Navigating the Changes
Megan Holt, LCSW
Key Points
• I am One of You…
• I Did Not Write This Law…
• I Often Do Not Understand It Either...
• I am Not the Expert…
Primary Payors
• Medicare
• Medicaid
• Private Payors (Insurance)
• Self-Pay / Uninsured
Eligibility & Rules (ACA)
• For the Uninsured Up to 400% FPL
• Qualified Health Plans Must Meet All
Essential Elements of ACA
• Subsidized by Federal Government
• States May Choose Medicaid Expansion
• States Must Establish Marketplaces
Essential Health Benefits (ACA)
•
•
•
•
•
•
Ambulatory Svcs
Prescription Drugs
Emergency Svcs
Preventive/Wellness
Hospitalization
Maternity & Newborn
Rehabilitative & Habilitative Services/Devices
Pediatric Services (Oral & Vision)
Mental Health & Substance Abuse Disorder Svcs
Avenues for the Uninsured (ACA)
• Option One:
• Insurance – New Marketplace
• Up to 400% FPL
• Subsidized – Income-Based
• Requires at least 2 Providers per County
• Metallic Plans – Must Be Fairly Issued
• Option Two:
• Tax Penalty
• Increases Each Year if Remain Uninsured
Avenues for the Uninsured (Ark)
• Medicaid
• Traditional Methods (17%FPL or Below)
• Disabled…
• Medically Frail (Includes SMI)
• Medicaid Expansion
• PRIVATE OPTION (up to 138% FPL)
• Insurance Marketplace (ACA)
• Exchange Plans (139% - 400% FPL)
Marketplace in Arkansas
• Blue Cross/Blue Shield of Arkansas
• Blue Cross/Blue Shield –Multi-State
• QualChoice
• Ambetter (Novasys)
Will Come Back to These….
Private Option (Arkansas)
• Arkansas’s Version of Medicaid
Expansion (But Not Medicaid)
• Childless Adults (19-65) With
Incomes ≤138% Federal Poverty Level
• Parents (19-65) With Incomes 17% 138% Federal Poverty Level (FPL)
• Not on Medicare and Not Disabled
Private Option (Arkansas)
• “Purchase” Insurance Plans in the New
Marketplace – Subsidized by Federal
Government
• Must be Silver Metallic Plan or Better
• Estimated 225,000 ≤138% FPL Should
Enroll
• IMD Exclusion Does Not Apply…so The
BridgeWay Can Accept PO Patients
Marketplace in Arkansas
• Blue Cross/Blue Shield of Arkansas
• Blue Cross/Blue Shield –Multi-State
• QualChoice
• Ambetter (Novasys)
Blue Cross Plans
Ambetter
QualChoice
Blue Cross Plans
Ambetter
QualChoice
Blue Cross Plans
QualChoice
Blue Cross Plans
Ambetter
QualChoice
Blue Cross Plans
QualChoice
Blue Cross Plans
Only
Blue Cross Plans
Only
Marketplace in Arkansas
• Metallic Plan Options
• Bronze (Covers 60% of Expenses)
• Silver (Covers 70% of Expenses)
• Gold (Covers 80% of Expenses)
• Platinum (Covers 90% of Expenses)
Marketplace in Arkansas
• Outside of Private Option…
• Deductibles and Co-Pays Apply to Most
Plans
• Some are as High as $6,500 Individual
and $12,000 Family
• Subsidies Only Impact Monthly
Premium
Marketplace in Arkansas
• Opened October 1, 2013
• Federal Plans Closed March 31, 2014
• Private Option Remains OPEN
• Coverage Began January 1, 2014
• Expected 500,000 Arkansans are
Uninsured
• Estimated 225,000+ Will Meet Private
Option or Medicaid Qualifications
Marketplace in Arkansas
• Outreach & Education
• Signing Up…
• www.arhealthconnector.org
• 1-855-283-3483
• More Info at www.healthcare.gov
• Certified Application Counselors
(CAC)
• Several at The BridgeWay
Summary
• Uninsured in Arkansas
• Medicaid (Must Qualify)
• Marketplace Insurance Plans
• Private Option (Fully Subsidized)
• ACA (Patient and Government Shared)
• Four (4) Qualified Health Plan
Companies in Arkansas
• Only 2 (BC/BS) Cover All of Arkansas
• Enrollment Ends March 31, 2014
Summary
• Private Option is Technically Not
Medicaid Expansion
(But Uses Federal Dollars the Same Way)
• Private Option “Insurance” Is
Accepted at The BridgeWay
• Adult Medicaid Payments to Free-
Standing Facilities are Still Denied
Working Together…
• Sign People Up…
• Call Us for Help (501-771-1500)
• Work With State Legislators…
www.TheBridgeWay.com
501-771-1500
1-800-245-0011