1. Take the Extended Health Coverage Fight to the Ohio Senate: What Advocates Can Do Now – 4/26/13 Medicaid Expansion in Ohio How it Impacts Hispanic Communities Nita Carter, Health Equity Director UHCAN Ohio Chair UHCAN Ohio Statewide Health Equity Committee 1

2. Take the Extended Health Coverage Fight to the Ohio Senate: What Advocates Can Do Now – 4/26/13 What I Will Cover Today Mediciad Expansion Status of Medicaid Expansion What this means for Hispanics in Ohio The Exchange and Hispanics in Ohio 2

3. Take the Extended Health Coverage Fight to the Ohio Senate: What Advocates Can Do Now – 4/26/13 What is Medicaid? Federal/State program providing comprehensive health coverage Covers certain groups: kids, pregnant women, parents, totally disabled, and older adults needing long term care 3

4. Take the Extended Health Coverage Fight to the Ohio Senate: What Advocates Can Do Now – 4/26/13 Affordable Care Act (ACA) and Medicaid Expansion Expansion of Medicaid is one way the ACA expands coverage. Under the Medicaid Expansion, ALL adults under age 65 who make under 138% Federal Poverty Level are newly eligible for Medicaid. 4

5. Take the Extended Health Coverage Fight to the Ohio Senate: What Advocates Can Do Now – 4/26/13 People Who Will Be Newly Eligible for Medicaid 5 Over 275,000 Ohioans in the next two years!

6. Take the Extended Health Coverage Fight to the Ohio Senate: What Advocates Can Do Now – 4/26/13 Who Would be Covered? 6 Parents with incomes 91-138% FPL People working in low-wage jobs that don’t offer health insurance – personal care aides, child care workers, food service workers, etc. People suffering from serious mental health and addictions, other serious health issues 26,000 Ohio veterans Retirees under 65 on fixed incomes

7. Take the Extended Health Coverage Fight to the Ohio Senate: What Advocates Can Do Now – 4/26/13 Who Would be Covered? 7 Affordable Care Act expands Medicaid coverage to ANYONE under age 65 with incomes below 138% Federal Poverty Level (FPL)

8. Take the Extended Health Coverage Fight to the Ohio Senate: What Advocates Can Do Now – 4/26/13 Medicaid Expansion is Up in the Air Unprecedented support – Ohio Alliance for Health Transformation – Regional Medicaid Expansion coalitions – Every imaginable stakeholder group But, Ohio General Assembly left it out of state budget 8

9. Take the Extended Health Coverage Fight to the Ohio Senate: What Advocates Can Do Now – 4/26/13 Who Pays for Current Ohio Medicaid? 9 YearOhio’s Cost Federal Government’s Cost 200740.34% 59.66% 200839.21% 60.79% 200927.66% 72.34% 201026.53% 73.47% 201136.31% 63.69% 201235.85% 64.15% 201336.42% 63.58% YearOhio’s Cost Federal Government’s Cost 20140%100% 20150%100% 20160%100% 20175%95% 20186%94% 20197%93% 2020+10%90% Who Pays for Medicaid Expansion?

10. Take the Extended Health Coverage Fight to the Ohio Senate: What Advocates Can Do Now – 4/26/13 Benefits of Medicaid Expansion 10 Boosts Ohio’s economy - And state revenues Creates jobs Promotes healthier Ohioans

11. Take the Extended Health Coverage Fight to the Ohio Senate: What Advocates Can Do Now – 4/26/13 Consequences of Not Expanding Medicaid Over 500,000 Ohioans remain uninsured – no option for people under 100% FPL – Untreated mental illness and addiction Lose federal funds – over $13 billion in 6 years Forego up to 27,000 new jobs 11

12. Take the Extended Health Coverage Fight to the Ohio Senate: What Advocates Can Do Now – 4/26/13 Medicaid for Immigrants - General Rule Citizens are eligible for Medicaid if they meet the eligibility requirements. For non-citizens: –If you arrived in US before 8/22/96 and are lawfully here, you’re eligible for Medicaid (if you meet the other eligibility requirements) –If you arrived in US on or after 8/22/96, most “qualified aliens” are barred from Medicaid, except refugees and asylees 12

13. Take the Extended Health Coverage Fight to the Ohio Senate: What Advocates Can Do Now – 4/26/13 Immigrants Eligible for Medicaid who entered after 8/22/96 Refugees, asylees (after date asylum granted); Deportees; battered spouse & her children; most Cubans, Haitians, others*  Eligible for 7 years from date of entry  After 7 years, must be US citizen or meet work/US veteran or active duty requirement. 13

14. Take the Extended Health Coverage Fight to the Ohio Senate: What Advocates Can Do Now – 4/26/13 Immigrants entering after 8/22/96: special Ohio problem US law bars most immigrants entering US after 8/22/96 from Medicaid for five years unless they meet one of two requirements during the first 5 years 40 work quarters under social security or Veteran or active duty in US armed forces or Become a citizen Ohio bars them forever – unless they meet one of the requirements above Sponsor affidavits of support signed after 12/97 (I-864) create additional barrier. 14

15. Take the Extended Health Coverage Fight to the Ohio Senate: What Advocates Can Do Now – 4/26/13 Immigrants not eligible for Medicaid (except Alien Emergency Medical Assistance) Non-immigrants such as students and foreign visitors Undocumented immigrants Other categories 15

16. Take the Extended Health Coverage Fight to the Ohio Senate: What Advocates Can Do Now – 4/26/13 Immigrant Kids Eligible for Medicaid U.S. born children are U.S. citizens, eligible for MA, regardless of parents’ status But citizen children w/ non-citizen parents have less MA than citizen children w/ citizen parents All legal immigrant children in U.S. before 8/22/96 =ok Children entering U.S. after 8/22/96 face same barriers as adults. NOTE: Sponsor is not responsible for benefits used by citizen children of sponsored immigrants. 16

17. Take the Extended Health Coverage Fight to the Ohio Senate: What Advocates Can Do Now – 4/26/13 All Low-Income Newborns Receive Equal Access to Medicaid All babies born in the US whose deliveries are covered by Medicaid may remain eligible for Medicaid for up to a year after their birth. Child must remain living with mother. At one year, child verifies citizenship. This deeming applies to all children whose delivery is paid by Medicaid, regardless of mother’s immigration status 17

18. Take the Extended Health Coverage Fight to the Ohio Senate: What Advocates Can Do Now – 4/26/13 AEMA - Alien Emergency Medical Assistance Ohio Administrative Code 5101:1-41-20, effective 3/15/05 Special category of Medicaid for people not meeting Medicaid citizenship requirement Must be state resident Must be financially and categorically eligible for Medicaid For non-citizens, regardless of immigration status, including legal residents, undocumented and visa holders (Caution: Visa holders should consult immigration attorney) Must have had an “emergency medical condition” 18

19. Take the Extended Health Coverage Fight to the Ohio Senate: What Advocates Can Do Now – 4/26/13 Enrolling for Insurance in the Exchange/Marketplace If you don’t have coverage through Medicaid, Medicare or employer sponsored coverage, you go to the new marketplace, the “Exchange” – Tax subsidies are available for people 138- 400% FPL ( around 15,000-44,000) – Small businesses purchase through Exchange – better coverage at lower cost 19

20. Take the Extended Health Coverage Fight to the Ohio Senate: What Advocates Can Do Now – 4/26/13 Federal Poverty Levels for 2013 20 Group Size100%138%150%200%300%400% One$11,490$15,856$17,235$22,980$34,470$45,960 Two15,51021,40423,26531,02046,530$62,040 Three19,53026,95129,29539,06058,590$78,120 Four23,55032,49935,32547,10070,650$94,200 Five27,57038,04741,35555,14082,710$110,280 Six31,59043,59447,38563,18094,770$126,360

21. Take the Extended Health Coverage Fight to the Ohio Senate: What Advocates Can Do Now – 4/26/13 www.healthcare.gov Get Ready to Enroll Enrollment in the Marketplace starts in October 2013. Whether you’re uninsured, need insurance for your small business, or just want to explore your choices, the Health Insurance Marketplace can help you find a plan that’s right for you. Checklist for individuals & families Learn 7 things you can do NOW to get ready for enrollment through the Marketplace in October. Checklist for small businesses If you’re a small business owner, you’ll be able to offer your employees new health plan choices through the Small Business Health Options Program (SHOP). 21

22. Take the Extended Health Coverage Fight to the Ohio Senate: What Advocates Can Do Now – 4/26/13 Proponents Escalate the Campaign – What Can you do? Letters to Editor Stories in Media Participate in our webinar to learn more Events around state Set up Community Forum 22

23. Take the Extended Health Coverage Fight to the Ohio Senate: What Advocates Can Do Now – 4/26/13 For more information: Visit our Medicaid Expansion Center “Like” Ohioans Support Medicaid Expansion on Facebook Join our email list Email rdillow@uhcanohio.org to join Ohio Consumers for Health Coverage’s email list 23 http://bit.ly/MECenter