The Affordable Care Act (ACA): Training of
Trainers (TOT) for Community-Based
Organizations
October 2013
Objectives
At the end of this training, you will be able to:
1. Understand some of changes under the Affordable Care Act
(ACA) and how health care coverage will expand through
Medicaid and the new insurance exchange
2. Identify who may be eligible for Medicaid and insurance
subsidies
3. Tell people how to sign up themselves or get help to do so
ACA: The Big Picture
http://kff.org/health-reform/video/youtoons-obamacare-video/
Insurance through Employers
1/2 the Population
• If already covered by employer, not much is changing – still get
coverage from employer
• New advantages: caps on out-of-pocket expenses, free
preventative care, can’t inflate prices for sick employees
• Bigger changes for large companies (50+ employees) that
don’t offer coverage now - must offer insurance or face
penalty (but penalty is delayed to 2016)
• Smaller employers (<50 employees) – don’t have to offer
coverage and don’t face penalties, but get incentives to do so
– they purchase on the marketplace and get tax breaks
Coverage through Government
1/3 of the Population
• Seniors on Medicare – not much will
change. Already have help with
prescription drugs and preventative care
• Medicaid is expanding to cover more people, especially poor
adults not currently eligible – both men and women, not just
pregnant women and parents
• States have option to expand Medicaid or not – about half are
expanding, including Colorado. Federal government pays almost
all of the cost in the early years.
Buying Insurance on
Your Own
(1 in 10 people)
• If not covered by employer or
employer’s coverage is too expensive, you can buy on
marketplaces – Ours is Connect for Health Colorado.
• Insurers compete, you choose how much coverage you want and
how much you want to pay for it (Bronze to Platinum Plans)
• All plans cover a set of services –e.g. hospital and doctor visits,
maternity care, mental health care, prescription drugs.
• Tax credits to make the insurance more affordable if you don’t
have other options and your income is below a certain level
Buying Insurance on
Your Own (1 in 10 people)
• Catastrophic policies available until age 30
• You can’t be denied or charged more based
on pre-existing conditions
• Men and women will pay the same price, unlike today
• Most will pay less (e.g. older people), some more (e.g younger
people) – but get better and more secure insurance.
• Must buy during open enrollment periods – through March
31, 2014
• Pay fines if you don’t have insurance, waivers for special
circumstances
Historic Opportunities with the ACA
“Sick Care” System
Uninsured in Denver:
2011:
17%
(American Community Survey)
2016:
Reduced to 6%
(Projections based on American
Community Survey)
•
•
•
Exclusionary
Episodic
High-cost
Sick Care (Before ACA)
“Health Care” System
•
•
•
•
Inclusive
Comprehensive
Preventive
Lower-Cost
Wellness & Prevention
Expansion of Health Coverage in 2014 under ACA
Medicaid: Based solely on income
0-133% of FPL: $15,282 for single
$31,322 for family of 4
Insurance: Subsidies for insurance
purchased at Connect for Health
Colorado:
133-400% of FPL: $45,900 for single
$94,200 for family of 4
No Denials for Pre-Existing
Conditions
Key Exclusion for All New
Coverage: Undocumented persons
and some legal residents.
Individual Insurance Mandate:
Everyone must have health coverage
or pay a penalty on 2014 federal tax
return - $95 or 1% of annual income
Free Preventive Services without Co-Pays
under ACA
Selected Preventive Services
Pregnancy and Newborns
Well Child Care
Bone Health
Sexual Health
Infections
Mental Health
Cardiovascular Disease
Cancer
Substance Use
Screening for anemia and infections; vitamin supplementation;
breastfeeding support and counseling; newborn screening
Screening for autism, hearing, vision, depression, obesity, lead; all
recommended vaccinations
Osteoporosis screening
Screening for STDs and intimate partner violence; STD prevention
counseling; Contraception
Hepatitis C & HIV testing; all recommended vaccinations for adults
Depression screening
Screening for high blood pressure, diabetes, high cholesterol and
obesity; dietary and obesity counseling
Screening for breast, cervical and colon cancer; counseling about sun
exposure
Tobacco use screening and cessation services; alcohol misuse
screening and counseling
More information available at www.Healthcare.gov
Uninsured in the Denver Metro Area
Source: Colorado Health Access Survey, 2011
Who Lacks Insurance Now in Denver?
Roughly 1 in 5 Denver residents are uninsured:
Percentage Uninsured
50%
40%
30%
26%
23%
21%
17%
20%
10%
29%
14%
9%
1%
0%
11%
14%
13%
Where in Denver will More People Qualify
for Coverage?
In darker
shaded areas
more people
will qualify
for Medicaid
and
insurance
exchange
subsidies
How Will Expanded Coverage Affect Your
Organization?
• Many uninsured patients and people with CICP who already
receive care at your organization may be eligible for Medicaid
or the Exchange
• Having more people covered will help your organization to
continue providing services
Barriers to Enrollment
• Lack of knowledge of the ACA
• Political opposition to the ACA
• Uncertainty about the details of the ACA
• 150 plans to choose from on the Exchange
• Chance of higher co-pays for clinic visits and
medications for those previously on CICP Z rating
• Minimal penalty for choosing not to enroll - $95 or
1% of household income in 2014.
Overcoming Barriers to Enrollment
• Assisting individuals to sign up for Medicaid and
the Exchange
• Accurate and widely available information about
how the ACA will help individuals
• Consistent public messages about
the benefits of health insurance
What You Can Do to Help Get People Enrolled
Identify
• Most uninsured people in
Denver will qualify for
Medicaid or Exchange subsidies
• Nearly all people with CICP will
qualify for Medicaid (CICP E rating
or lower and some with F rating)
or Exchange subsidies
• Many parents whose children
have Medicaid or CHP+ will be
eligible for the new coverage
programs.
Household
Size
Up to 133% of FPL
Subsidies on
the Exchange:
1
$15,282
$45,960
2
20,628
62,040
3
25,975
78,120
4
31,322
94,200
5
36,668
110,280
6
42,015
126,360
7
47,361
142,440
8
52,708
158,520
For each
additional
person, add
$5,347
$16,080
Medicaid:
Up to 400% of FPL
What You Can Do to Help Get People Enrolled
Advise
• Tell patients and clients about the
importance of health insurance
• Advise them what forms of coverage they
might be eligible for
What You Can Do to Help Get People Enrolled
Refer to Phone and Online Enrollment Sites
Give patients and clients information about how to
check their eligibility and sign up for Medicaid or
subsidized insurance by phone or online
Phone:
Toll-free: 1-800-221-3943
TDD: 1-800-659-2656
Apply Online: Colorado.gov/PEAK
Phone:
Toll-free: 1-855-PLANS4YOU
Toll-free: 1-855-752-6749
Apply Online: ConnectforHealthCO.com
What You Can Do to Help Get People Enrolled
Refer to In-Person Enrollment Assistance Sites
Refer clients to organizations that can assist with
enrollment in Medicaid or purchasing insurance on
the insurance exchange. Sites may have interpreters
to help clients enroll.
Lists of sites available at:
colorado.gov/apps/maps/hcpf.map
List of sites available at:
connectforhealthco.com/let-ushelp/assistance-network/
What You Can Do to Help Get People Enrolled
Tell People What Documents They Need
• Social Security numbers, or document numbers for legal
immigrants (bring card if possible)
• Employer and income information for every member of
the household who needs coverage (for example, from
pay stubs or W-2 forms)
• Policy numbers for any current health insurance plans
covering members of the household
• Information on job-based plans that anyone in the
household is eligible for.
Medicaid and
Connect for
Health
Colorado
Enrollment
Assistance
Sites in Denver
Enrollment Services at Denver Health
Denver Health and its
Community Health Centers
throughout Denver are inperson assistance sites for
both Medicaid and the
insurance exchange. A person
may enroll at the main
location or in other locations
shown here.
Call for an appointment:
303-602-2300
Main Location:
Denver Health Pavilion M
723 Delaware St
Denver, CO 80204
Same day walk-in appts are
available at this location on firstcome, first-serve basis
Other Locations on Campus:
Women’s Care Clinic, Pavilion C
790 Delaware St
Davis Pavilion, Pavilion D
700 Delaware St
TB and Immunization Clinic
Registration, Denver Public
Health, Pavilion H
605 Bannock St
Enrollment Locations at Denver Health
Community Health Centers
Eastside Health
For appointments call 303-602-2310
after 2PM daily
Center
501 28th St.
Denver, CO 80205
La Casa Health Center
4545 Navajo St.
Denver, CO 80211
Lowry Health Center
1001 Yosemite St.
Denver, CO 80230
Montbello Health
Center
12600 E. Albrook Dr.
Denver, CO 80239
Park Hill Health
Center
4995 E. 33rd Ave.
Denver, CO 80207
Westside Health
Center
1100 Federal Blvd.
Denver, CO 80204
Westwood Health
Center
4320 W. Alaska St.
Denver, CO 80219
Summary
% of Denver Residents Insured
• ACA offers insurance coverage options for
better access to care
94%
• Insured people in Denver could increase to
11%
94%
Gain coverage
• Expanded coverage will help Denver’s safety
through ACA
net organizations continue to serve the needs
of Denver residents
• There are many enrollment resources to help
83%
people get insurance
Had Coverage
in 2011
• You can help by letting people know about
the benefits of insurance and telling them
how to sign up or get help to sign up