The Affordable Care Act & California August 27, 2013.

The Affordable Care Act & California

August 27, 2013

The Affordable Care Act

Section IPresented

by Carmen Burgos

Introduction

“ The YouToons Get Ready for Obamacare:

Health Insurance Changes Coming Your Way Under the Affordable Care Act"

http://www.kff.org/video-download/

Authorization to present granted by Kaiser on 8/1/2013

The Affordable Care Act

Does not apply to you if you have: Medicare Medi-Cal or the Children’s Health Insurance Program

(CHIP) TRICARE (for service members, retirees and their

families) The Veteran’s Health Plan Program An employer plan Insurance you bought that is at least at the Bronze level A grandfathered health plan

The Affordable Care Act

On March 23, 2010, Congress passed and the President signed The Affordable Care Act into law.

Requires most U.S. Citizens and Legal Permanent Residents to have health insurance or pay a penalty (exceptions apply)

Creates a “State Based” Exchange where individuals can buy affordable coverage when not covered by employer or eligible for public programs

Requires employers with 50 or more full-time employees to offer coverage

Medi-Cal Expansion to new groups

The Affordable Care Act

Tax credits and cost sharing subsidies to individuals Basic Health Plan Option for States*

(In California for incomes between 138% -200% FPL) Plans offered through the Exchange will be required to meet

a minimum set of standards. Insurers will offer four levels Platinum, Gold, Silver, Bronze

plus a catastrophic coverage plan for individuals under 30 years of age .

Gives individuals the opportunity to comparison shop for coverage from a variety of plans through the Exchange/Covered California.

The Affordable Care Act con’t

All new plans must offer certain free preventive services

Prohibits insurance companies from rescinding coverage 

Insurance companies are prohibited from imposing lifetime dollar limits on essential benefits

Individuals with incomes between 138 - 400% of the FPL who do not have access to affordable insurance through an employer or government program can buy insurance through the Exchange

A cap on out-of-pocket expenses (co-pays, deductibles)-$5,950 for an individual and $11,900 for a family

Insurances cannot charge you more due to your health condition

Essential Health Benefits/Minimum Standards

Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance abuse disorders Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services Pediatric services including oral and vision

Covered California/Market Place

Kern County-Health Plans

Region 14

Anthem-PPO

Blue Shield-PPO

Health Net-PPO

Kaiser-HMO

Comparing Insurance Plans

Category % of expenses paid by health Plan

% of expenses paid by Individual

Platinum 90% 10%

Gold 80% 20%

Silver 70% 30%

Bronze 60% 40%

Tax credits and cost sharing *Based on 2013 income levels

You are You qualify for Your estimated cost to buy health insurance

One person making less than $15,856

Medi-Cal No cost

One person making$20,000

A tax credit of $2,304 that you can use to pay for your premium and subsidies

Your premium cost is $1060 per year or $89 per month

Family of 4 making less than $31,810

Medi-Cal No cost

Family of 4 making $40,000 A tax credit of $4,140 that you can use to pay for premiums and subsidies

Your premium cost is $2,028 per year or $169 per month

Family of 4 making $80,000 A tax credit of $4,740 that you can use to pay for premiums

Your premium cost is $7,596 per year or $633 per month

Health Reform Exclusions

Health Care reform does not change current eligibility rules or scope of benefits for individuals without immigration status

People who would have to pay more than 8 % of their income for health insurance

People with incomes below the threshold required for filing taxes (in 2013, $10,000 for a single person)

People who qualify for religious objections American Indians Those without coverage for less than three months Incarcerated individuals

Immigrant Eligibility&

The Affordable Care Act

Naturalized Citizens No difference between U.S. born citizens Must buy health insurance or pay tax penalty Verification of citizenship status in the exchange: Can first be verified via Social Security Administration

(SSA) records If unable to verify via SSA, will go to Department of

Homeland Security’s (DHS) records to verify citizenship

Will have opportunity to provide other proof or correct records if unable to be verified electronically

Legal Immigrants

“Lawfully present” Broader group of legal immigrants Includes green card holders, refugees, asylees, as well as T

and U visa holders, and others in process of adjusting their status

No waiting periods for exchanges or tax credits Federal Medicaid still restricted to narrower group of legal

immigrants (“qualified” immigrants) with 5 year waiting period and other barriers

CA provides state funded Medi-Cal to these immigrants and should continue to do so after 2014

Legal Immigrants

Immigrants who are “lawfully present” in the U.S. can:

Buy health insurance in the state exchanges Apply for tax credits for premiums and co-

payments Eligible for Pre Existing Condition Insurance Plans

(PCIP) Eligible for Basic Health Program (BHP) Are subject to the individual mandate

Children of Undocumented Immigrants

U.S. citizen or legal immigrant children of undocumented parents should have the same access to health insurance and health services as other children

Eligible for Medi-Cal Eligible to buy health insurance and get tax credits

in the exchange via “child only plans” Can seek health care services anywhere, including

community health centers or school based clinics

Undocumented Immigrants

Under the ACA

Cannot buy health insurance in the State Based Exchange

Cannot apply for tax credits for premiums or co-payments Exception: Eligible family members of mixed-status family should be eligible for tax credits

Explicitly excluded from individual mandate to have insurance and related tax penalty

Remain ineligible for:

Federal Medicaid, Children’s Health Insurance Program (CHIP) or Medicare

Undocumented Immigrants

Exceptions: Eligible for Emergency Medicaid (Restricted Medi-

Cal) Eligible family members of undocumented family

can apply for these federal health programs States like CA can still choose to cover a broader

group of immigrants in their state-funded health programs

Undocumented Immigrants Remain eligible for health programs that are available regardless

of immigration status (e.g., public health)

Hospitals must still provide emergency care regardless of insurance or immigration status (EMTALA)

Community health centers can continue to provide non-emergency health care regardless of immigration status

Eligible to be covered in group health insurance as dependent

Insurance companies may offer insurance outside the state exchange that are available to undocumented, but may or may not be affordable or comprehensive

Important dates to remember October 1, 2013 open enrollment begins for plans offered through

Covered California

January 1, 2014 healthcare coverage begins for plans purchased through Covered California

March 31, 2014 open enrollment closes for plans purchased through Covered California except for life changing events i.e. loss of a job, death of a spouse, birth of a child,

*Remember, you must buy your insurance through Covered California to be

eligible for premium assistance/tax credits

MedicaidMedi-CalMedi-Cal ExpansionCurrent Provisions (LIHP)

Section II

Presented by

Yvonne Hernandez

Medicaid Federal Program

Purpose – provide “medically necessary” treatments, services, medicines and devices to certain groups of low – income people

Generally FamiliesPregnant womenPhysically and mentally disabled individualsThose suffering with chronic diseasesSeniors

Determines who qualifies for Medi-Cal For U.S. Citizens and LPR’s except CA

Medi-Cal State Version

Medi-Cal is California's Medicaid ProgramAdministered by the state Department of

Health Care Services (DHCS)

You can learn more about Medi-Cal at www.dhcs.ca.gov

Medi-Cal ExpansionMAGI Medical

Key changes for the expansion population

MAGIModified Gross Adjusted Income

Household income will be calculated using MAGI, based on tax filing units (including anyone claimed as a dependent) using standard IRS guidelines for defining income and household in addition to foreign income and tax exempt income

Undocumented individuals are excluded from the count of household members

All MAGI household income is counted, whether or not the individual is applying for coverage

Differences MAGI Income and current Medi-Cal income

The federal income tax code excludes some types of income currently used in calculating Medi-Cal income, therefore the following will not count as income for MAGI households

Veterans Benefits

Child Support Received

Alimony Received

Workers’ Compensation

Most Social Security Benefits

Gifts and Inheritances

Paid Alimony

Child Care

Retirement Savings

Some Health Premium Costs

Scholarships, grants, awards used for education purposes

Lump Sums

American Indian / Alaskan Native Income

Non - MAGI Will remain unchanged for the following populations

They will remain subject to the current income and asset test

Undocumented will remain eligible for restricted-scope Medi-Cal

AgedBlindDisabledLong Term CareMedically Needy

Individuals deemed eligible for Medi-Cal as a result of other programs such as CalWORKs, Adoption Assistance Program, or Foster Care

Current Provision (LIHP)

StateLow Income Health Plan (LIHP)

CountyKern Medical Center Health Plan (KMCHP)

Medi-Cal

Small Businesses &

The Affordable Care Act

Section III

Presented by

Ruben Cortez

Small Business

7.2 Million Small Businesses

½ of the private workforce

Most are very small

80% have less than 10 workers

2 in 5 do not have health coverage

Advantages of offering Coverage

Compete

Retain quality workers

18% more than larger business

Double by 2018 to $243 Billion in CA

Small business employer & tax credits

Half did not know about the credit

More likely to offer coverage

Purchase insurance through exchange

Most small firms lack HR departments

Save employers’ valuable time

Shared Responsibility

Businesses with fewer than 50 workers

(There will be no penalty)

96% of all businesses are exempt from any requirement to offer insurance.

Covered California/The Exchange

Individual responsibility requirement

Small employers still eligible for Tax Credit up to 35%

Up to 50% next year through Small Business Health Option Program (SHOP)

Helpful links Affordable Health Insurance / Covered California (AKA The

Exchange): 1-888-975-1142 http://www.coveredca.com/ Health Insurance Marketplace 1-800-318-2596 (24 hours a day, 7

days a week ) [email protected] Low Income Health Plan

http://www.dhcs.ca.gov/provgovpart/Pages/lihp.aspx Kern Medical Center Health Plan

http://www.kernmedicalcenter.com/ Businesses

www.healthlawguideforbusiness.org Small Business Health Insurance Options Program (SHOP) Monday

through Friday hours 9am-5pm Eastern time-1-800-706-7893

Contact information:

Kern Health Consumer Centera Unit of Greater Bakersfield Legal Assistance, Inc.615 California Avenue Bakersfield, CA 93304Office: (661)321-3982 Fax:   (661)325-4482

Section I Carmen Burgos/Project [email protected] (661)321-3980

Section II Yvonne Hernandez/Case [email protected] (661)326-4785

Section III Ruben Cortez/Case [email protected](661)321-3982