+
ACA and Vets & Families
NASW IL Conference
Oct 28 2013
+ ACA 101
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ACA 101
ACA signed into law on March 23, 2010 with
major provisions to start January 1, 2014
“Health Insurance Marketplaces” have been
established and will open October 1, 2013
Individuals are responsible to obtain health
coverage through an employer, directly from
an insurance company or through the
Marketplace
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ACA 101: Key Components
Available Now…
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Extended dependent coverage to
age 26
No pre-existing condition exclusion
for children
Preventive services without cost
sharing
CountyCare-the early expansion of
Medicaid in Cook County
No lifetime limits on care
Small business tax credits
No insurance rescissions except in
cases of fraud/intentional
misrepresentation
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2014 and Beyond…
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New Marketplace to buy insurance and
receive financial help to pay for it
New Medicaid Adult Group available to
adults under 138% FPL
Financial Assistance to purchase private
insurance
Medicaid available to former foster
children up to age 26 at any income level
No pre-existing condition exclusion for
adults
All plans must cover Essential Health
Benefits
No annual limits on care
No gender rating
Closing Medicare Part D donut hole
Individual and Employer Responsibility
ACA 101: Preventive Care
 No
Cost Sharing for certain preventive services, if
provided in-network. However, there may still be
some costs for the doctor’s visit if the visit includes
other services besides the preventive service.
 List
of covered services the same for all plans and
includes immunizations, cancer screenings, access
to birth control, and a range of other services.
 The
full list is available at healthcare.gov/prevention
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ACA 101: Highlights of Preventive Care
26 Covered Preventive Services-- Highlights
Alcohol & Drug Use Assessments
Behavioral Health Assessments
Depression for adolescents
Developmental Screening & Surveillance
Immunizations – birth to age 18
Obesity screening & counseling
Hearing, Vision screenings
STI – screening & counseling
Oral health screening & assessment for birth HIV screening -- adolescents
– 10
Autism screening at 18 & 24 months
Blood Pressure screening for children
www.healthcare.gov for full list and more details
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ACA 101: Essential Health Benefits
All health plans in the Marketplace,
individual & small group, are qualified
health plans (QHP).
Illinois’
Benchmark
Federal VIP for
vision for children
Supplemented by All
Kids for dental for
children
BCBS Blue
Advantage
•
Ambulatory patient services
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Emergency services
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Hospitalization
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Maternity and newborn care
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Mental health and substance use
disorder services
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Prescription drugs
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Rehabilitative and habilitative
services and devices
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Laboratory services
•
Preventive and wellness services
including chronic disease
management
•
Pediatric services including oral
and vision care
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ACA 101: New Pathways to Coverage
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+ Healthcare Coverage Pathways
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for Veterans and their Families
 VA
 Marketplace
Medicaid
 Tricare
and
Important Dates

OCTOBER 1, 2013
- Open Enrollment in the Marketplace/New Medicaid Begins.
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DECEMBER 15, 2013
- Must be enrolled by this date for Marketplace health coverage to
begin by 1/1/14
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JANUARY 1, 2014
- New Medicaid Adult Group Coverage begins. (No backdating before
this date.)
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MARCH 31, 2014
- Open Enrollment for Marketplace ends (Medicaid is always open).
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+ Marketplace in IL
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Marketplace in IL: Overview
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 Web shopping tool for individuals and small business to
purchase private and public health insurance.
 Gives consumers the tools and power to have control over their
insurance decisions
 Apples-to-apples comparison of plans
 Find the right fit!
 www.getcoveredillinois.gov
Marketplace in IL: Eligibility & Application
 The applications for
Medicaid and Financial
Assistance in the Marketplace will ask for
information about:
 Illinois Residency
 Citizenship/immigration status
 Income/Tax filing status
 Dependents and household composition
 Information will
be electronically verified.
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+Eligibility: Income

Modified adjusted gross income (MAGI) guides paths to health
coverage
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Why MAGI?
 It will standardize the calculation of income across all insurance
affordability programs
 It is used both by the Marketplace and Medicaid to determine
eligibility.
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Income is compared to program limits to determine source of health
coverage
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MAGI is an income counting methodology, it is not a number on a
tax form
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When using MAGI, resources/assets are not a consideration

Veterans benefits are not counted
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+Application: Household Composition
How a household is
determined is different
for the Marketplace
and Medicaid
The information
collected affects the
person’s benefits so it
must be entered
correctly.
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+Application: Household Composition
Marketplace
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Household information is provided
to the Marketplace based on
whether a person files taxes, plans
to file taxes or is claimed as a
dependent
Tax information is used to
determine the group size to
compare income to the FPL and
determine eligibility and amount
of tax credits and subsidy
Application for health coverage
can be for all persons who file
taxes together
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Medicaid
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Medicaid programs use tax
information to determine the
group size and income eligibility
for Medicaid benefits
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Eligibility for Medicaid is
determined by income limits for
the type of Medicaid program
considered

Application for health coverage is
generally for persons living in the
house together
+ Veterans and their
Families
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+
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VA Health Care Information
Veterans who obtain health care through the USVA meet the
requirements for minimum essential health benefits
Veterans may be able to blend other health coverage with
USVA coverage to increase access to providers
• Veterans enrolled in USVA health coverage are eligible to enroll in Medicaid if the
individual qualifies for the benefit
• Veterans enrolled in USVA health coverage are able to access this benefit as well as
Medicare if the individual qualifies for Medicare
• Veterans who have private insurance through an employer can be enrolled in USVA
health coverage as well as private insurance
If enrolled in USVA healthcare coverage the veteran is not
eligible for tax credits and subsidy through the Marketplace
+ VA and Families
 Families
members of Vets enrolled in VA health
care cannot receive VA health benefits
 Exception:
Civilian Health and Medical Program
(CHAMPVA); Spina Bifida Health Care Program
 Options
for families: Tricare, Marketplace
(Medicaid)
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+ CHAMPVA Eligibility Definitions
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Term
Definition
Beneficiary
A CHAMPVA-eligible spouse, widow(er), or child.
Child
Includes birth, adopted, stepchild, or helpless child as determined
by a VA regional office (see the “Rules that Impact CHAMPVA
Eligibility” section of the CHAMVPA handbook).
Dependents
A child, spouse, or widow(er) of a qualifying sponsor.
Qualifying Sponsor
A Veteran who is permanently and totally disabled from a serviceconnected condition, died as a result of a service-connected
condition, was rated permanently and totally disabled from a
service-connected condition at the time of death, or died on active
duty and whose dependents are not otherwise entitled to DoD
TRICARE benefits.
Service-Connected
A VA regional office determination that a Veteran's illness or injury
is related to military service.
Spouse
The wife or husband of a qualifying sponsor.
Widow(er)
The surviving spouse of a qualifying sponsor.
+ Tricare and ACA
 Two
Beneficiary categories: Sponsor (SM) and
Dependents (family members)
 Some
Tricare Plans qualify for Minimum Essential
Coverage (MEC) and others don’t
 Tricare
Prime; Reserve Select; Young Adult = yes
 Tricare for dependent parents and in-laws = no
 If
electing Tricare, then no tax credit or subsidy
through the marketplace
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+ Tricare Eligibility
 Eligibility depends
on military status
 Active Duty
 Reserve/National Guard
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SMs and Families are eligible so long as the SM is attending drills
 Families
 Survivors’
remaining eligible when a sponsor dies
depends on
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If the sponsor was AD or not
If the survivor is a spouse or child
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+ Tricare’s differences
 Tricare
Young Adult
 Tricare’s
current age limit for children: 21 or age 23 if in
school full-time
 Young Adult is a Tricare option that the child (or parent)
may purchase for additional coverage
 Mental
health and substance use disorder
coverage limits may not meet the requirements
for parity
 Other
costs
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+ Medicaid Expansion in 2014
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In 2014, anyone up to 138% (133% plus 5% income
disregard) FPL is eligible for Medicaid, called “newly
eligible” Medicaid.
• No disability requirement.
• Must be under 65, not entitled to or enrolled in
Medicare A or enrolled in Part B.
• Modified gross income (MAGI) and no asset test,
which is different from current Medicaid and All Kids
Programs.
Federal government pays for much greater percentage of
this expansion.
Veterans Benefits are not countable income
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+ Additional information and Resources
 Visit http://getcoveredillinois.gov
 Talk
to a navigator: http://getcoveredillinois.gov/gethelp/
 http://tricare.mil
 www.va.gov
 www.Illinoishealthmatters.org
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