SPECIAL NEEDS WORK GROUP

JULY 18 , 2013

The Affordable Care Act: An Update

What does the ACA do?

GOOD News!!!People will be able to

get insurance!!(It may be a little complicated – it may be

confusing at first)

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What does the ACA do?

GOOD News!!!People will be able to

get insurance!!

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What does the ACA do?

GOOD News!!!Real insurance that provides real coverage

10 Essential benefit areasAffordable – to fit your budget

premium and cost-sharing subsidies

Choice of plans – Simple language, no fine print

You can get help signing up

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The Work Ahead

GOOD News!!!Most Important Information to share

Web site – www.healthcare.govTelephone numberLocal Help

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The Work Ahead

Not as GOOD News!!!People don’t know this is coming.

According to a survey by Enroll America:78% of uninsured adults don’t know about

these changes.72% of people eligible for the affordability

programs don’t know

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What Does This Mean for CYSHCN?

Changes in Medicaid

Access to insurance for other family members

Help in applying and renewing

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Changes in Medicaid

PH-95 (children with disabilities) category stays as it is This is a disability category and is not affected by

the other changes in Medicaid PHLP has not heard of any new plans to impose co-

paysBe aware of the changes to non-disability

Medicaid May be incorrectly applied

May make it easier for other family members to obtain coverage

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Changes in Medicaid - Household

Uses tax-filing standards Self plus dependents

If someone else claims a dependent, that person doesn’t count in the household

Biggest impact will be on complex households where a child lives with a non-parent, with one parent but is claimed by the other, etc.

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Changes in Medicaid - Renewal

Renewal of coverage – once a year Based on electronic data sources as the primary

means

Agency will send a pre-populated form with available information to the head of household. If no corrections, will automatically renew coverage

Eliminates six-month reporting, unless client reports substantial change in circumstances (income, household, residence, etc.)

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Changes in Medicaid - Applying

No wrong door Eligibility for tax credits and subsidies is based on

ineligibility for Medicaid or CHIP Marketplace must screen for Medicaid and CHIP If not eligible for Medicaid or CHIP, DPW or PID must

send application to the MarketplaceElectronic records as primary source of

information Search federal and state databases for income and

citizenship info Not ask client for paper proof as a first step

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Changes in Medicaid - Applying

Single streamlined application Apply online, over the phone, in-person, by mail Paper application is fixed but online is dynamic,

asking only the necessary questions Asks the questions for Medicaid, CHIP and the tax

credits and subsidies Does not require submission of verification documents

at point of application Can provide real time eligibility determination for

Marketplace products

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Changes in Medicaid - Applying

Help in applying and renewing Web site for the Marketplace

www.healthcare.gov Phone number for the Marketplace

800-318-2596 (with language access)

TTY 855-889-4325

Materials in English, Spanish, Chinese, French Creole, Korean, Polish, Portuguese, Vietnamese

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Changes in Medicaid - Applying

Help in applying and renewing Navigators

Paid, trained, and certified by the federal government Responsible for public education, outreach and

application and renewal assistance Have to be culturally and linguistically competent and

accessible for people with disabilities Certified Application Counselors

No federal funding Can do some or all of Navigator activities Will be trained and certified by the federal government

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Similar to Medicaid Same, single streamlined application

Same web site and phone number

Uses MAGI income and household size

Electronic data sources

Provides Essential Health Benefits

Renewal once a year

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Insurance through the Marketplace

Differences Income tax credit and subsidies available Reconciliation at tax time

So if not filing a tax return now, will have to in 2015 for 2014

May owe money back to IRS if subsidy was overpaid Four levels of cost sharing

Bronze, Silver, Gold and Platinum Subsidies and tax credits only for silver (80%)

Able to compare and choose from an array of plans Real-time enrollment

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Insurance through the Marketplace

How You Can Help

Most Important Facts to share:

All insurance plans will have to cover doctor visits, hospitalizations, maternity care, emergency room care, and prescriptions.

You might be able to get financial help to pay for a health insurance plan.

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How You Can Help

Most Important Facts to share:

If you have a pre-existing condition, insurance plans cannot deny you coverage.

All insurance plans will have to show the costs and what is covered in simple language with no fine print

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Don’t Forget!

Help in applying and renewing Web site for the Marketplace

www.healthcare.gov Phone number for the Marketplace

800-318-2596 (with language access)

TTY 855-889-4325

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PA Health Law ProjectAnn Bacharach – 215-625-3596

Helpline – 1-800-274-3258 For advice on applying, enrolling, renewal,

obtaining services For clients who need a lawyer to represent

them at hearings and appeals

Where to go for help22