Health Reform and
Health Coverage:
Changes Ahead for Kids and Families
Kim VanPelt
St. Luke’s Health Initiatives
September 16, 2013

Employer-based coverage
Medicaid
The “Exchange”
2

• Over 300,000 Arizonans will benefit
• Provides coverage up to 138% of the federal poverty level
(approximately $32,500 for a family of four)
• Supported by the Governor, passed by the Legislature
• Restores the will of the voters
• Approximately 60 percent of voters support restoration or expansion
• Eligibility screening begins in October, coverage begins on January
1, 2014

• Prevents discrimination in pricing based on preexisting conditions
• Essential benefits chosen by Arizona allows for coverage of many services
• Those who have self-insured or grandfathered plans will not benefit from essential benefits, elimination of cost-sharing

• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services
• Prescription drugs;
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services
• Chronic disease management
• Pediatric services, including oral and vision care

• Arizona picked state employee plan, administered by United Health Care, as benchmark
• www.cms.gov/CCIIO/Resources/Data-
Resources/Downloads/arizona-ehbbenchmark-plan.pdf

• Exchange now called the Marketplace
• Arizona deferring to the federal government to run
• Online site for individuals and small businesses to compare and purchase health coverage
• Intended to simplify and structure health insurance choices for individuals, families and small businesses
• Exclusive mechanism for receiving federal subsidies and plans with cost-sharing limits

• Open enrollment begins October 1
• Open enrollment will occur through the end of
March
• 1.3 million Arizonans predicted to eventually receive coverage through the marketplace

Expected Enrollment by Type
• Individual Exchange:
496,000
• AHCCCS (assuming Medicaid expansion):
343,000

Level of Coverage Plan Pays on Average
Bronze
Silver
Gold
Platinum
60%
70%
80%
90%
Enrollees Pay on Average
(In addition to the monthly plan premiums)
40%
30%
20%
10%

• Eligible to adults under 30 years of age
• Also available to those who obtain a hardship waiver from the marketplace
• Includes plans with high deductibles, lower premiums
• Includes coverage or three primary care visits and preventive services

• Tax credit is advanceable or refundable
• Eligibility is based on
– Projected household income and family size
– 100 – 400% FPL ($23,550 -$94,200 for a family of four in 2013)
– Obtaining qualified coverage through the marketplace
– Ineligible for government-sponsored coverage, affordablesponsored insurance, or certain other minimum essential coverage
• Tax credits available to immigrants who are lawfully present

• Eligibility for reduced cost sharing is based on
– Incomes at or below 250% of FPL ($58,875 annually for a family of four in 2013)
– Receiving the new premium tax credit
– Enrolling in a marketplace silver-level plan
– No cost sharing for members of Tribes

• Beginning in 2014, most people must have health coverage or pay a fee when you file your tax return
• Some people may qualify for an exemption

• Builds off of the successful outreach efforts for the Pre-Existing
Conditions Insurance Pool
• More than 300 members
• Two goals:
– Maximize enrollment of individuals and families in the new insurance marketplace and Medicaid
– Identify and assess outreach efforts so that we can build on our successes

Local Action Needed to Ensure Success
• Awareness
• Outreach
• Enrollment Assistance

• Navigators
• Certified Application Counselors
• Toll Free Hotline
• Brokers

• Members of the same family may qualify for different programs
• KidsCare II disappears in 2014
• Businesses may begin dropping family coverage

• Health E Arizona Plus
• Marketplace

• August – Navigator grants awarded
• August – September – Navigators and certified enrollment assisters trained
• October – Determination of which plans will participate in the exchange
• October - Open enrollment in the exchange begins
• October - Media campaign begins, driving people to Healthcare.gov
• January 1, 2014 – Coverage purchased through exchanges takes effect

• www.healthcare.gov
• Marketplace Call Center (Consumers) - 24/7
English and Spanish and 150 Languages 1-800-318-
2596, 1-855-889-4325 (TTY)
• www.marketplace.cms.gov
• www.coveraz.org