WHAT DOES HEALTH REFORM MEAN FOR CABRINI CLINIC & FOR OUR PATIENTS? The Patient Protection & Affordable Care Act (ACA)

WHAT DOES HEALTH REFORM MEAN FOR

CABRINI 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 makes FTCA more attractive to

free clinics by extending that coverage to 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?

The Supreme Court ruled that States can “opt out” of

Medicaid ExpansionPolitical target Critical 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

2013 FPL Individual Family of 4100% $11,490 $23,550MI - 35% $ 4,022 $ 8,243133% $15,282 $31,322400% $45,960 $94,200

Timeline for ACA

2010

2012

2011-2014

2014

President Obama signed ACA into law. Implementation is over the next few years.

The Supreme Court ruled that Medicaid Expansion is optional for the states.

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

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

Timeline for ACA cont’d.

2014-2019

2019

Eligible persons will be enrolled in Medicaid and other programs beginning Oct. 1, 2013. 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, approximately 29M persons.

THE SUPREME COURT OF THE USA RULED THAT EXPANSION OF MEDICAID IS OPTIONAL,

STATE BY STATE.GOVERNOR SNYDER RECOMMENDS MEDICAID EXPANSION FOR MICHIGAN, BUT THE STATE LEGISLATURE TOOK IT OUT OF HIS BUDGET.

FREE CLINICS NEED TO ADVOCATE FORMEDICAID EXPANSION

IN MICHIGAN AND OTHER STATES

Medicaid Expansionis Critical!

Even with Medicaid Expansion,who will remain uninsured?

Undocumented immigrantsNaturalized citizens here < 5 yrs.Choose to pay the penalty rather

than acquire insuranceEligible but unenrolledCoverage is not affordableIn between coverage, due to

income changeThose <133% of FPL in states

that opt out of M/A expansionCitizens who cannot pull together

the documentation required to apply

And where will they

find care?

ACA:Implications for Free Clinics

Many uninsured clients of our free clinic may 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 Medicaidfor uninsured. What happened to free clinics in these states?

None closed; in fact volume continued to grow.Free Clinics helped enroll and navigate patients through the changes.Patients moved in and out of coverage as their income changed, e.g. with seasonal jobs. They required a lot of help navigating the system.PCP shortage, especially of PCPs who will accept Medicaid, resulted in some 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?

Will Michigan opt for expansion of Medicaid?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?Are we eligible to be a FQHC, and should we consider

becoming or partnering with a FQHC?What if ACA is not implemented?Other questions?