHI P refer to Marketplace If eligible, enroll in Medicaid/CHIP 25 1111111 1111111 1111111 1111111 1111111 11111 If potentially eligible referred to Medicaid/CHIP 1111111 1111111 1111111 1111111 1111111 11111 The Marketplace

26. Open Enrollment Period Enrollment Date/PeriodEffective Coverage Begins Oct. 1 – Dec. 15, 2013Jan. 1, 2014 1 st – 15 th of month (Jan. – March) 1 st of following month 16 th – last day of month (Dec. – March) 1 st of second following month Initial Open Enrollment Ends March 31, 2014 Changes can be made within 30 or 60 days of triggering event (marriage, birth, move) that allows for a change 26 ***Those who are eligible for Medicaid can apply for coverage any day of the year!

27. + Role for Social Workers

28. The Role for Social Workers Educate clients on health insurance Educate clients on the Affordable Care Act Connect uninsured clients to Assisters Become a Certified Enrollment Specialist Connect to larger campaigns to elevate messages or even volunteer to canvass your community, host/participate in phone banks, and support events Connect with other stakeholders across Illinois, using IHM HelpHub

29. Education: Barriers 29 Healthcare system Lack of knowledge/information Financial Attitudes and perceptions Culture Communication Professional Bias Physical and social environment Physical proximity Politics and Policy

30. All insurance plans will have to cover doctor visits, hospitalizations, maternity care, emergency room care, and prescriptions. You might be able to get financial help to pay for a health insurance plan. If you have a pre-existing condition, insurance plans cannot deny you coverage. All insurance plans will have to show the costs and what is covered in simple language with no fine print. Key Messages 30 One of these = top message for 89% of population Source: Enroll America, November 2012

31. Certified Application Counselors Who? Community based organization that wants to help by training your staff to assist people applying for coverage through the Marketplace What? Help people understand, apply, and enroll for health coverage through the Marketplace. Your organization must agree to make sure that designated individuals complete required training, and that they comply with privacy and security laws, and other program standards. How? Complete a brief application and access training at: http://marketplace.cms.gov/help-us/cac.html 31

32. Major Campaigns Get Covered Illinois BeCovered Illinois Enroll America-Get Covered America Many other groups will run campaigns, so there will be no shortage of graphics, materials, resources, or ideas. Connecting Communities to Coverage 2013 32

33. Illinois Health Matters HelpHub An online community where enrollment and outreach stakeholders in Illinois can share their experiences and get access to resources related to the ACA To request an invite, email helphub@illinoishealthmatters.org with the name of your organization, lead agency (if part of IPC or Navigator grant) and /or details of your ACA involvement. helphub@illinoishealthmatters.org

34. Resources Illinois Health Matters http://www.illinoishealthmatters.org EverThrive Illinois ACA http://www.ilmaternal.org/hcr Kaiser Family Foundation http://healthreform.kff.org/ www.GetCoveredIllinois.gov

35. + Questions? Kathy Waligora, M.S.W. Manager Health Reform Initiatives EverThrive Illinois kwaligora@ilmaternal.org 312-491-8161 x29