8 million signed upPresident Obama 4/17/14

Marketplace Results

14.5 million new coverage Less 5.2 million canceled policies

9.3 million newly insuredRand Corp 4/8/14

12.8 million covered8 million Marketplace

4.8 MedicaidEnroll America 5/1/14

414,514- Arizona Lives Covered

Marketplace Enrolled(as of 04.19.2014): 120,071

Phoenix/Tucson 102,480

Rural areas 17,591

Medicaid (AHCCCS as of 08.01.2014): +294,443 (All categories)

Selected AHCCCS Categories

Restoration of Childless Adults 181,018

Expansion from 100% to 133% FPL 27,281

Loss of KidsCare (CHIP) (44,771)

Navigators

Certified

Application

Counselors (CAC)

Health-e-Arizona

Plus Assisters

Insurance Brokers

Connecting to Coverage

Navigators & Application Counselors

Unbiased FACILITATORS

Can assist with AHCCCS or Marketplace

Strict conflict of interest and privacy

requirements

Must show all Marketplace options

Will assist in multiple languages

Insurance Brokers

Represent multiple insurance companies;

not necessarily all Marketplace plans

Sell group and individual, off and on

the Marketplace

Paid commission by insurance company

Motivated to retain customers

Not trained to assist with AHCCCS

2013-2014: Navigators Entities

Arizona Alliance for Community Health Centers,

Statewide

Arizona Board of Regents, University of Arizona

The Center for Rural Health, Tucson

Campesinos Sin Fronteras, Inc., Yuma County

Greater Phoenix Urban League, Inc., Maricopa,

Pinal and Pima Counties

About the Arizona Alliance for Community Health

Centers (AACHC)

Arizona’s Primary Care Association since 1985.

Comprises the state’s largest network of Primary Care Providers.

Is committed to working with a variety of partners to expand tools that

health centers and organizations serving those in need can utilize to

address the needs of their patient populations and improve health outcomes

while continuing to demonstrate a cost savings.

Has strong local, state, regional and federal partners with which it leverages

resources to accomplish goals.

Provides a variety of educational opportunities for members, including peer

networking committees which provide a forum for sharing of best practices

among member colleagues for optimal healthcare delivery.

Arizona’s largest

primary care network;

serving rural, urban

and tribal areas

State-wide Reach

“Everyone is entitled

to his own opinion,

but not to his own

facts.”― Daniel Patrick Moynihan

What Is Insurance?

“ A small known

loss to protect you

from a large

unknown loss”

Do It Yourself

healthearizonaplus.gov

1-855-HEAplus

(1-855-432-7587)

DES Offices

Paper Applications

AHCCCS Marketplace

Healthcare.gov

Marketplace hotline:

(800) 318-2596 or

TTY: (855) 889-4325

Paper Applications

Where to Find Help

Navigators and Application Counselors call

211

Online Map and Information

Coveraz.org

AHCCCS & Marketplace

New Words – Too Many Words

Arizona’s Consumer Assistance ModelAwareness

Community Outreach

Enrollment Assistance

Evaluation

Coordination, continuity, accurate resources

How to view health plans and prices:

https://www.healthcare.gov/find-premium-

estimates/

https://www.cuidadodesalud.gov/es/find-

premium-estimates/

Employer sponsored

Insurance: 46

Uninsured: 18

Medicaid (AHCCCS): 18

Medicare: 13

Private Insurance: 4 Other Public

If Arizona Had 100 People

Uninsured: 18

1,000,000Under the age of 65

Who Has the Most to Gain?

AHCCCS

45%

Apprx. 450,000

Marketplace

55%

Apprx. 550,000

Opportunities to help

Consumers don’t understand insurance

Provider networks

Rx benefits

Out of pocket expenses

Health coverage more complex than a ticket

Benefits of coverage

Benefits of a healthcare home

Lessons

Consumer insurance literacy

What Consumers Should Think About

YourNeeds

Your Budget

Your Preferences

Helping Consumer Understand What The Options Are:

Narrowing the Options based on what the consumer wants.

Travel Out of State Often?

Favorite Company?

What’s Important?

Six Insurance Companies and 78 plans

http://marketplace.cms.gov/getofficialresources/g

et-official-resources.html

http://coveraz.org/

Beware

• Provider networks

• Where are the

doctors and

hospitals located?

• RX Formularies – all

are not the same.

• All sales are final –

can’t change plans.

BEWARE

Legitimate Brokers, Navigators

and Certified Application

Counselors don’t charge fees to

consumers for their services.

www. Helathcare.com

Any Questions?

Thank You

Lourdes Paez

Workforce Development Coordinator

lourdesp@aachc.org

Individuals Within Mixed-Status

Families Eligible Under the

Affordable Care Act

New Options for Immigrants

Under the Affordable Care Act of 2010 (ACA)

individuals who are “lawfully present” in the United

States are now eligible for new affordable coverage

options that started January 1, 2014.

• US citizens

• “Lawfully Present”

Immigrant Statuses that Qualify for Marketplace

Coverage

•Lawful Permanent Resident (LPR/Green Card holder)

•Asylee

•Refugee

•Cuban/Haitian Entrant

•Paroled into the U.S.

•Conditional Entrant

•Battered Spouse, Child and Parent

•Trafficking Survivor and his/her Spouse, Child, Sibling or Parent

•Granted Withholding of Deportation or Withholding of Removal,

under the immigration laws or under the Convention Against Torture

(CAT)

•Temporary Protected Status (TPS)

•Lawful Temporary Resident

•Individual with Nonimmigrant Status (includes worker visas, student

visas, and citizens of Micronesia, the Marshall Islands, and Palau)

•Administrative order staying removal issued by the Department of

Homeland Security

•Member of a federally-recognized Indian tribe or American Indian

born in Canada

•Deferred Enforced Departure (DED)

•Deferred Action Status* *EXCEPTION: Individuals granted deferred action under the Deferred Action for Childhood Arrivals (DACA)

program are not eligible to enroll in coverage in the Marketplace.

Cont.

Mixed-Status Families

What is a mixed-status family?

Mixed-status family refers to a household made up of

individuals with different citizenship or immigration

statuses, such as a family with an undocumented

mom, a “lawfully present” dad, a child who is a US

citizen because he or she was born in the United

States.

Quick Guide to Immigrant Eligibility for ACA

Who is eligible for coverage in a mixed-status

family?

Each member of a mixed-status family may be eligible for a

different health insurance program and some members may

not be eligible for any health insurance program.

Eligibility for private health insurance and the subsidies that

make insurance more affordable also know as premium tax

credits and cost sharing reductions through the ACA’s health

insurance marketplace are only available to US citizens and

people who are “lawfully present” in the US.

Undocumented Immigrants

• No federal coverage

• Not allowed to purchase private health insurance at full cost in

a state insurance exchange

• Not eligible for premium tax credits or lower copayments

• Exempt from the individual mandate

Citizen or lawfully present children of undocumented parents are eligible:

• To purchase from state insurance exchange

• For premium tax credits and lower copayments

• Medicaid or Children's Health Insurance Program (CHIP)

Undocumented Immigrants cont.

Undocumented Immigrants who do not meet the Medicaid

immigration eligibility requirement or are not eligible to purchase

through the marketplace can still apply for :

• Emergency Medicaid

• Immunizations

• Community Health Centers/FQHCs

• Migrant Centers

• Others

Can an eligible member of a mixed family apply

for Medicaid or a marketplace plan?

YES!

A person who is not eligible, such as an undocumented parent,

may apply on behalf of eligible family members, including when

the ineligible person is the head of household and the

household’s primary tax return filer.

Immigrants in general, and mixed status families in particular,

often do no know what they may be eligible for and are worried

about applying. They need reassurance from eligibility workers

and other experts from whom they seek help.

Non applicant

A non applicant is someone who is not applying for health

insurance but who is in an applicants household. By law, the

information required from a non applicant is limited because

only information strictly necessary to determine an applicants

eligibility may be required.

• Should not be asked for their citizenship or immigration status

• May say “I’m not applying for myself. I’m only applying for my child.”

• Must provide information about their income

• Will be asked for SSN, but do not have to provide one if they

do not have one.

Key Points to remember about mixed-status

families

• An ineligible family member such as an undocumented parent

may complete an application for an eligible member such as a

US citizen child.

• By law, individuals who are not applying for themselves are not

required to provide information about their citizenship or

immigration status and are not required to provide a Social

Security number if one is not issued to them.

• Information about applicants or members of their households obtained in order to determine eligibility will not be used by US

Immigration and Customs Enforcement (ICE) for immigration

purposes. ICE issued a clarification of this policy on 10/25/13

http://www.ice.gov/doclib/ero-outreach/pdf/ice-aca-memo.pdf

Do mixed-status families have to file tax returns

because of the ACA?

If a member of a mixed-status household is eligible for a

premium tax credit to make health insurance more affordable

under the ACA and enrolls in a health insurance, the household

must file tax returns for the year in which they eligible person has

health insurance.

A tax return must be filed in order to “reconcile” the amount of the tax credit and so the applicant can be eligible for a

premium tax credit when he or she renews his or her coverage

for the following year. If the household’s primary tax filer is not

eligible for a SSN, the household must file tax returns using an

ITIN.

Example: Mom, who is undocumented, applies for health

insurance for her US citizen son. The marketplace determines

that they boy is eligible for a premium tax credit and he is

enrolled in health insurance for 2014. Since they boy is eligible for

a premium tax credit, mom must use an ITIN to file an income tax

return for the 2014 tax year by April 15, 2015, tax filing deadline

Individual Mandate - Penalty

2014

• 1% of your yearly household income

• $95 per person for the year ($47.50 per child under 18)

2015

• 2% of your yearly household income

• $325 per person

2016

• 2.5% of your yearly household income

• $695 per person

Public Charge

Public Charge is a term used in immigration law that describes a

person who cannot support themselves and who depends on

benefits that provide cash for their income.

Depending on your immigration status, the Department of

Homeland Security can refuse to let you enter the US, reenter

the US, or become a lawful permanent resident if they think you will not be able to support yourself without these benefits in the

future.

Highlights of Public Charge

• Use of Medicaid, CHIP, or other health programs by you or

your family members will NOT affect the public charge

decision.

• Use of food stamps, WIC, public housing or other noncash

programs by you or your family will NOT affect the public

charge decision

• Buying health insurance through the new health insurance marketplace and obtaining premium tax credits or cost

sharing reductions that make coverage more affordable will

not be considered in the public charge decision.

Important dates and Resources

Open Enrollment for 2015

• November 15, 2014 – February 15, 2015

• Arizona Alliance for Community Health Centers – www.aachc.org

• National Immigration Law Center – www.nilc.org

• Health Insurance Marketplace - www.healthcare.gov

• AZ Medicaid, Nutrition Assistance + more - www.healthearizona.org

• Cover Arizona – www.coveraz.org

Questions?

Thank You!

Brenda Cardenas

Navigator Coordinator

brendac@aachc.org