1. The Affordable Care Act & California August 27, 2013

2. The Affordable Care Act Section I Presented by Carmen Burgos

3. Introduction “ The YouToons Get Ready for Obamacare: Health Insurance Changes Coming Your Way Under the Affordable Care Act" http://www.kff.org/video-download/ Authorization to present granted by Kaiser on 8/1/2013

4. The Affordable Care Act Does not apply to you if you have:  Medicare  Medi-Cal or the Children’s Health Insurance Program (CHIP)  TRICARE (for service members, retirees and their families)  The Veteran’s Health Plan Program  An employer plan  Insurance you bought that is at least at the Bronze level  A grandfathered health plan

5. The Affordable Care Act  On March 23, 2010, Congress passed and the President signed The Affordable Care Act into law.  Requires most U.S. Citizens and Legal Permanent Residents to have health insurance or pay a penalty (exceptions apply)  Creates a “State Based” Exchange where individuals can buy affordable coverage when not covered by employer or eligible for public programs  Requires employers with 50 or more full-time employees to offer coverage  Medi-Cal Expansion to new groups

6. The Affordable Care Act  Tax credits and cost sharing subsidies to individuals  Basic Health Plan Option for States* (In California for incomes between 138% -200% FPL)  Plans offered through the Exchange will be required to meet a minimum set of standards.  Insurers will offer four levels Platinum, Gold, Silver, Bronze plus a catastrophic coverage plan for individuals under 30 years of age.  Gives individuals the opportunity to comparison shop for coverage from a variety of plans through the Exchange/Covered California.

7. The Affordable Care Act con’t  All new plans must offer certain free preventive services  Prohibits insurance companies from rescinding coverage  Insurance companies are prohibited from imposing lifetime dollar limits on essential benefits  Individuals with incomes between 138 - 400% of the FPL who do not have access to affordable insurance through an employer or government program can buy insurance through the Exchange  A cap on out-of-pocket expenses (co-pays, deductibles)-$5,950 for an individual and $11,900 for a family  Insurances cannot charge you more due to your health condition

8. Essential Health Benefits/Minimum Standards  Ambulatory patient services  Emergency services  Hospitalization  Maternity and newborn care  Mental health and substance abuse disorders  Prescription drugs  Rehabilitative and habilitative services and devices  Laboratory services  Preventive and wellness services  Pediatric services including oral and vision

9. Covered California/Market Place

10. Kern County-Health Plans Region 14  Anthem-PPO  Blue Shield-PPO  Health Net-PPO  Kaiser-HMO

11. Comparing Insurance Plans Category% of expenses paid by health Plan % of expenses paid by Individual Platinum90%10% Gold80%20% Silver70%30% Bronze60%40%

12. Tax credits and cost sharing *Based on 2013 income levels You areYou qualify forYour estimated cost to buy health insurance One person making less than $15,856 Medi-CalNo cost One person making $20,000 A tax credit of $2,304 that you can use to pay for your premium and subsidies Your premium cost is $1060 per year or $89 per month Family of 4 making less than $31,810 Medi-CalNo cost Family of 4 making $40,000A tax credit of $4,140 that you can use to pay for premiums and subsidies Your premium cost is $2,028 per year or $169 per month Family of 4 making $80,000A tax credit of $4,740 that you can use to pay for premiums Your premium cost is $7,596 per year or $633 per month

13. Health Reform Exclusions  Health Care reform does not change current eligibility rules or scope of benefits for individuals without immigration status  People who would have to pay more than 8 % of their income for health insurance  People with incomes below the threshold required for filing taxes (in 2013, $10,000 for a single person)  People who qualify for religious objections  American Indians  Those without coverage for less than three months  Incarcerated individuals

14. Immigrant Eligibility & The Affordable Care Act

15. Naturalized Citizens  No difference between U.S. born citizens  Must buy health insurance or pay tax penalty  Verification of citizenship status in the exchange:  Can first be verified via Social Security Administration (SSA) records  If unable to verify via SSA, will go to Department of Homeland Security’s (DHS) records to verify citizenship  Will have opportunity to provide other proof or correct records if unable to be verified electronically

16. Legal Immigrants  “Lawfully present”  Broader group of legal immigrants  Includes green card holders, refugees, asylees, as well as T and U visa holders, and others in process of adjusting their status  No waiting periods for exchanges or tax credits  Federal Medicaid still restricted to narrower group of legal immigrants (“qualified” immigrants) with 5 year waiting period and other barriers  CA provides state funded Medi-Cal to these immigrants and should continue to do so after 2014

17. Legal Immigrants  Immigrants who are “lawfully present” in the U.S. can:  Buy health insurance in the state exchanges  Apply for tax credits for premiums and co- payments  Eligible for Pre Existing Condition Insurance Plans (PCIP)  Eligible for Basic Health Program (BHP)  Are subject to the individual mandate

18. Children of Undocumented Immigrants  U.S. citizen or legal immigrant children of undocumented parents should have the same access to health insurance and health services as other children  Eligible for Medi-Cal  Eligible to buy health insurance and get tax credits in the exchange via “child only plans”  Can seek health care services anywhere, including community health centers or school based clinics

19. Undocumented Immigrants Under the ACA  Cannot buy health insurance in the State Based Exchange  Cannot apply for tax credits for premiums or co-payments Exception: Eligible family members of mixed-status family should be eligible for tax credits  Explicitly excluded from individual mandate to have insurance and related tax penalty Remain ineligible for:  Federal Medicaid, Children’s Health Insurance Program (CHIP) or Medicare

20. Undocumented Immigrants Exceptions:  Eligible for Emergency Medicaid (Restricted Medi- Cal)  Eligible family members of undocumented family can apply for these federal health programs  States like CA can still choose to cover a broader group of immigrants in their state-funded health programs

21. Undocumented Immigrants  Remain eligible for health programs that are available regardless of immigration status (e.g., public health)  Hospitals must still provide emergency care regardless of insurance or immigration status (EMTALA)  Community health centers can continue to provide non- emergency health care regardless of immigration status  Eligible to be covered in group health insurance as dependent  Insurance companies may offer insurance outside the state exchange that are available to undocumented, but may or may not be affordable or comprehensive

22. Important dates to remember  October 1, 2013 open enrollment begins for plans offered through Covered California  January 1, 2014 healthcare coverage begins for plans purchased through Covered California  March 31, 2014 open enrollment closes for plans purchased through Covered California except for life changing events i.e. loss of a job, death of a spouse, birth of a child, * Remember, you must buy your insurance through Covered California to be eligible for premium assistance/tax credits

23. Medicaid Medi-Cal Medi-Cal Expansion Current Provisions (LIHP ) Section II Presented by Yvonne Hernandez

24. Medicaid  Federal Program  Purpose – provide “medically necessary” treatments, services, medicines and devices to certain groups of low – income people Generally  Families  Pregnant women  Physically and mentally disabled individuals  Those suffering with chronic diseases  Seniors  Determines who qualifies for Medi-Cal  For U.S. Citizens and LPR’s except CA

25. Medi-Cal  State Version  Medi-Cal is California's Medicaid Program  Administered by the state Department of Health Care Services (DHCS)  You can learn more about Medi-Cal at www.dhcs.ca.gov www.dhcs.ca.gov

26. Medi-Cal Expansion MAGI Medical Age 19 -65 Childless adults non-disabled Effective January 1, 2014, Medi-Cal eligibility will expand to those who are: non-elderly 133 % FPL, with a 5 % income disregard, resulting in eligibility for individuals in households up to 138 % FPL Foster youth will be covered until age 26

27. Key changes for the expansion population Definition of household size Elimination of the asset test Calculation of income

28. MAGI Modified Gross Adjusted Income  Household income will be calculated using MAGI, based on tax filing units (including anyone claimed as a dependent) using standard IRS guidelines for defining income and household in addition to foreign income and tax exempt income  Undocumented individuals are excluded from the count of household members  All MAGI household income is counted, whether or not the individual is applying for coverage

29. Differences MAGI Income and current Medi-Cal income  The federal income tax code excludes some types of income currently used in calculating Medi-Cal income, therefore the following will not count as income for MAGI households Veterans Benefits Child Support Received Alimony Received Workers’ Compensation Most Social Security Benefits Gifts and Inheritances Paid Alimony Child Care Retirement Savings Some Health Premium Costs Scholarships, grants, awards used for education purposes Lump Sums American Indian / Alaskan Native Income

30. Non - MAGI  Will remain unchanged for the following populations  They will remain subject to the current income and asset test  Undocumented will remain eligible for restricted-scope Medi-Cal Aged Blind Disabled Long Term Care Medically Needy Individuals deemed eligible for Medi-Cal as a result of other programs such as CalWORKs, Adoption Assistance Program, or Foster Care

31. Current Provision (LIHP)  State  Low Income Health Plan (LIHP)  County  Kern Medical Center Health Plan (KMCHP ) Medi-Cal LIHP KMCHP Medi-Cal

32. General Eligibility Requirements Age 19 -64 NOT enrolled or eligible for other State health plans Has income at or below the 133 % FPL ( 1 Single Adult - $ 1,273.50 ) Resident of Kern County for 30 days U.S Citizen or LPR for 5 yrs Supporting Documentation Proof of Kern County Residency Valid Picture Identification Proof of U.S. Citizenship or Legal Residency Social Security card for all applicants Verification of all income in household Record of application/ denial for state benefits / health plan

33. Small Businesses & The Affordable Care Act Section III Presented by Ruben Cortez

34. Small Business  7.2 Million Small Businesses  ½ of the private workforce  Most are very small  80% have less than 10 workers  2 in 5 do not have health coverage

35. Advantages of offering Coverage  Compete  Retain quality workers  18% more than larger business  Double by 2018 to $243 Billion in CA

36. Small business employer & tax credits  Half did not know about the credit  More likely to offer coverage  Purchase insurance through exchange  Most small firms lack HR departments  Save employers’ valuable time

37. Shared Responsibility  Businesses with fewer than 50 workers (There will be no penalty)  96% of all businesses are exempt from any requirement to offer insurance.

38. Covered California/The Exchange  Individual responsibility requirement  Small employers still eligible for Tax Credit up to 35%  Up to 50% next year through Small Business Health Option Program (SHOP)

39. Helpful links  Affordable Health Insurance / Covered California (AKA The Exchange): 1-888-975-1142  http://www.coveredca.com/http://www.coveredca.com/  Health Insurance Marketplace 1-800-318-2596 (24 hours a day, 7 days a week ) marketplace@healthcare.govmarketplace@healthcare.gov  Low Income Health Plan http://www.dhcs.ca.gov/provgovpart/Pages/lihp.aspx http://www.dhcs.ca.gov/provgovpart/Pages/lihp.aspx  Kern Medical Center Health Plan http://www.kernmedicalcenter.com/ http://www.kernmedicalcenter.com/  Businesses www.healthlawguideforbusiness.org  Small Business Health Insurance Options Program (SHOP) Monday through Friday hours 9am-5pm Eastern time-1-800-706-7893

40. Contact information: Kern Health Consumer Center a Unit of Greater Bakersfield Legal Assistance, Inc. 615 California Avenue Bakersfield, CA 93304 Office: (661)321-3982 Fax: (661)325-4482 Section ICarmen Burgos/Project Manager cburgos@gbla.org (661)321-3980 Section IIYvonne Hernandez/Case Manager yvonnehernandez@gbla.org (661)326-4785 Section IIIRuben Cortez/Case Manager rcortez@gbla.org (661)321-3982