Affordable Care Act
in Illinois
Oct 2013
CCU Training
John Spears
IL Dept of Healthcare & Family Services
The Affordable Care Act (ACA)
Principal Goal
1.
Establishes Health Insurance
Marketplace - A place to compare and pick
a private health insurance plan with financial
help available to help make coverage more
affordable.
2.
Encourages States to expand Medicaid
3.
Encourages States to create better,
more convenient systems for signing
up - Illinois’ ABE (Application for Benefits
Eligibility)
The Affordable Care Act (ACA)
If you have Medicare or
Medicaid, you are covered!
You do not need to do anything.
(Nor can you get a better deal by applying.)
Existing Coverage
ABE or
Marketplace
Navigators & Assistors
Certified Application Counselors
Telephone application
Paper application
In-Person application for
Medicaid
How to Apply
Marketplace
Eligible
Medicaid
Eligible
State Intake
Eligibility
System
Federal
Marketplace
State or Federal – No Wrong Door
The Health Insurance Marketplace
Create an account online: Starting 10/1/2013
enter information about you & your family, including
your income, household size, and more.
 Pick a plan: Next you’ll see all the plans and
programs you’re eligible for and can compare them
side-by-side. You’ll also see if you get financial help
with premiums and out-of-pocket costs.
 Enroll: Choose a plan that meets your needs and
enroll!
First open Enrollment is 10/1/13 - 3/31/14.

Coverage starts on 1/1/2014 if you enroll by 12/15/2013.
Illinois Health Insurance Marketplace
How Does It Work?
Every Plan must cover:
doctor visits
emergency services
hospitalization,
maternity and newborn care,
mental health and substance use disorder
services,
 prescription drugs,
 rehabilitative services and devices,
 laboratory services,
 preventive and wellness services and chronic
disease management, and
 pediatric services, including oral and vision care.

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Illinois Health Insurance Marketplace
What Benefits Do You Get?
 Bronze
60%
 Silver – 70%
 Gold – 80%
 Platinum – 90%
*Average costs paid by plan for an average
person. Remainder paid by individual
Health Insurance through the
Marketplace – Actuarial Value*
Eligibility is based on Household income,
and family size (at end of year)
 Income between 100% to 400% of the
Federal Poverty Level (FPL)
 Ineligibility for government-sponsored
coverage, affordable employer-sponsored
insurance, or other minimum essential
coverage

Family Size
100 – 400% FPL Monthly Income
2
$1,261 - $5,044
3
$1,591 - $6,364
4
$1,921 - $7,684
Marketplace Subsidies




The amount of the Premium Tax Credit depends
on actual household income as a percentage of
the (FPL) and family size
A sliding scale that increases the taxpayer’s
own contribution towards the premium cost as
household income as a percentage of the FPL
increases
Advance payments are paid directly to the
insurer on your behalf
Reconciled at tax time against the actual
Premium Tax Credit amount you are eligible for
Premium Tax Credits
Medicaid Coverage
New ACA Eligible Adults
 Adults,
age 19-64, not receiving Medicare
Individuals under 138% will be eligible in a new
Medicaid group ($1,321 per month or about $15,850 annual for 1)
 Former
Foster Care - children under 26 who were on
Medicaid when they aged-out of foster care.
Medicaid Eligibility Changes for
2014
AABD Group
ACA Adult Group
Any Age
Age 19-64
Covers Longterm care services
Higher income standard
Access to Waiver services
No asset test
Asset test
No ability to spenddown
Lower income standard
Supplements Medicare
Spenddown if over 100% FPL
Waiver services apply to spenddown
Disability test required
AABD or ACA Adult?
Program
1 person
2 in family
Family Care
$1,321
$1,784
Aged, Blind or Disabled*
$958
$1,293
Health Benefits for Workers with
Disabilities**
$3,351
$4,524
Medicare Savings Program***
$1,292
$1,744
ACA Adults
$1,321
$1,784
Marketplace Insurance Subsidy
$3,832
$5,172
*$2,000 resource test for 1, $3,000 for 2
**$25,0000 resource test, retirement accts exempt
***$7,080 resource test for 1, $10,620 for 2
Monthly Income Standards
6/30/2016
18
Transfer lookback increased to 60 months
 Expanded role for HFS OIG’s LTC-ADI
LTC Only
 New hardship waiver process
 Spousal Impoverishment amounts changed
 LTC spouses required to cooperate
 For LTC cases, only medical bills/receipts from
the last 6 months for spenddown
 Home equity limited to $525,000 for LTC cases

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Must be asset eligible for each backdate month
Self-employment resources limited to $6,000
Annuities and loans must make IL the beneficiary
MAJOR CHANGES for LTC
LTC &
Community
AABD 25

Applicant transferred:
◦
◦
◦
◦

$5,100
$3,600
$5,800
$4,200
6/2007
8/2008
12/2009
10/2011
Client applies 7/1/13 and none of the transfers are
considered allowable.
-
$13,600 (6/2007 transfer over 60 months)
/ $5400 private pay rate for the facility
= 2.518 (2.52)
2 whole months of penalty - July & August
plus .52 days in September = 15.6 days
Eligible beginning 9/16/13
LTC Penalty Example
26
Resources
Check out these websites:

Illinois’ Health Care Reform site
www.healthcarereform.illinois.gov

Federal Health Care Reform sites
www.HealthCare.gov (Health Insurance Marketplace
info)

Marketplace.cms.gov/help-us/cac.html (to begin
federal process of signing up to be a Certified
Application Counselor (CAC))

Marketplace.cms.gov/training/get-training.html (to
access federal computer based training even if not
registering to be a CAC)