affordable care act overview

Affordable Care ActOverview

Session 1

Presented by Tokie Moriel & John Tvedt

1DHS/DFO/IMTA/2013-07-15

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What is ACA?

• The Affordable Care Act (ACA)

• Comprehensive reforms that:

– Improve access to affordable health

– Protect consumers


ACA Key Facts

• Stronger Consumer Rights and Protections

• More Affordable Coverage

• Better Access To Care

• Stronger Medicare


Consumer Rights & Protections

• End to Pre-Existing Condition Discrimination

• End to Limits on Care

• End to Coverage Cancellations


More Affordable Coverage

• Value for Your Premium Dollar

• Stopping Unreasonable Rate Increases

• Small Business Tax Credits


Better Access to Care

• Free Prevention Benefits

• Coverage for Young Adults

• Coverage for Americans with Pre-Existing Conditions

• Affordable Insurance


Strengthening Medicare

• Lower Cost Prescription Drugs

• Free Preventive Services

• Fighting Fraud

• Providing Choices while Lowering Costs


Federal Rules

• The Department of Health and Human Services (HHS) and the Internal Revenue Service (IRS) issued federal rules that included changes and alignment to eligibility:

– Requirements

– Methods and processes


Eligibility Requirement Changes

• Modified Adjusted Gross Income (MAGI) based income standards

– Medicaid uses current monthly income

– Cost Sharing Reductions (CSR) and Advanced Premium Tax Credits (APTC) use projected annual income

• Redefines household composition

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• Income Changes.

– Non-recurring Lump sums

– Scholarships and grants

– Income of American Indians and Alaska Natives

– Child Support

– Worker Compensation

– Veteran’s Benefits

– Depreciation of business expenses

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• Federal Poverty Level (FPL)

• Determining proper coverage

Seamless, Streamlined System of Eligibility and Enrollment

Submit single, streamlined application to the FFM or the State

Eligibility is verified and determined

Enroll in affordable coverage

• Online • Phone • Mail • In Person• Other electronic

means

• Supported, in part, by the Federally-managed data services hub

• Eligibility for: • Medicaid and CHIP • Enrollment in a QHP • Advance payments

of the premium tax credit and cost-sharing reductions

• Online plan comparison tool available to inform QHP selection

• Advance payment of the premium tax credit is transferred to the QHP

• Enrollment in Medicaid/CHIP or QHP


A Seamless System of Coverage

400%

CHIP/Medicaid for Children

FPL Varies by State (average

241% FPL)

FPL

250%

FPL

133%FPL

100%FPL

Qualified Health Plans without Financial Assistance

Qualified Health Plan w/ Premium Tax Credits

250%-400% FPL Medicaid/CHIPChildren

Qualified Health Plan w/ Premium Tax Credits and

Cost-sharing reductions between 100% - 250% FPL


Iowa Health and Wellness Plan

101% - 133% FPL

FFM Plan Levels of Coverage

Levels of Coverage

• Bronze• Silver• Gold• Platinum

Plan Pays On Average

• 60 %• 70%• 80%• 90%

Enrollees Pay On Average*(In addition to monthly premium)

• 40%• 30%• 20%• 10%


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A Seamless Path to Affordable Coverage

• The Affordable Care Act:

– Expands access to affordable coverage

– Simplifies Medicaid & CHIP

– Ensures a seamless system of coverage

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Expanding Access to Coverage

• Enrollment in the new income-based category without having to first screen for other eligibility groups

• Enables people with disabilities and those needing long-term care services & supports to enroll in the group that best meets their needs

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Expanding Access to Coverage

• Creates new coverage group for former foster care children

• Expansion of Presumptive Medicaid increases the number of providers allowed to make presumptive determinations for more populations.

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Simplifying Medicaid & CHIP

• Switch to MAGI methodology

• Modernize verification process

• Federal data matches

• Renewals at least every 12 months

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Coordination: A Seamless System of Coverage

• Single, streamlined application for all insurance affordability programs

• Website that provides program information and facilitates enrollment in all insurance affordability programs

• Coordinated verification policies across Medicaid, CHIP and the FFM

• Standards and guidelines for eligibility determinations and information transfers

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Coordination: Key Provisions of ACA

• The Medicaid/CHIP agency:

– Determines eligibility for individuals transferred from another insurance affordability program

– Evaluates an individual for potential eligibility for other insurance affordability programs

– Certifies for the FFM/other programs the criteria applied in determining Medicaid eligibility

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Coordination: Key Provisions of ACA

• Medicaid/CHIP agencies have established agreements with the FFM that clearly delineate the responsibility of each program to:

– Minimize burden on individuals

– Ensure compliance with the other eligibility coordination requirements of the provision (i.e., MAGI screen)

– Ensure prompt determinations of eligibility and enrollment consistent with timeliness standards

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State Responsibilities: Potential Eligibility for Other Programs

• For individuals determined as not eligible for Medicaid/CHIP, the agency:

– Evaluates the individual for potential eligibility for other insurance affordability programs

– Transfers the individual’s electronic account to the FFM for CSR/APTC determinations for insurance plan enrollment

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Coordinated Eligibility Determinations with FFM

• The Federally Facilitated Marketplace makes initial assessment of Medicaid/CHIP eligibility; State make the final eligibility determination

• Assessments made using the applicable Medicaid/CHIP income standards, citizenship and immigration status, using verification rules and procedures consistent with Medicaid and CHIP regulations

• The FFM and Iowa have entered into an agreement outlining each entities responsibilities ensuring a seamless and coordinated process

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Coordinated Eligibility Determinations with FFM

• When the FFM makes an initial assessment, Iowa:

– Accepts the electronic account

– Does not request duplicative information/documentation

– Promptly determines Medicaid/CHIP eligibility without requiring a new application

– Accepts any findings made by another program, no further verification

– Notifies the other program of the receipt of the electronic account and Medicaid’s final eligibility determination if the individual is receiving coverage through another program

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Non-MAGI Populations Applying through FFM

• The FFM will transfer applications to Iowa for a determination of Medicaid on a basis other than MAGI

• Iowa will:

– Notify the FFM of the final determination of eligibility for those individuals who are participating in an insurance affordability program

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Non-MAGI Populations Applying through Iowa

• Evaluating eligibility for other insurance affordability programs for individuals undergoing a Medicaid determination on a basis other than MAGI

• Iowa:

– Determines potential eligibility other insurance affordability programs

– Transfers the individual’s account to the FFM

– Provides timely notice to the FFM

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Continuation of Coverage

• Coverage renewal

– FFM

– State

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A New Approach

• Shifts verification responsibilities

• Less reliance on paper

• “Which coverage is right for you?”

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Time Frames

• October 1, 2013

– Open enrollment for insurance affordability programs

– Must accept single streamlined applications and apply new rules

– Must be able to transmit information to Marketplace

– Evaluate under current rules for eligibility prior to 1/1/14

• January 1, 2014

– Coverage under insurance affordability programs can begin

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Conclusion

• Additional ACA webinars

• Session review – Income Maintenance Workers ONLY

affordable care act overview

Documents

affordable health

affordable coveragevalue

system of eligibility

state eligibility

iowa health

seamless path

expanding access

qhp enrollment