The New Health Care Law and You Two thirds of the uninsured live in 13 states Uninsured by State 67% of uninsured live in 13 states Number of Uninsured <230K 230K 600K 600K 1.1M Source: Census Bureau, Current Population Survey, March 2011 and 2012 1.1M+ 3 One fifth of the uninsured live in the top 13 counties and half live in the top 114 counties Uninsured by County 10% of the uninsured live in just 4 counties (LA, Harris, Cook, Miami) 20% of the uninsured live in top 13 counties (Top 4 + Next 9) 50% live in the top 114 counties (3.8% of total counties in the US) 4 Need to Inform, Educate and Assist with Enrollment Six Months Before Open Enrollment Begins, Many Americans Remain Unaware Of, or Confused About the ACA As far as you know, which comes closest to describing the current status of the health care law? KFF Health Tracking Poll, April 2013 4/13/2015 The Health Insurance Marketplace 101 5 Looking at the Model by Zip Code (Source: Enroll America) Uninsured by Zip Code 9,000 35% 8,000 30% 7,000 25% 6,000 5,000 20% 4,000 15% 3,000 10% 2,000 5% 1,000 0 0% Uninsured Uninsured Rate The Health Insurance Marketplace A new way to get health insurance • • Enrollment starts October 1, 2013 Coverage begins January 2014 About 25 million Americans will have access to quality health insurance • Up to 20 million may qualify for help to make it more affordable • Working families can get help through the Marketplace 4/13/2015 The Health Insurance Marketplace 101 7 All Qualified Health Plans Will Cover These Essential Health Benefits 1. Ambulatory patient services 6. Prescription drugs 7. Rehabilitative and habilitative services and devices 2. Emergency services 3. Hospitalization 4. Maternity and newborn care 8. Laboratory services 9. Preventive and wellness services and chronic disease management 5. Mental health and substance use disorder services, including 10. Pediatric services, including behavioral health treatment oral and vision care 4/13/2015 The Health Insurance Marketplace 101 8 The Law Makes Health Insurance More Affordable In many cases, you can get preventive services for free: Cancer screenings such as mammograms & colonoscopies Vaccinations such as flu, mumps & measles Blood pressure screening Cholesterol screening Tobacco cessation counseling and interventions Birth control Depression screening And more… Visit www.healthcare.gov/prevention for a full list. Eligibility and Enrollment Marketplace initial open enrollment period starts October 1, 2013 and ends March 31, 2014 Marketplace eligibility requires consumers to • Live in its service area, and • Be a U.S. citizen or national, or • Be a non-citizen who is lawfully present in the U.S. for the entire period for which enrollment is sought • Not be incarcerated 4/13/2015 The Health Insurance Marketplace 101 10 Application and Eligibility Enroll (Marketplace) Submit single, streamlined application to the Marketplace • • • • Verify and determine eligibility Eligible for Marketplace or Medicaid/CHIP Screen Online Phone Mail In Person 4/13/2015 Supported by Data Services Hub The Health Insurance Marketplace 101 (Medicaid/CHIP) 11 Assistance – It’s Available If You Need It Help will be available in the Marketplace • Toll-free call center - 24/7Federal Call Center is up and running and the number is: 1-800-318-2596. 150 languages • Website chat 24/7 (English and Spanish) • Help in-person Navigators Other trained enrollment assisters Local Community Health Centers, libraries, hospitals and other locations in local communities Agents and brokers 4/13/2015 The Health Insurance Marketplace 101 12 Help to Pay Qualified Health Plan Costs Based on family income and size • Premium discount Family of four with annual income $23,550* – $94,200* or less And not eligible for certain other insurance coverage like Medicaid • Lower cost-sharing (like copays) Family of 4 with annual income $58,875* or less (some other restrictions) *2013 amounts 4/13/2015 The Health Insurance Marketplace 101 13 www.HealthCare.gov Now - Sign up for Email and Text Alerts and Get Ready Starting October 1, 2013, you will be able to apply through this site 4/13/2015 The Health Insurance Marketplace 101 15 Marketplace.cms.gov Get the latest resources to help people apply, enroll, and get coverage in 2014 4/13/2015 The Health Insurance Marketplace 101 16 Arizona Provider Website www.coveraz.org ACA Requirements for States Medicaid changes 1/1/14 • Technology changes • Eligibility determination methods Provide access to the Federally Facilitated Marketplace 10/01/13 New Application and Eligibility System DES’ AHCCCS’ AZTECS ACE Health -eArizona Health-e-Arizona Plus Between Arizona and the Federally Facilitated Marketplace, Consumers Have a Wide Range of Program Options Full Range of AHCCCS Benefits Other Federal and Local Programs • AHCCCS Health Insurance (Medicaid) • ALTCS • Freedom to Work (FTW) • Breast and Cervical Cancer Treatment Program (BCCTP) • Medicare Savings Programs (MSP) • Nutrition Assistance (SNAP or Food Stamps) • Temporary Assistance for Needy Families (TANF) • Clinic-based Sliding Fee Scale programs SFS) • County-based Community Assistance Programs (CAP) Exchange Programs • Premium Tax Credit Program • Cost Sharing Reduction Program • Private Insurance, No Subsidy • Small Business Health Opportunities Program (SHOP) for employers of 50 employees or less Many Programs are Accessed Through Start Here Health-e-Arizona Plus Health-e-Arizona Plus SNAP TANF Clinic SFS County CAP AHCCCS & KidsCare Apply for SNAP = Supplemental Nutrition Assistance Program (Nutrition Assistance) TANF = Temporary Assistance for Needy Families (Cash Assistance) Clinic SFS = Clinic-based Sliding Fee Scale programs County CAP = County-based Community Assistance Programs (CAP)(Pima and Santa Cruz Counties) PTC = Premium Tax Credit Program CSR= Cost Sharing Reduction Program SHOP = Small Business Health Opportunities Program FFM PTC CSR Referral to FFM Private Insurance (No Subsidy) SHOP Link to FFM Applications Started at the FFM Start Here Health-e-Arizona Plus SNAP TANF Clinic SFS No Access County CAP FFM AHCCCS & KidsCare Assessment SNAP = Supplemental Nutrition Assistance Program (Nutrition Assistance) TANF = Temporary Assistance for Needy Families (Cash Assistance) Clinic SFS = Clinic-based Sliding Fee Scale programs County CAP = County-based Community Assistance Programs (CAP)(Pima and Santa Cruz Counties) PTC = Premium Tax Credit Program CSR= Cost Sharing Reduction Program SHOP = Small Business Health Opportunities Program PTC CSR Private Insurance (No Subsidy) Apply for SHOP Integration with FFM Arizona Federally Facilitated Marketplace Arizona Wants to Avoid Consumer Confusion HEAplus ? ? ? Federally Facilitated Marketplace Upcoming Milestones 01/01/14 Medicaid changes are effective QHP enrollment is effective 09/01/13 Consumer Support Line 10/01/13 Health-e-Arizona Plus and Health Insurance Marketplace go live QHP open enrollment begins What is the MIHS Plan? Focus on Micro-targeting Collaborate with VISTA and AmeriCorp Volunteers Develop Matrix of Leads within Clinics or Areas of the Hospital Create and/or Distribute Informational Materials Created www@aca.mihs Created SharedGroup Folder: ACA 26 What is the MIHS Plan? Training staff on how to help customers by: • Identify those who will benefit • Inform them of the programs (Medicaid Expansion and Marketplace) • Educate patient (Family Learning Centers) • Refer patients (Consumer Assisters, Brokers, Agents and Navigators) • Enroll (HEA Plus or FFM) Explore scheduling enrollment events 4/13/2015 The Health Insurance Marketplace 101 27 For More Information 1. Contact your Medical Provider or Case Manager 2. Visit www.healthcare.gov Visit www.CuidadoDeSalud.gov 3. Health Insurance Marketplace Toll-free Call Center Available 24/7 1-800-318-2596 TTY: 1-855-889-4325 4. Contact our Family Learning Center Staff at 602-344-1352 5. E-mail MIHS at aca@mihs.org 28 Acknowledgements This presentation is a compilation of many sources including: Center for Medicare and Medicaid Services, The Health Insurance Marketplace (July 2013) Census Bureau, Current Population Survey, (March 2011 and 2012) Enroll America Kaiser Family Foundation, Tracking Poll (April 2013) Arizona Health Care Cost Containment System Administration (May 2013) Arizona Alliance for Community Health Centers (July 2013) 4/13/2015 29