Affordable Care Act

1. Affordable Care Act What does it mean for our families and communities? www.icirr.org

2. Overview • Review of Affordable Care Act (ACA) • Private insurance reforms and the Marketplace • ACA and immigrants/refugees www.icirr.org

3. Already Have Insurance? • Everyone needs to have insurance by March 31, 2014 with some exceptions • If you have insurance through your employer that is affordable, you don’t have to do anything • If you have private insurance that complies with the base requirements, you don’t have to do anything • If you are on public insurance (Medicare, Medicaid), you don’t have to do anything and your coverage will be getting better www.icirr.org

4. Key Dates • October 1, 2013 • “Get Covered Illinois” opens to buy health care insurance • December 15, 2013 • Last day to sign up for insurance to have a January 1, 2014 effective date • January 1, 2014 • New health insurance coverage purchased on “Get Covered Illinois” begins • March 31, 2014 • Last day to sign up for health care insurance for 2014 www.icirr.org

5. Why is the new health care law important? Currently and after 2014: • Insurance companies will cover some of the costs • Preexisting conditions • Preventive care services • Women • Medicare patients • Children under the age of 26 • Small businesses • Lifetime limits • High-risk pool • Medicaid • Tax credits Changes today: • Costs • Preexisting condition • Lifetime limit • Underinsured • Women

6. Available Now • Dependent Coverage up to age 26 • Consumer protections/transparency • No pre-existing condition exclusion for children • No lifetime limits • Health plans cannot drop people when they get sick • Insurers are required to spend 80-85% of premium dollars on patient care (and refund consumers when they spend less!) • Preventative Services – no co-pay for many services in private insurance & Medicare • Small business tax credits • Increased primary care rates for Medicaid providers in 2013-2014 • Closing of Medicare Part D “donut hole” (entirely by 2020)

7. Starting in 2014 and beyond • State or federal “Health Insurance Marketplace” – new marketplaces with Essential Health Benefits package (Enrollment begins Oct. 1, 2013) • Large Medicaid Expansion to Adults up to 138% FPL • No pre-existing condition exclusion • Consumer protections – no annual limits, no rating by health status or gender only by age, location & smoker/non-smoker • Shared Responsibility Provisions • Individual Mandate • Employer Mandate (for orgs with 50+ FTEs) – postponed until 2015

8. Essential Health Benefits Package: What is it? • Ambulatory patient services; • Emergency services; • Hospitalization; • Maternity and newborn care; • Mental health and substance use disorder services; • Prescription drugs; • Rehabilitative and habilitative services and devices; • Laboratory services; • Preventive and wellness services including chronic disease management; • Pediatric services including oral and vision care. • All non-grandfathered health plans in individual & small group market must cover these essential benefits at a minimum • Illinois has chosen BCBS Blue Advantage as the Benchmark Plan supplemented by AllKids for dental and Federal VIP for vision for children. Illinois is currently developing their Medicaid Expansion Benchmark – most likely similar to FamilyCare.

9. The Marketplace (“Get Covered Illinois): • User friendly format to understand terms, compare benefits & services across plans • Enables you to: • Enroll in Medicaid and possibly other public benefits • Find out if you’re eligible for financial assistance that make coverage more affordable • Health plans required to have enough doctors, perform well on quality measures • Will keep health insurance low www.icirr.org

10. Financial help for families with household incomes100%-400% FPL

11. List of Insurance Companies selling plans in the Marketplace • Blue Cross & Blue Shield of Illinois • Humana, Inc. • Aetna Inc. • Land of Lincoln Health Inc. Co-Op • Coventry Health Care Inc. • Carle Foundation • These 6 Insurance companies will be selling over 150 plans in the Marketplace. www.icirr.org

12. Individual Mandate/Responsibility Provision • Requires most individuals (including children) to carry “minimum essential” health coverage • Many exemptions: • Religious reasons • Undocumented non citizen • Household income is below the minimum threshold for filing a tax return(Go to www.irs.gov/uac/Do-I-Need-to-File-a-Tax-Return%3F for tax assistant) • Unaffordable coverage (insurance premiums exceed 8% of family income) • Payment, exemption or penalty is through the federal income tax return: www.icirr.org

13. ACA’s New Medicaid Eligibility Category Current Program New Category Why it is good for Illinois? www.icirr.org

14. Current Specialized Medicaid Programs in IL • On top of the traditional Federal program, Illinois has three programs for families and children www.icirr.org

15. Medicaid’s New Eligibility Category • In 2014: • U.S. Citizens, Lawfully Residing Immigrants and LPRs with five years in U.S., ages 19-64 with incomes up to 133% FPL ($14,856 individual) • Enrollment is via Get Covered Illinois or through ABE (Application for Benefits Eligibility – www.abe.illinois.gov) • Also able to apply for SNAP and cash benefits at same time www.icirr.org

16. What? • A new Medicaid program • Who? • Lives in Cook County. • Be 19-64 years old • Have income at or below 133% of the FPL ($14,856 individual;$20,123 couple-annually) • Not be eligible for “State Plan” Medicaid (Parent, Pregnant, Blind or receiving disability income) • Not be eligible for Medicare • Be a legal immigrant for 5 years or more OR be a US citizen • Have a SS# or have applied for one www.icirr.org

17. The ACA and Immigrants Naturalized Citizens Legally present immigrants Undocumented www.icirr.org

18. U.S. Citizens and Immigrants under the ACA www.icirr.org

19. Resources • www.ifrpil.org • Getcoveredillinois.gov • www.kff.org • www.healthcare.gov • http://www.ageoptions.org/services-and-programs_AffordableCareActTipSheets.html • www.illinoishealthmatters.org • http://www.illinoisfreeclinics.org/clinic-search • http://www.nafcclinics.org/clinics/search • www.ilmaternal.org www.icirr.org

20. Special Thanks to