Fcom and aca ppt

WHAT DOES HEALTH REFORM MEAN FOR

OUR FREE CLINIC& FOR OUR PATIENTS?

The Patient Protection & Affordable Care Act (ACA)

WHAT IS THE ACA?HOW WILL ACA HELP THE UNINSURED?WHO WILL REMAIN UNINSURED AFTER 2014?HOW WILL ACA AFFECT OUR PATIENTS & OUR

CLINIC?WHAT DO WE NEED TO DO TO PREPARE FOR

ACA?

OUTLINE

ACA:What are some of the Benefits?

Medicaid eligibility will be expanded to childless adults and to 133% of FPL

Above 133% of FPL, low and middle income people and small businesses will get subsidies to make insurance affordable

Children can stay on parents’ plan until 26 years old

No lifetime or annual capsNo denials based on pre-existing

conditionsNo co-pays or deductibles for

preventive care80% of premium must be spent on

enrolleesInsurance companies have to justify

rate increases

Some free clinics receive liability coverage for their volunteer health professionals through the

Federal Tort Claims Act (FTCA).

ACA extends that coverage to free clinic board members, officers, employees,

and individual contractors, but not to the clinic entity itself.

Does ACA helpFree Clinics?

ACA:

What are some of the Barriers?

Supreme Court Challenge to the MandatePolitical target for repealCritical shortage of Primary

Care Providers, especially PCPs who accept Medicaid

The rising cost of health care

January 1, 2014, 30 million (of 53 million) uninsured will be eligible for coverage

Eligibility for Medicaid will increase from 35% of Federal Poverty Level in MI to 133% of FPL across the nation

Childless adults will be eligible

This will help many of the patients we serve.

How will ACA help the Uninsured?

2012 Federal Poverty Levels

2012 FPL Individual Family of 4100% $11,170 $23,050MI - 35% $ 3,910 $ 8,068133% $14,856 $30,656400% $44,680 $92,200

Timeline for ACA

2010

2011-2014

2014

President Obama signed ACA into law. A few changes took effect immediately; others are being implemented over the next few years.

Planning and implementation at federal and state levels. Numbers of uninsured continue to grow.

30 million will become eligible for coverage, either through Medicaid or the exchanges.

Timeline for ACA cont’d.

2014-2019

2019

Those eligible will be enrolled in Medicaid and other programs. The numbers of uninsured will gradually decline.

The newly insured will try to find a medical home, but face a critical shortage of Primary Care Providers, especially PCPs accepting Medicaid.

The number of uninsured will level off to those who are not eligible for coverage through ACA.

Who will remain uninsured?

And where will they find care?

Undocumented immigrantsNaturalized citizens here < 5

yrs.Choose to pay the penalty

rather than acquire insuranceExempt from the mandate and

choose to remain uninsured, e.g., veterans, uninsured <3 mos., exempt from filing federal tax return, Native American, incarcerated, religious conscience reasons.

Citizens without documentation

ACA:Implications for Free Clinics

Many uninsured clients of our free clinic will be eligible for Medicaid

Our clients will need help through the transition

Potential negative impact on our donors and volunteers?

Potential negative impact on our relationship to area hospitals?

We need to re-evaluate our mission and services, and educate our community on the impact of ACA.

VT, WI, and MA received federal waivers to expand Medicaid for uninsured. What happened to free clinics?None closed; in fact volume continued to grow.Free Clinics helped enroll and navigate patients through the changes.PCP shortage, especially of PCPs who will accept Medicaid, resulted in free clinics providing care to Medicaid patients but not billing.Dental Care and Rx Assistance remain huge gaps in service.

What is the experience of free clinics in states where

most of the uninsured received coverage?

What Questions Should We Be Asking?

What will be the impact of the ACA on our clinic?How many of our patients will receive insurance coverage

under ACA? Where will they find care?Who will remain uninsured in our community?Will our clinic be needed post-2019? Whom will we serve?What do we need to do to prepare for ACA changes?What options are open to us for the future?Should we consider becoming or partnering with a FQHC?What if ACA is not implemented?Other questions?