Affordable Care Act:
Implementation in Illinois
Implications for Low Income
Populations and Legal Services
Attorneys
The Affordable Care Act: Quick Review
• Medicaid Expansion to 138% FPL for adults
(CountyCare Early Implementation)
• Marketplace Insurance with Financial Help
including Premium Tax Credits to 400% FPL
and Cost-Sharing Subsidies to 250% FPL
• Insurance Reforms: Guaranteed Issue, Rating,
Pre-existing Conditions
• Individual and Employer Mandates
Recall the uninsured who qualify for the Marketplace
<138% FPL
Insured,
6,228,332
Uninsured
1,528,237
Medicaid
Marketplace w/
Financial help
100% - 400% FPL
Marketplace
>400% FPL
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Important Timelines
• Open Enrollment for Marketplace = October 1,
2013- March 31, 2014
• Purchase insurance on Marketplace by
December 15, 2013 to ensure coverage by
January 1, 2014.
• Enroll in Medicaid anytime but outside of
Cook County, new adult group begins
coverage January 1, 2013.
Who helps navigate the Marketplace?
Illinois Assister Program
Navigators,
In-Person Counselors,
Certified Application Counselors
Registered
Agents &
Brokers
Resource
Center
Individuals
Marketplace
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Where to Begin the Path to Coverage
Illinois Landing
Page
Illinois Health Insurance
Marketplace
If potentially
eligible referred to
Medicaid/CHIP
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Assess Medicaid/CHIP
Eligibility
Application for
APTC/CSR
Eligibility
Determination for
APTC/CSR
Select and enroll in
Quality Health Plan
without APTC/CSR
Select and enroll
in Quality Health
Plan with
APTC/CSR
ABE
Application available to
state office
State worker Processes
Application
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Eligibility
Determination
If denied for
Medicaid/CHIP refer
to Marketplace
If eligible, enroll in
Medicaid/CHIP
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Potentially eligible: for Premium Tax Credit/ Marketplace
Potentially eligible: AllKids
Marketplace
Potentially eligible: Moms and Babies (Pregnant or child
under 1)
Potentially eligible: ACA
Adult Medical or Family
Care
Marketplace
Marketplace
Household
Size
100%*
133%
150%
200%
250%
300%
400%
1
$11,490
$15,282
$17,235
$22,980
$28,725
$34,470
$45,960
2
15,510
20,628
23,265
31,020
38,775
46,530
62,040
3
19,530
25,975
29,295
39,060
48,825
58,590
78,120
4
23,550
31,322
35,325
47,100
58,875
70,650
94,200
5
27,570
36,668
41,355
55,140
68925
82,710
110,280
6
31,590
42,015
47,385
63,180
78,975
94,770
126,360
7
35,610
47,361
53,415
71,220
89,025
106,830
142,440
8
39,630
52,708
59,445
79,260
99,075
118,890
158,520
For each
additional
person, add
$4,020
$5,347
$6,030
$8,040
$10,050
$12,060
$16,080
* lawfully present residents below 100% FPL and ineligible for Medicaid may qualify
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What Benefits Can a Person Apply for
Through ABE?
ABE
www.abe.illinois.gov
Medicaid
Coverage
ACA Adult,
Family
Care,
AllKids,
Moms and
Babies
AABD
Medical,
Medically
Needy
/Spend
down and
HBWD
Cash
Food
Medicare
Savings
Program
TANF
AABD Cash
SNAP
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New Medicaid and Marketplace
Methodology
• For New Adult Group, All Kids and Family
Health Plans: Use Modified Adjusted Gross
Income Test and no asset test.
• For Existing AABD Medicaid: Use existing
Medicaid income methodology with asset
test.
• MAGI combines tax status, household, income
and existing Medicaid rules.
Non-Citizen Eligibility
• Medicaid eligibility remains the same: LPR
over 5 years, refugee/asylee, children,
pregnant women, emergency.
• Marketplace eligibility is more liberal: lawfully
residing may buy at any income level and
receive financial assistance.
Shared Responsibility (the mandate)
Most individuals without insurance will pay a penalty (with
their federal income tax return). Employer Penalty delayed
for one year.
Individuals must maintain Minimum Essential Coverage
(MEC) for themselves and dependents. Taxpayers filing a
joint return are jointly liable for penalties. Medicaid=MEC.
Some individuals will be exempt from the penalty, others
may be eligible for financial help on Marketplace.
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Exemptions from the mandate
Income or
Affordability
• Hardship or domestic circumstances
• Lacks coverage for less than three months (one 3month period per year)
• Household income below threshold for federal taxes
• Contribution for single coverage exceeds 8% of
household income
Membership/
Affiliation
• Religious conscience
• Membership in a health care ministry
• Member of an Indian tribe
Legal or
Residential
• Incarceration
• Not lawfully present in the U.S. or non-resident aliens
• U.S. citizens living abroad for 330+ days in 12-months
• Residents of U.S. territories
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Contact Information and Resources
www.illinoishealthmatters.org
www.healthcare.gov
Stephanie Altman
Health & Disability Advocates
saltman@hdadvocates.org
www.hdadvocates.org
312-265-9070