WHAT IS THE PATIENT
PROTECTION AND
AFFORDABLE CARE
ACT?
Effects on
Community
Level
Organizations
and Their
Practices
WHAT IS THE PATIENT PROTECTION AND
AFFORDABLE CARE ACT?
Quick Quiz
Test Your Knowledge
What do you know about the
Patient Protection and
Affordable Care Act?
PPACA: A CLOSER LOOK
 The Patient Protection and Affordable Care Act
(PPACA), aka Obamacare or Affordable Care Act
(ACA)
 Signed into law March 2010
 Most expansive overhaul to the U.S. Healthcare
system since the Social Security Act
 Virginia is working aggressively to be compliant
with the required aspects of the PPACA
PPACA: KEY POINTS AND CHANGES
ACROSS THE NATION
Subsidizes health plans for small businesses and nonprofits in 2010, 2015
Standardizes health plan methods for electronic Health and
Human Resources delivery in 2012
Makes consumer health information available online in
2012
Includes health insurance coverage of young adults on
family plans to age 26 in 2010
Mandates individual health insurance coverage on January
2014
PPACA: KEY POINTS AND CHANGES
ACROSS THE NATION
Medicaid for former VA foster care youth extended to age
26
Medicaid Program assisting pregnant women has changed
Designed to complement Medicaid by providing health
insurance options to those who do not qualify for Medicaid
benefits
Establishes Health Insurance Marketplace (HIM) where
people can purchase subsidized and full -cost insurance in
2014
Applications can now be taken by paper, phone, fax and
on-line in 2014
PPACA: KEY POINTS AND CHANGES
ACROSS THE NATION
Mandates individual health insurance coverage in
January 2014
Standardizes eligibility rules across all 50 states
so that eligibility determinations on certain
Medicaid programs can be applied consistently and
efficiently from state to state in 2014
Gives states the option to expand Medicaid to all
citizens at or below 133% of the federal poverty
level
PPACA: PREPARING THE COMMONWEALTH
FOR NEW REQUIREMENTS
Expanded access to benefit applications and
resources through CommonHelp
Smarter processing of Medicaid applications
using Federal Data Hub resources
On-line credentials checked electronically fighting fraud & abuse
PPACA: PREPARING THE COMMONWEALTH
FOR NEW REQUIREMENTS
VA Medicaid Call Center for additional citizen
access
Electronic coordination of applications
between Medicaid and the Health Insurance
Marketplace (HIM)
Preparing to be available October 1, 2013
COMMONWEALTH PROCEEDING WITH
MEDICAID REFORM
There is no current plan to expand eligibility
within the Virginia Medicaid program.
Governor and Legislature have agreed to
undertake major reforms within the Medicaid
program.
The 2013 General Assembly established a
legislative body to oversee reforms.
PPACA: KEY POINTS AND CHANGES
ACROSS THE COMMONWEALTH
Looking at MAGI (Modified Adjust Gross
Income) to determine eligibility
New eligibility rules have allowed workers to
make determinations automatically in some
cases, with certain Medicaid programs
CommonHelp and the new streamlined
application
Creates online accounts to apply for Social Service benefits
Streamlined, self directed application process
Works with the Health Insurance Marketplace (HIM ) to transfer
citizen’s application to the FFM if they do not qualify for Medicaid
TAKING A CLOSER LOOK: WHAT IS THIS
HEALTH INSURANCE MARKETPLACE?