What Tribal Leaders Need to Know About the Affordable Care Act (ACA)
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DESCRIPTIONWhat Tribal Leaders Need to Know About the Affordable Care Act (ACA) National Indian Health Outreach & Education Initiative March 11, 2014. Learn more about. Impact of the ACA on American Indians and Alaska Natives (AI/ANs) Medicaid Expansion Benefits AI/ANs - PowerPoint PPT Presentation
What Tribal Leaders Need to Know About theAffordable Care Act (ACA) National Indian Health Outreach & Education InitiativeMarch 11, 2014
Impact of the ACA on American Indians and Alaska Natives (AI/ANs)Medicaid Expansion Benefits AI/ANs AI/ANs Can Enroll in Health Plans through the Marketplace or local I/T/UIncreased Resources for I/T/Us and CHS SavingsTribal Sponsorship Exemptions for AI/ANsImpact on Tribal Employers
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Impact of the ACA on American Indians and Alaska Natives
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (ACA)
The ACA protects the rights of all Americans, including American Indians and Alaska Natives (AI/ANs), to access affordable health care
More than 32 million people in this country who would otherwise not have health insurance will have access to health coverage
The Health Care Law
Health Care & Federal Trust Responsibility
Permanent reauthorization of the Indian Health Care Improvement Act
Strengthens the Indian Health Service and ensures that AI/ANs will be able to continue to receive services from I/T/UsProvides special protections for Indians to gain greater access to health coverage
Impact of the ACA on American Indians and Alaska Natives (AI/ANs)
Expanded Authority for IHS: Reauthorization of the IHCIA allows IHS to modernize its health care delivery systems & permit tribal governments to make technical changes in the future
Greater Workforce: New resources to increase the number of doctors, nurses and other health care providers in AI/AN communities
Strengthening the Indian Health Service
Increased Revenue: Third party billing increases funding to IHS that supports both direct care and contract health care services
Medicaid Expansion Benefits American Indians and Alaska Natives
Medicaid Expansion for Indian Country
Tribal Leaders must continue to advocate for Medicaid Expansion if their state has not opted to expandStates have the option to expand Medicaid eligibility to adults ages 19 - 64 with income up to $31,322/yr. for a family of 4, or $39,155/yr. in Alaska* Average income of AI/AN households is $35,192**Modified Adjusted Gross Income used to determine eligibilityNo premiums or deductibles for AI/ANs who are eligible to and do receive IHS, tribal 638, or urban Indian health services
No copays for services received from an Indian health care provider or through referral under contract health services
AI/AN Benefit from Medicaid Expansion*2013 Federal Poverty Level**US Census Bureau, 2012
AI/ANs Can Enroll in Health Plans through the Marketplace or Local I/T/U
AI/ANs May Apply for Medicaid, Childrens Health Insurance Program (CHIP), or Marketplace plans Enrollment assistance is available through the Marketplace or local I/T/UTax Credits for health plans lower the monthly premiums qualified individuals pay (up to 400% FPL)Family of four with annual income $23,550* - $94,200*Zero and Limited Cost Sharing Plan Variations available to members of federally recognized tribes or ANCSA Corporations
AI/AN Can Enroll In Health Plans through the Marketplace or Local I/T/U
*2013 Federal Poverty Level
Members of federally recognized tribes or ANCSA Corporations:
No out of pocket costs if enrolled in a Zero Cost Sharing Plan Variation (300%FPL) for services provided by an I/T/U or through referral by contract health services.
Special Monthly Enrollment Period and can change their enrollment status in any plan through the Marketplace once a month.
Eligible for an Exemption from the Shared Responsibility Payment. Note: Exemption is not automatic, application required.
Protections for Indian Country in the Marketplace
300% FPL = individual income of $34,470/yr. and family of four $70,650/yr.
The Application Process
OnlinePhoneMailIn PersonSupported by Data Services HubFind out more about the Marketplace in your state by visiting healthcare.gov.
Increased Resources forI/T/Us
Increased Resources for I/T/Us and CHS Savings through AI/AN Enrollment
Tribal Sponsorship of Marketplace Plans
Some tribes are purchasing health insurance (Qualified Health Plans) for some or all of its citizens through the Marketplace. Zero cost sharing plan variation and limited cost sharing plan variation available at different metallic levels.
Tribal Sponsorship of Health Insurance Plans
Plan levels in Marketplace: Bronze, Silver, Gold & Platinum
Plans will vary by: the cost of premium & out of pocket costs.
Lower Premium Higher PremiumHigher AV Means Less Cost Sharing
All insurance plans certified by the Marketplace must:
Include 10 Essential Health Benefits (EHB)
Limit cost-sharing deductibles, copayments, and out-of-pocket maximum amounts
Offer zero cost sharing plan variation and limited cost sharing plan variations for AI/AN
What are Qualified Health Plans (QHPs)
10 Essential Health BenefitsAmbulatory Patient ServicesPrescription DrugsEmergency servicesRehabilitative & Habilitative Services and DevicesHospitalizationLaboratory ServicesMaternity & Newborn CarePreventive & Wellness Services and Chronic Disease ManagementMental Health & Substance Use Disorder Services, Including Behavioral Health TreatmentPediatric Services, including Oral & Vision Care
Benefits of Tribal Sponsorship
Tribe could purchase the bronze plan (lowest premium) for Tribal citizens. Many Tribal citizens will qualify for tax credits (lowers monthly premium) and cost sharing reductions. Tax credits available up 400% FPL. Family of four with annual income $23,550* - $94,200*Members of federally recognized tribes and ANCSA Corporations may enroll in zero cost sharing plan variation (300% FPL)Individuals not eligible for plan variations could qualify for cost sharing reductions if
Exemptions for American Indians and Alaska Natives
Individuals who can afford health insurance but choose not to buy it, must pay a fine known as an individual shared responsibility payment.
In 2014, the fine is $95 per person ($47.50 per child under 18) with maximum of up to $285 per family using this method OR up to 1% of yearly household income, whichever is higher. For 2014, the payment is made through 2014 tax return filing in April 2015.
In 2015, it is $325 per person or 2% of income; and in 2016, it is $695 per person or 2.5% of income.
How Much is the Fine for Not Having Insurance?
Who Qualifies for an Exemption from the Fine?
Members of federally recognized tribes or ANCSA Corporations; or individuals eligible for services from an Indian health care provider.
Individuals/families where the lowest-priced coverage available would cost more than 8% of the household income. Individuals uninsured for less than 3 months of the year.
Individuals who do not have to file a tax return because their income is too low.
If other other circumstances apply. See healthcare.gov/exemptions/ for other exemptions.
Members of federally recognized tribes and ANCSA Corporations May apply for the exemption through the Marketplace; ORMay claim the exemption when they file their 2014 taxes (due April 15, 2015). Individuals eligible to receive services through an Indian health care providerMay only apply for the exemption through the Marketplace. Once you receive the exemption, you dont have to apply again unless your circumstances change (i.e., no longer enrolled or not eligible for services).
How do AI/ANs Claim the Exemption?
AI/AN Exemption Application
Available at: http://marketplace.cms.gov/getofficialresources/publications-and-articles/tribal-exemption.pdfCovers both types of AI/AN exemptions.One application can be used for the tax household.Instructions for the Application will be available soon.
What is Needed to Apply?
Required documentation to apply:Documents showing tribal membership or eligibility for services from the I.H.S., a tribal health care provider or an urban Indian health care provider. Social security numbersInformation about people in your tax household
Complete and sign the application. Mail the application with the required documents to address provided. Per application, applicant will receive a response within 1-2 weeks if more information is needed. If exemption is approved, applicant will receive a certificate of exemption number for filing of tax return.
Impact of ACA on Tribal Employers
Tribal Employer Opportunities & Requirements
ACA Employer Provisions At-A-Glance
ACA Provisions Number of employees 1 to 2425 to 4950 to 99100-200> 200Small Business Health Care Tax CreditX
Small Business Health Options Program (SHOP)XX(up to 50)
IRS Assessable Payments & ReportingX(transition relief in 2015)XX
Why is this Important for Tribes?If a Tribe is considered a large employer, it may incur an assessable payment for not offering health insurance.Tribes may be eligible to purchase health insurance through the Small Business Health Options Program (SHOP). Tribes can strategize to meet ACA employer requirements in a cost effective manner.
Small Tribal Employer Opportunity
What is SHOP?SHOP = Small Business Health Options Program Designed to help small businesses purchase health insurance for employees.Allows an employer to compare plans based on