The New Health Care Law and You
Two thirds of the uninsured live in 13 states
Uninsured by State
67% of uninsured live in 13 states
Number of Uninsured
<230K
230K 600K
600K 1.1M
Source: Census Bureau, Current Population Survey,
March 2011 and 2012
1.1M+
3
One fifth of the uninsured live in the top 13 counties
and half live in the top 114 counties
Uninsured by County
10% of the uninsured live
in just 4 counties (LA,
Harris, Cook, Miami)
20% of the uninsured live
in top 13 counties
(Top 4 + Next 9)
50% live in the top 114
counties (3.8% of total
counties in the US)
4
Need to Inform, Educate and Assist with Enrollment
Six Months Before Open Enrollment Begins, Many Americans Remain Unaware Of, or Confused About the ACA
As far as you know, which comes closest to describing the current status of the health care law?
KFF Health Tracking Poll, April 2013
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Looking at the Model by Zip Code
(Source: Enroll America)
Uninsured by Zip Code
9,000
35%
8,000
30%
7,000
25%
6,000
5,000
20%
4,000
15%
3,000
10%
2,000
5%
1,000
0
0%
Uninsured
Uninsured Rate
The Health Insurance Marketplace
 A new way to get health insurance
•
•
Enrollment starts October 1, 2013
Coverage begins January 2014
 About 25 million Americans will have access to
quality health insurance
• Up to 20 million may qualify for
help to make it more affordable
• Working families can get help
through the Marketplace
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All Qualified Health Plans Will Cover
These Essential Health Benefits
1. Ambulatory patient services 6. Prescription drugs
7. Rehabilitative and
habilitative services and
devices
2. Emergency services
3. Hospitalization
4. Maternity and newborn
care
8. Laboratory services
9. Preventive and wellness
services and chronic disease
management
5. Mental health and
substance use disorder
services, including
10. Pediatric services, including
behavioral health treatment
oral and vision care
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The Law Makes Health Insurance More Affordable
In many cases, you can get preventive services for free:








Cancer screenings such as mammograms & colonoscopies
Vaccinations such as flu, mumps & measles
Blood pressure screening
Cholesterol screening
Tobacco cessation counseling and interventions
Birth control
Depression screening
And more…
Visit www.healthcare.gov/prevention for a full list.
Eligibility and Enrollment
 Marketplace initial open enrollment period starts
October 1, 2013 and ends March 31, 2014
 Marketplace eligibility requires consumers to
• Live in its service area, and
• Be a U.S. citizen or national, or
• Be a non-citizen who is lawfully present in the U.S. for the
entire period for which enrollment is sought
• Not be incarcerated
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Application and Eligibility
Enroll
(Marketplace)
Submit single,
streamlined
application
to the
Marketplace
•
•
•
•
Verify and
determine
eligibility
Eligible for
Marketplace or
Medicaid/CHIP
Screen
Online
Phone
Mail
In Person
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Supported by
Data Services
Hub
The Health Insurance Marketplace 101
(Medicaid/CHIP)
11
Assistance – It’s Available If You Need It
 Help will be available in the Marketplace
• Toll-free call center - 24/7Federal Call Center is up and running
and the number is: 1-800-318-2596.
 150 languages
• Website chat 24/7 (English and Spanish)
• Help in-person
 Navigators
 Other trained enrollment assisters
 Local Community Health Centers, libraries, hospitals and
other locations in local communities
 Agents and brokers
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Help to Pay Qualified Health Plan Costs
 Based on family income and size
• Premium discount


Family of four with annual income
$23,550* – $94,200* or less
And not eligible for certain other insurance
coverage like Medicaid
• Lower cost-sharing (like copays)

Family of 4 with annual income $58,875*
or less (some other restrictions)
*2013 amounts
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13
www.HealthCare.gov
Now - Sign up for
Email and Text Alerts
and Get Ready
Starting October 1, 2013,
you will be able to apply
through this site
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Marketplace.cms.gov
Get the latest
resources to
help people
apply, enroll,
and get
coverage in
2014
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Arizona Provider Website
www.coveraz.org
ACA Requirements for States
Medicaid changes 1/1/14
• Technology changes
• Eligibility determination methods
Provide access to the Federally
Facilitated Marketplace 10/01/13
New Application and Eligibility System
DES’
AHCCCS’
AZTECS
ACE
Health
-eArizona
Health-e-Arizona Plus
Between Arizona and the Federally Facilitated Marketplace,
Consumers Have a Wide Range of
Program Options
Full Range of AHCCCS
Benefits
Other Federal and Local
Programs
• AHCCCS Health
Insurance (Medicaid)
• ALTCS
• Freedom to Work
(FTW)
• Breast and Cervical
Cancer Treatment
Program (BCCTP)
• Medicare Savings
Programs (MSP)
• Nutrition Assistance
(SNAP or Food
Stamps)
• Temporary Assistance
for Needy Families
(TANF)
• Clinic-based Sliding
Fee Scale programs
SFS)
• County-based
Community Assistance
Programs (CAP)
Exchange Programs
• Premium Tax Credit Program
• Cost Sharing Reduction
Program
• Private Insurance, No Subsidy
• Small Business Health
Opportunities Program (SHOP)
for employers of 50
employees or less
Many Programs are Accessed Through
Start
Here
Health-e-Arizona Plus
Health-e-Arizona Plus
SNAP
TANF
Clinic SFS
County
CAP
AHCCCS &
KidsCare
Apply for
SNAP = Supplemental Nutrition Assistance Program (Nutrition Assistance)
TANF = Temporary Assistance for Needy Families (Cash Assistance)
Clinic SFS = Clinic-based Sliding Fee Scale programs
County CAP = County-based Community Assistance Programs (CAP)(Pima and Santa Cruz Counties)
PTC = Premium Tax Credit Program
CSR= Cost Sharing Reduction Program
SHOP = Small Business Health Opportunities Program
FFM
PTC
CSR
Referral to FFM
Private
Insurance
(No
Subsidy)
SHOP
Link to FFM
Applications Started at the FFM
Start
Here
Health-e-Arizona Plus
SNAP
TANF
Clinic SFS
No Access
County
CAP
FFM
AHCCCS &
KidsCare
Assessment
SNAP = Supplemental Nutrition Assistance Program (Nutrition Assistance)
TANF = Temporary Assistance for Needy Families (Cash Assistance)
Clinic SFS = Clinic-based Sliding Fee Scale programs
County CAP = County-based Community Assistance Programs (CAP)(Pima and Santa Cruz Counties)
PTC = Premium Tax Credit Program
CSR= Cost Sharing Reduction Program
SHOP = Small Business Health Opportunities Program
PTC
CSR
Private
Insurance
(No
Subsidy)
Apply for
SHOP
Integration with FFM
Arizona
Federally Facilitated
Marketplace
Arizona Wants to Avoid Consumer Confusion
HEAplus
?
?
?
Federally
Facilitated
Marketplace
Upcoming Milestones
01/01/14
Medicaid changes are
effective
QHP enrollment is
effective
09/01/13
Consumer
Support Line
10/01/13
Health-e-Arizona Plus and
Health Insurance Marketplace
go live
QHP open enrollment begins
What is the MIHS Plan?
 Focus on Micro-targeting
 Collaborate with VISTA and AmeriCorp Volunteers
 Develop Matrix of Leads within Clinics or Areas of the Hospital
 Create and/or Distribute Informational Materials
 Created www@aca.mihs
 Created SharedGroup Folder: ACA
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What is the MIHS Plan?
 Training staff on how to help customers by:
• Identify those who will benefit
• Inform them of the programs (Medicaid Expansion
and Marketplace)
• Educate patient (Family Learning Centers)
• Refer patients (Consumer Assisters, Brokers, Agents and
Navigators)
• Enroll (HEA Plus or FFM)
 Explore scheduling enrollment events
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For More Information
1. Contact your Medical Provider or Case Manager
2. Visit www.healthcare.gov
Visit www.CuidadoDeSalud.gov
3. Health Insurance Marketplace Toll-free Call Center
Available 24/7 1-800-318-2596
TTY: 1-855-889-4325
4. Contact our Family Learning Center Staff at 602-344-1352
5.
E-mail MIHS at aca@mihs.org
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Acknowledgements
This presentation is a compilation of many sources including:
 Center for Medicare and Medicaid Services, The Health
Insurance Marketplace (July 2013)
 Census Bureau, Current Population Survey, (March 2011 and
2012)
 Enroll America
 Kaiser Family Foundation, Tracking Poll (April 2013)
 Arizona Health Care Cost Containment System Administration
(May 2013)
 Arizona Alliance for Community Health Centers (July 2013)
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