1. 0 Presented to:Medical Associations and Societies – Group Meeting Presented by: Blake Fulenwider, Deputy Commissioner, DCH June 12, 2013 Affordable Care Act (ACA) Update

2. 1 ACA Update Agenda DCH & The Affordable Care Act (ACA) Medicaid Expansion Health Insurance Exchange

3. 2 DCH & The Affordable Care Act What’s DCH’s Role in all of this? Medicaid Expansion CHIP to Medicaid Transfer Federal Premium Tax Medicaid and CHIP Eligibility Determination Health Insurance Exchange State Health Benefit Plan Other State Entities Involved: Governor’s Office OPB Dept. of Insurance Dept. of Human Services

4. 3 Medicaid Expansion Eliminate categorical eligibility for Low Income Medicaid (LIM) Make eligible and enroll virtually all individuals at or below 138% FPL –In Georgia, primarily childless adults –New eligibility categories match with substantial FFP –Currently eligible but not enrolled match with standard FFP

5. 4 Who is Eligible? Covered Groups Medicaid Federal Poverty Level PeachCare for Kids Federal Poverty Level Infants up to Age 1Up to 185%185% - 235% Children Age 1 to 5Up to 150%150% - 235% Children Age 6 to 19Up to 100%100% - 235% Pregnant WomenUp to 200%No coverage ParentsUp to 42%No coverage Women with Breast and Cervical Cancer Up to 200%No coverage Aged, Blind and DisabledNot based on FPLNo coverage Childless AdultsNo coverage Former Foster Care ChildrenNo income limits, age limit to 26 (w/ACA) Covered to 19

6. 5 5 Who Are Our Members? Expansion

7. 6 Medicaid Expansion Enrollment –Additional 620,000 enrollees in Medicaid in 2014 –Grows to 695,000 enrollees by 2023 Cost –10-year Total Estimate $4.5 Billion in additional state expenditure $40.8 Billion (State + Federal)

8. 7 Medicaid Expansion Decisions By State

9. 8 DCH: Health Insurance Exchange (HIX) Federally-subsidized coverage in a U.S. HHS-approved health plan –that meets Minimum Essential Benefits (MEB) and is certified as a Qualified Health Plan (QHP) able to be offered on the exchange in a state or on the Federally Facilitated Exchange (FFE) Advance Premium Tax Credits (APTC) and Cost Sharing Reductions (CSR) –for families with household income between 138% FPL to 400% FPL. Family expected contribution a percentage of household income, not to exceed 9.5%. Includes Plan Management, Consumer Outreach and Assistance –as well as ‘assisting in enrollment’ into a QHP Major IT infrastructure required

10. 9 Health Insurance Exchange (HIX) Options HHS Providing states with three options State-Based ExchangeFederal-State PartnershipFederally-Facilitated Exchange State establishes and operates its own AHBE and SHOP functions in compliance with federal rules and requirements. A federal exchange by definition, but state assumes responsibility for operation of any or all of these functions: Plan Management Consumer Outreach and Assistance Both HHS operates all AHBE and SHOP functions in a state. State has the option to perform: Reinsurance program Medicaid/CHIP eligibility determination

11. 10 Health Insurance Exchange Decisions By State 18 State-Based; 7 Partnership; 26 Federally-Facilitated Exchanges State-BasedPartnershipFederally-Facilitated California Colorado Connecticut District of Columbia Hawaii Idaho Kentucky Maryland Massachusetts Minnesota Nevada New Mexico New York Oregon Rhode Island Utah Vermont Washington Arkansas Delaware Illinois Iowa Michigan North Carolina West Virginia Alabama Tennessee Alaska Texas Arizona Virginia Florida Wisconsin Georgia Wyoming Indiana Kansas Louisiana Maine Mississippi Missouri Montana Nebraska New Hampshire New Jersey North Dakota Ohio Oklahoma Pennsylvania South Carolina South Dakota Source: Kaiser Family Foundation; statehealthfacts.org; 5/07/2013.

12. 11 Health Insurance Exchange Decisions Map View By State Source: Kaiser Family Foundation; statehealthfacts.org; 1/14/2013

13. 12 AHBE and SHOP AHBE (Individual Exchange) Focus: Individuals Eligible Users: –Resident of state in which exchange is based –Not incarcerated –U.S. Citizen or legal alien Restrictions: To access Premium Tax Credits and Cost-Sharing Subsidies, must be: –Between 138 – 400% FPL –Not offered AHBE-qualified coverage through employer or government program No Cafeteria Plan Pre-Tax Treatment SHOP (Small Business Exchange) Focus: Employers Eligible Users: –Full Time Equivalent Employees of small businesses with 1 to 100 workers Options: –State option to limit to businesses of 1-50 or less until 2016 –State may expand to 100+ as of 2017, with approval of US HHS Subsidies: –Limited 2-year employer tax credit Section 125 “Cafeteria Plan” Pre-Tax Treatment

14. 13 Individual Applies Through FFE (FFE makes Medicaid/CHIP Assessment) DRAFT

15. 14 HIX: A Regulatory Mechanism HHS using state-based exchanges, state partnership and Federally Facilitated Exchanges as regulatory mechanism –Minimum Essential Benefits –Employer and Employee Mandate –Premium Subsidies –Assessment for Medicaid and CHIP –A gatekeeper to health insurers in the marketplace

16. 15 Georgia’s Response Georgia will not expand Medicaid eligibility –Lack of flexibility in management of the program –Uncertainty about cost and budget implications Georgia will utilize the Federally-Facilitated Exchange (FFE) –FFE will manage all exchange functions –DCH will continue to make final determination for Medicaid eligibility

17. 16 Title or Chapter Slide (use as needed; feel free to delete) Thank You