The Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act

Young Adult Outreach and Education

Who Doesn’t Have Insurance?

19.7% of residents in California lack insurance

32.3% of 18-34 year olds in California lack insurance

15.7% of residents in the U.S. lack insurance

26.9% of 18-34 year olds in the US lack insurance

Who are Young Invincibles?

What’s already in placeWhat’s comingHealth care and

undocumented immigrants

Young adult outreach

Overview

ACA Provisions Already in Effect that Help Young

Adults

Dependent Coverage Free Preventive Care No denial for pre-existing condition for

under 19 Student Health Plans Women’s Health Domestic Violence Support Contraception Community Health Centers

What’s Already in Effect

Under 26 can stay on parent’s plan

Under 19 – no denial for pre-existing conditions

Free Preventive Care – no co-pays on screenings and check-ups

Dependent Coverage and Preventive Care

Previously limited regulations

Now subject to standardized ACA requirements Must include preventive

care benefits 80/20 Ratio

Student Health Plans

Women’s Health Benefits

Well-women visits

Support for breastfeeding

Domestic violence screening and counseling

Mammograms and cancer screenings

Domestic Violence Provisions in the ACA

Aug. 2012: New plans must cover screenings and counseling for domestic violence with no cost-sharing

Jan. 2014: No denial of coverage for victims of domestic or sexual assault

Law provides $1.5 billion over 5 years for home visitation models

Funds for youth and teen programs on violence prevention and healthy relationship training

Contraception

As of Aug 2012, new health insurance plans must cover contraception with no co-pay

Religious institutions exempt

Religiously-affiliated institutions get 1 year delay After Aug. 2013, employees

and students get coverage directly from insurance companies

Currently 8,000 CHCs provide care to 20 million individuals

In June 2012 grants went to 219 CHCs around the country Increased number of patients

served by 1.25 million

Growth of Community Health Centers (CHCs)

What Changes Will Come in 2014?

Medicaid Expansion

Subsidies

Exchanges/Marketplaces

Individual Mandate

Changes to Come

California and Medi-Cal

Currently may be eligible:Enrollees of SSI/SSP, CalWorks (AFDC), Refugee Assistance, Foster Care or Adoption Assistance ProgramCertain individuals under 21, 65 or olderBlind or disabled individualsPregnant womenEligible in 2014:

EVERYONE at or below 133% of FPL

Changes for Americans with Disabilities

Expands and supports the Money Follows the Person program through 2016

Helps states create home and community-based services through improved Medicaid

Improves data collection on health disparities and improved training and culture competency for health care providers

In 2014, no annual limits, no denying coverage for pre-existing conditions

Those making 133-400 % of the federal poverty level (FPL) will qualify for subsidies (tax credits) to buy insurance on the exchange

133% of FPL for 1 person is $14,900

400% of FPL for 1 person is $44,000

Subsidies/Tax Credits

How Much of a Subsidy?

FPL IncomePremiu

mTax

CreditActual Cost

133% $1,275 $283 $244 $39

250% $2,397 $283 $90 $193

• Four tiers of plans – Bronze, Silver, Gold, and Platinum

• Subsidies are calculated based on Silver plan• Individuals can use subsidy for any plan

Shop for insurance

Each state is different, some will have federally-facilitated exchanges (FFEs)

Subsidies applied directly

Ex-cha-cha-cha-Changes

Catastrophic plans Young adults (under 30)

and those with financial hardship eligible

No Annual Limits in 2014 (already phasing out)

Tax Credit for employers (already started)

Other important parts of the ACA

Picture Source: http://wymancenter.org/the-importance-of-bulking-up-the-muscle-of-perseverance/

How many young people in California could get health

insurance?

Source: Census Bureau, CPS 2010

Exchanges in the States

Picture Source: Kaiser Family Foundation, Last updated November 14, 2012

Created in 2010 Five-member board unaffiliated with other interest

groups Minimum requirements for insurance providers to

join the exchange Must offer at least one choice at each of the four

levels Carriers that do not participate in the exchange

may not sell catastrophic-only plans.

California Health Benefit Exchange

Individuals must have qualifying health insurance

If not, penalties $95 the first year Rises in 2016, ex.

$695Exemptions

Individual Mandate and Penalties

Picture Source: http://thepinkleague.com/2012/08/30/so-whats-the-lowdown-the-basics-of-football-part-2/

Jessica, 23 years old

Part-time student, part-time job

$10,000/year before taxes ~ 87% of poverty

Qualifies for Medi-Cal

Jeff, 22 years old

Part-time student, full-time construction worker

Earns $23,000/year Takes home: $1,438/month Total health premium:

$283/month With tax credits he pays:

$121/month

Young adults have high rates of uninsurance Many provisions in the ACA that help young adults

Dependent Coverage Student Health Plans Contraception and Women’s Health

Changes to come Expanded Medicaid Subsidies Exchanges Individual Mandate

Summary: ACA and Young Adults

Health Care for Undocumented

Immigrants

Medi-Cal for Undocumented Immigrants

Undocumented immigrants who are not eligible for full scope Medi-Cal can qualify for Emergency Medi-Cal as long as they meet requirements

Services include: Breast and cervical cancer treatment Kidney dialysis Family Planning, access, care and treatment Child health and disability prevention Access for infants and mothers

The ACA does not cover undocumented immigrants

Medi-Cal could expand by 30% in the next few years

The state expects to enroll 1.5 million or more adults in Medi-Cal as 2014 reforms occur

There are concerns over cuts in the reimbursement rates for providers

ACA Expansion and Medi-Cal

Outreach and Education for

Young Adults in California

Health Care Outreach Mobile Technology Social Media Challenges Navigators Timeline

Overview

Traditional Outreach Tabling Group

presentations Hosting events

New Outreach Strategies

Health Care Outreach

Your Healthcare Finder Find doctors in the area For Android and iPhone

Mobile Website Text Message Services QR Codes

Can be scanned and direct users to your website

Mobile Outreach

Find doctors and Community Health Centers in your area Search by location with

GPS or zip code Search by name or

category Shows user ratings of

doctors in the area

Find a Doctor

Explains how to find health insurance for different people (students, chronic conditions, buying your own plan)

Explains the health care law

Defines common health insurance terms

Healthcare FAQ

Fun game for people to play while passing time in the waiting room

Waiting Room Game

Facebook Create events Send news updates

Twitter Connect with new

people Coordinate plans Retweet Be fun!

Using Social Media

Picture Source: Wikimedia Commons

It’s expensive ACA offers new options

I’m young and healthy Injuries can happen to anyone Make it personal

Why do I need health insurance? Uninsured drives up health

care costs Individual mandate requires

insurance

Challenges

State exchanges – formal “Navigator” program Funded through State’s

Exchange Aids with outreach and

enrollment States with federal

exchanges – Assisters will provide help on outreach

Navigators & Assisters

California’s Assisters Program

Certified Enrollment Assisters (Navigators)

Compensated by the Exchange

Non-profit organizations, community clinics, County Social Services offices employing Eligibility Workers, and labor unions.

Direct Benefit Assistors

Not be paid by the Exchange

Health insurance agents, hospitals, and providers.

Recommendations:

Present – end of 2012: Educate young adults about ACA Ensure eligible young adults are on

dependent coverage Jan 2013 – Oct 2013:

Educate young adults about the upcoming Exchanges.

Oct 1st, 2013 – March 31st, 2014 Open enrollment for exchanges Ensure young adults are getting

subsidies and Medicaid, if possible

Timeline: What to Look For

ACA is phasing in, some changes already underway

Outreach and education Traditional outreach Social media and mobile

technology Big changes in 2013

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Key Takeaways

@YI_Care