WHAT DOES
HEALTH REFORM MEAN
FOR OUR FREE CLINIC
& FOR OUR PATIENTS?

 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?

ACA:








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 caps
No denials based on pre-existing conditions
No co-pays or deductibles for preventive care
80% of premium must be spent on enrollees
Insurance 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 extends that coverage to free clinic board members, officers, employees, and individual contractors, but not to the clinic entity itself.

ACA:




Supreme Court Challenge to the Mandate
Political target for repeal
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.

2012 FPL Individual Family of 4
100% $11,170 $23,050
MI - 35%
133%
400%
$ 3,910 $ 8,068
$14,856 $30,656
$44,680 $92,200

Timeline for ACA
2010
2011-2014
2014



President Obama signed ACA into law. A few changes took effect immediately; others are being implemented over the next few years.
Planning and implementation at federal and state levels. Numbers of uninsured continue to grow.
30 million will become eligible for coverage, either through Medicaid or the exchanges.

Timeline for
ACA cont’d.
2014-2019
2019



Those eligible will be enrolled in
Medicaid and other programs. 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.






Undocumented immigrants
Naturalized citizens here < 5 yrs.
Choose to pay the penalty rather than acquire insurance
Exempt from the mandate and choose to remain uninsured, e.g., veterans, uninsured <3 mos., exempt from filing federal tax return, Native American, incarcerated, religious conscience reasons.
Citizens without documentation

ACA:





Many uninsured clients of our free clinic will 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.

What is the experience of free clinics in states where most of the uninsured received coverage?
VT, WI, and MA received federal waivers to expand Medicaid for uninsured. What happened to free clinics?



None closed; in fact volume continued to grow.
Free Clinics helped enroll and navigate patients through the changes.
PCP shortage, especially of PCPs who will accept Medicaid, resulted in free clinics providing care to Medicaid patients but not billing.
 Dental Care and Rx Assistance remain huge gaps in service.










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?
Should we consider becoming or partnering with a FQHC?
What if ACA is not implemented?
Other questions?