The Landscape of ACA Implementation
in Florida
Sept. 13th, 2013
Leah Barber-Heinz
Advocacy Director, Florida CHAIN
AGENDA
1. Implementation Timeline
2. Overview of the Marketplace and eligible Floridians
3. Enrollment help- Navigators, CACs, Health Centers
4. Medicaid Expansion
5. Resources
1. Timeline
•
August 15th- Navigator funding announced
•
mid-September- Navigator training began online
•
September 23rd- Legislative committee weeks
begin
•
October 1st- Open enrollment begins (17 days)
•
January 1st, 2014- Coverage begins
•
March 31st- Open enrollment period ends
•
October 1st, 2014- Open enrollment begins again
2. Marketplace Overview
• A new, transparent, and competitive
insurance marketplace
• Individuals and small businesses can buy
affordable and qualified health benefit plans
• Choices of health plans that meet benefits
and cost standards
• Income between 100% to 400% of the
Federal Poverty Level (FPL) ($23,550 –
$94,200 for a family of four)
Health Insurance Affordability Programs in Florida
Post ACA
Who will enroll in the marketplace?
Uninsured & under-insured (inadequate and/or unaffordable coverage)
Floridians with incomes between 100% and 400% of poverty level
% of poverty level
Individual
Family of 4
100% FPL
$11,490
$45,960
400% FPL
$23,550
$94,200
•
Currently about 2.7 million such Floridians
•
Majority will not have had private insurance previously
•
Compared with existing private insurance market:
-
More racially diverse
Less likely to be English-proficient
Less formal education
• Others can buy, but below 100% and above 400% of poverty = no
tax credits
3. Enrollment help
Assistance that helps people choose the
right health coverage option for themselves
& their families
4 sources for enrollment assistance
• Navigators
• Certified Application
Counselors (CACs)
• Health Centers (FQHCs)
• Marketplacewww.healthcare.gov,
1-800-318-2596
Navigators: What do they do?
• Provide unbiased help for people so
they can buy coverage in Marketplace or
connect with Medicaid and KidCare.
• Educate consumers on health
coverage options
• Assist with eligibility, enrollment,
and health plan selection
Navigators must:
• Prioritize serve low-income, disadvantaged, and
hard-to-reach populations
• Help people understand how premium tax credits
work and the potential impact on families’ finances
• Explain how health insurance, benefits, cost sharing,
and appeals processes work
• Provide information that can be understood for
those with limited English proficiency
Who are Florida Navigators?
University of South Florida: Florida Covering Kids & Families (FL-CKF) is a
community and consumer-focused nonprofit initiative of The Lawton and Rhea
Chiles Center for Healthy Mothers and Babies, based in the College of Public
Health, at the University of South Florida (USF), located in Tampa, Florida. FL-CKF,
in collaboration with a state-wide consortium of 10 partners, will assist
consumers and small employers with the enrollment process and conducting
public education activities to raise awareness about the Marketplace.
Epilepsy Foundation of Florida plans to utilize their existing partnerships with
schools and universities, government agencies, hospitals, and faith-based entities
to educate and help enroll consumers in the Marketplace.
Advanced Patient Advocacy, LLC for nearly 14 years has partnered with health
care providers and state and local governments in 21 states to provide services to
communities to help educate and enroll uninsured consumers. They will work
with medical centers to identify uninsured individuals and provide education and
assistance to help them make informed decisions about enrollment in the
Marketplaces.
Who are Florida Navigators cont.
National Hispanic Council on Aging works closely with its Hispanic Aging
Network composed of 39 community-based organizations across the continental
U.S., D.C., and Puerto Rico. The NHCOA will deploy Navigators in Dade County,
Florida, and Dallas County, Texas, to enroll the uninsured Hispanic population
Cardon Healthcare Network has over 20 years of experience providing in-person
eligibility assistance to Medicaid enrollees in 33 states. Cardon Healthcare
Network will use this experience to provide outreach and assistance with its
existing robust infrastructure.
Mental Health America will target underserved individuals with behavioral
health disorders who are uninsured or underinsured. The National Office of
Mental Health America (MHA) will serve as the lead agency in the Initiative. The
Mental Health America of East Central Florida (MHAECF) will serve Brevard,
Flagler, Orange, Putnam, St. Johns, and Volusia counties in Florida.
USF, Covering Kids and Families
Holmes
Jackson
Walton
Gadsde
n
Bay
Nassau
Leon
Madison Hamilton
Duval
Baker
Liberty
Gulf
Franklin
Wakulla
Taylor
Clay
Lafayette
Alachua
Dixie
1. Families Count
Flagler
Levy
Marion
2. PAEC
3. North Central Florida Health
Planning Council, Inc.
(WellFlorida Council, Inc.)
Putnam
Volusia
Citrus
Lake
Seminole
Hernando
Orange
Pasco
Osceola
4. The Health Planning Council
of NE FL
Polk
5. Treasure Coast Health Council
Manatee Hardee
6. Health Planning Council of
S.W. Florida, Inc.
Sarasota
7. Kids Healthcare Foundation
8. PCAN
9. United Way of Brevard
Florida CHAIN-Statewide
Other navigator entities
St. Lucie
Highlands
De Soto
Martin
Charlotte
Lee
Glades
Hendry
Palm Beach
Broward
Collier
What are Certified Application Counselors
(CACs)?
• Provide information about full range about
Marketplace plans, Medicaid and CHIP
• Help people apply and enroll in Marketplace,
Medicaid and CHIP
• HHS provided training and certification
• Federal funding not available
What Organizations Can Be CACs?
• Screen and certify that staff will protect information
• Have a track record of helping people enroll in public
benefits programs or social services
Practically Speaking, CAC entities are likely to be:
•Community Health Centers
(such as FQHCs)
•Hospitals
•Health Care Providers
•Indian Health Services and
Providers
•Ryan White HIV/AIDS
providers
•Behavioral or mental health
providers
•Agencies with experience
providing social services such as
SNAP outreach, energy assistance,
or tax assistance, which are:
•Non-federal government
entities
•501(c) nonprofits
•Local government agencies
such as health departments,
libraries
What is the difference between CACs and
Navigators?
• CACs perform similar but more limited functions:
• CACs are not required (but may) do outreach
• CACs are not subject to same stringent conflict of interest
standards but must disclose potential conflicts of interests
• CACs do not have to meet cultural and linguistically appropriate
standards (CLAS) beyond other obligations they already have
• CAC may refer individuals with disabilities
• CACs do not have to refer consumers to ombudsman or other
consumer assistance programs
How does an organization become a CAC?
• Apply on-line.
http://marketplace.cms.gov/help-us/cacapply.html
• If accepted, must enter into agreement with
Marketplace
• Must screen and certify staff and volunteers
Federally Qualified Health Centers and
Enrollment Assistance
Florida: Health Center Outreach
& Enrollment Assistance
46 awards totaling $8,052,533
FL health centers expect to hire
163 new workers, who will assist
158,160 people with enrollment
into affordable health insurance
coverage.
http://www.hrsa.gov/about/news/2013tab
les/outreachandenrollment/fl.html
What is Outreach and Education?
• Informing people about
coverage options
• Monitoring how things are
going and report
• Working together to fix
problems and highlight
successes
• Identifying needed
improvements in systems
and policies- STORY BANK
4. Medicaid Expansion
• Up to 138% Federal Poverty Level
• $26,951 for a Family of 3
• 100% Federally funded through
2017, then tapers to 90% match
2020
• Effectively a State option due to
Supreme Court decision
• Governor, State Senate, Hospitals,
Business community and advocates
support
Medicaid Expansion cont.
Medicaid Expansion
815,000 to 1,295,000
would gain coverage in Florida
•
Low income childless
adults- 58%
•
Low income working
parent (s)- 42%
•
Persons with
disabilities- 49,000
•
Working adults- 46.4%
Source: Florida CHAINhttp://floridachain.org/wp-content/uploads/2013/03/expansion-population-charts-as-of-03.21.13.pdf
Medicaid Expansion- Call to Action
Almost 3 million Floridians will be
newly eligible
But we all need to make sure people know about the
new benefits and programs and help
them enroll
5. Resources
To prepare for and enroll in Marketplace- www.healthcare.gov
Healthcare expansion advocacy and campaignswww.healthcareforflorida.org
Outreach/Enrollment materialshttp://marketplace.cms.gov/getofficialresources/publications-andarticles/publications-and-articles.html (just google CMS/Outreach
Enrollment Materials)
Share your story portal- http://floridachain.org/shareyourstory/
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