1. SPECIAL NEEDS WORK GROUP JULY 18, 2013 The Affordable Care Act: An Update

2. What does the ACA do? GOOD News!!! People will be able to get insurance!! (It may be a little complicated – it may be confusing at first) 2

3. What does the ACA do? GOOD News!!! People will be able to get insurance!! 3

4. What does the ACA do? GOOD News!!! Real insurance that provides real coverage 10 Essential benefit areas Affordable – to fit your budget  premium and cost-sharing subsidies Choice of plans – Simple language, no fine print You can get help signing up 4

5. The Work Ahead GOOD News!!! Most Important Information to share  Web site – www.healthcare.gov  Telephone number  Local Help 5

6. The Work Ahead Not as GOOD News!!! People don’t know this is coming. According to a survey by Enroll America: 78% of uninsured adults don’t know about these changes. 72% of people eligible for the affordability programs don’t know 6

7. What Does This Mean for CYSHCN? Changes in Medicaid Access to insurance for other family members Help in applying and renewing 7

8. Changes in Medicaid PH-95 (children with disabilities) category stays as it is  This is a disability category and is not affected by the other changes in Medicaid  PHLP has not heard of any new plans to impose co-pays Be aware of the changes to non-disability Medicaid  May be incorrectly applied May make it easier for other family members to obtain coverage 8

9. Changes in Medicaid - Household Uses tax-filing standards  Self plus dependents  If someone else claims a dependent, that person doesn’t count in the household  Biggest impact will be on complex households where a child lives with a non-parent, with one parent but is claimed by the other, etc. 9

10. Changes in Medicaid - Renewal Renewal of coverage – once a year  Based on electronic data sources as the primary means  Agency will send a pre-populated form with available information to the head of household. If no corrections, will automatically renew coverage  Eliminates six-month reporting, unless client reports substantial change in circumstances (income, household, residence, etc.) 10

11. Changes in Medicaid - Applying No wrong door  Eligibility for tax credits and subsidies is based on ineligibility for Medicaid or CHIP  Marketplace must screen for Medicaid and CHIP  If not eligible for Medicaid or CHIP, DPW or PID must send application to the Marketplace Electronic records as primary source of information  Search federal and state databases for income and citizenship info  Not ask client for paper proof as a first step 11

12. Changes in Medicaid - Applying Single streamlined application  Apply online, over the phone, in-person, by mail  Paper application is fixed but online is dynamic, asking only the necessary questions  Asks the questions for Medicaid, CHIP and the tax credits and subsidies  Does not require submission of verification documents at point of application  Can provide real time eligibility determination for Marketplace products 12

13. Changes in Medicaid - Applying Help in applying and renewing  Web site for the Marketplace www.healthcare.gov  Phone number for the Marketplace 800-318-2596 (with language access) TTY 855-889-4325  Materials in English, Spanish, Chinese, French Creole, Korean, Polish, Portuguese, Vietnamese 13

14. Changes in Medicaid - Applying Help in applying and renewing  Navigators  Paid, trained, and certified by the federal government  Responsible for public education, outreach and application and renewal assistance  Have to be culturally and linguistically competent and accessible for people with disabilities  Certified Application Counselors  No federal funding  Can do some or all of Navigator activities  Will be trained and certified by the federal government 14

15. Similar to Medicaid  Same, single streamlined application  Same web site and phone number  Uses MAGI income and household size  Electronic data sources  Provides Essential Health Benefits  Renewal once a year 15 Insurance through the Marketplace

16. Differences  Income tax credit and subsidies available  Reconciliation at tax time  So if not filing a tax return now, will have to in 2015 for 2014  May owe money back to IRS if subsidy was overpaid  Four levels of cost sharing  Bronze, Silver, Gold and Platinum  Subsidies and tax credits only for silver (80%)  Able to compare and choose from an array of plans  Real-time enrollment 16 Insurance through the Marketplace

17. How You Can Help Most Important Facts to share: 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. 17

18. How You Can Help Most Important Facts to share: 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 18

19. Don’t Forget! Help in applying and renewing  Web site for the Marketplace www.healthcare.gov  Phone number for the Marketplace 800-318-2596 (with language access) TTY 855-889-4325 19

20. PA Health Law Project Ann Bacharach – 215-625-3596 Helpline – 1-800-274-3258  For advice on applying, enrolling, renewal, obtaining services  For clients who need a lawyer to represent them at hearings and appeals Where to go for help 20