Affordable Care Act (ACA) Learning Sessions for Social Sector Leaders & Community Advocates December 5, 2012 Coordinated by Access HealthColumbus Community Advisory Committee Purpose Spread knowledge of federal health care reform in non-profit organizations to improve their ability to serve clients during the implementation of the Accountable Care Act (ACA). Today’s Objectives 1. Provide an update on Health Benefit Exchanges (HBE) 2. Improve knowledge on: • Medicaid Ohio expansion possibilities • ACA cost and affordability for health benefits through the HBE 3. Obtain input on shaping future Learning Sessions
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December: ACA Learning Session on Exchanges, Medicaid, and Affordability
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Affordable Care Act (ACA) Learning Sessions for Social Sector Leaders & Community Advocates
December 5, 2012
Coordinated by Access HealthColumbus Community Advisory Committee
Purpose Spread knowledge of federal health care reform in non-profit organizations to improve their ability to serve clients during the implementation of the Accountable Care Act (ACA). Today’s Objectives 1. Provide an update on Health Benefit Exchanges (HBE) 2. Improve knowledge on:
• Medicaid Ohio expansion possibilities • ACA cost and affordability for health benefits through the HBE
3. Obtain input on shaping future Learning Sessions
Affordable Care Act
Near Universal Insurance Coverage
Guaranteed Issue &
Insurance Mandate
Improvement Programs
(and grants)
Health Benefit
Exchanges
Expansion of Medicaid
Subsidized commercial
insurance for middle-income
families (market based)
11/16/12 – Ohio submitted intent for federal Health Benefit Exchange
Early 2013 – Ohio’s budget process will include the governor’s recommendation on Medicaid expansion for Ohio
June 2013 – State will finalize budget with Medicaid expansion decision
Fall 2013 – People begin to enroll through Health Benefit Exchanges
January 2014 -- • Permanent insurance reforms take effect • Low income subsidies start • Coverage through exchanges becomes
effective • Mandates take effect
o Individual Mandate o Employer Mandate
Health Insurance Exchanges
Exchanges were upheld by the Supreme
Court.
– Each state shall establish a qualified Exchange by
January 1, 2014.
– If a state chooses not to operate an exchange,
the federal government will do so.
– People will begin enrolling through exchanges in
the fall of 2013.
Health Benefit Exchange Options
1. An state built Health Benefit Exchange
2. A federally facilitated Health Benefit Exchange
3. A hybrid/partnership Health Benefit Exchange
- Some features of each
Ohio’s Health Benefit Exchange decision, November 16, 2012
Governor John Kasich sent a letter to the director of Centers for Medicare and Medicaid Services Center for Consumer Information and Insurance Oversight to indicate Ohio’s Health Benefit Exchange decision under the Affordable Care Act.
• “At this point, based on the information we have, states do not have any flexibility to build and manage exchanges in ways that respond to unique needs of their citizens or markets.”
• “Ohio will not operate a federally-mandated exchange but instead will exercise its right under the law to leave that to the federal government;”
• “Ohio will … retain the right to regulate the state’s insurance industry…”
• Ohio will retain the right to determine Medicaid and CHIP eligibility for its citizens
• Ohio reserves right to amend its intentions should HHS announce changes, etc.
Key Exchange Functions in a Federally–facilitated Exchange (FFE) - Objectives
Objectives of the FFE:
Positive consumer experience
Attractive and viable market for insurers
Working quickly and effectively with States
Reducing administrative and operational burdens on all
exchange participants
From: General Guidance on FFEs, issued by Health and Human Services, May
16, 2012
Key Exchange Functions in a Federally–facilitated Exchange (FFE) - Activities
Health and Human Services activities for FFE:
• Developing a unified FFE infrastructure
• Will look to States, consumers, issuers, health care providers, employers, and other local stakeholders to provide input in each state
• Early 2013- Qualified Health Plan Issuer applications will be released
• Summer 2013- Agreements with Qualified Health Plan Issuers will be completed
• October 1, 2013- Open enrollment on exchanges for the 2014 coverage year will begin
From: General Guidance on FFEs, issued by Health and Human Services, May 16, 2012
Medicaid Expansion, Ohio possibilities
On June 28, 2012, the United States Supreme Court issued an opinion upholding the constitutionality of the ACA, with the exception of one provision.
States now can decide not to expand their Medicaid programs without losing all federal Medicaid funding.
Source: Supreme Court Policy Brief, Health Policy Institute of Ohio, July 2012, http://bit.ly/SjDBca
Health Benefit Exchange Navigators – Pending House Bill 613
• Sponsored by Representative Barbara Sears (R-
Sylvania)
• introduced into the Revised Code the manner in which
the State of Ohio will regulate Navigators under the
Affordable Care Act (ACA)
• HB 613 establishes separate certification requirements
for Navigators and Insurance Agents with Ohio
Department of Insurance in charge of both
Health Benefit Exchange Navigators – Pending House Bill 613
• Under HB 613, a Navigator would not be permitted to sell,
solicit or negotiate health insurance.
• The bill would prevent Navigators from enrolling an
individual or employee in a health insurance plan.
• The bill is scheduled for a possible vote in the House
f http://cciio.cms.gov/resources/files/FFE_Guidance_FINAL_VERSION_051612.pdf http://healthreform.kff.org/subsidycalculator.aspx http://uhcanohio.org/content/health-care-reform-0