2. The Affordable Care Act and West Virginians Libraries West Virginia Library Commission Conference October 10, 2013

3. Todays Presentation Review the four major provisions of the Affordable Care Act (ACA) Review the new enrollment process and who will be involved in enrollment Discuss how libraries can be involved in the enrollment process 2

4. ACA Has Four Main Goals New regulations of the insurance industry Renewed emphasis on prevention Cost containment, particularly for Medicare Expands health insurance to virtually all Americans 3

5. Health Insurance Coverage Is Expanded In Two Ways Medicaid is expanded to cover everyone under 138% of the federal poverty level who is under age 65. New Health Insurance Marketplaces are created where subsidized, private insurance products are sold. 4

6. New Coverage Options 5

7. Expanding Health Insurance The Medicaid expansion is projected to cover an estimated 133,500 low-income West Virginians. Federal government pays almost all of the costs. 6

8. Medicaid Expansion: Income Eligibility for a Family of Three 7

9. Medicaid Eligibility Income Household size US citizenship State Residency Under age 65 8 < 138% of FPL

10. Income Eligibility for Medicaid Family Size138% of FPL155% of FPL 1$15,856$17,810 2$21,404$24,040 3$26,951$30,272 4$32,499$36,502 9 138% applies to children over age one and adults. 155% applies to pregnant women and children under age one.

11. Changes in CHIP With the increase in Medicaid eligibility, many children currently enrolled in CHIP will become Medicaid eligible and cannot remain on CHIP: 10,800 CHIP kids transfer to Medicaid 2,800 kids gain CHIP coverage under the new income eligibility rules 10

12. Health Insurance Marketplace 11

13. Health Insurance Marketplace A marketplace allows consumers to compare and choose private health insurance policies that best suits their needs. Policies offered through a web site, 1-800 number, by mail or with personal assistance. 12

14. Health Insurance Marketplace The marketplace is open to individuals who do not have employer sponsored health insurance and small businesses. Significant tax credits for individuals between 100% and 400% of the FPL. An estimated 99,000 West Virginians will qualify for premium tax credits in the exchange. 13

15. Subsidy for family of 4 earning $50,000 14 Policy Cost = $789 Family Pays = $282 Govt. Subsidy = $507 (64% ) Additional assist with deductibles and copayments plus out- of-pocket maximum protection

16. FPL for Cost Sharing Subsidies and Premium Subsidies Family Size250% of the FPL400% of the FPL 1$28,725$45,960 2$38,775$62,040 3$48,825$78,120 4$58,875$94,200 15 250% of the FPL level is the eligibility threshold for cost sharing reductions and 400% of the FPL is the threshold for premium assistance

17. Health Insurance Marketplace Highmark Blue Cross Blue Shield the only carrier to participate in 2014 They are offering 11 different plans: 4 gold plans; 3 silver and 3 bronze plans; and one catastrophic plan. Two additional ones from BCBS nationally, but appear to be identical to state offered plans. 16

18. Three Levels of Plan Options in West Virginia Gold plan Insurance company pays 80% of claims and consumers on average pay 20% of the claims. Silver = 70/30 Bronze = 60/40 17

19. Premiums in the Various Metal Levels Premiums in a gold plan would be higher, while deductibles and copayments would be lower Conversely, the premiums in a bronze plan will be lower, while the cost sharing would be higher 18

20. The Marketplace and Small Businesses Eligibility for the SHOP marketplace is 50 or fewer employees, about 42,000 West Virginia businesses employing 280,000 people. Highmark is offering 4 plans in the SHOP Marketplace in 2014 19

21. How Will the Enrollment Process Work? 20

22. The Enrollment Process Simplified enrollment for Medicare, CHIP and premium tax credits in the health insurance marketplace One enrollment form No face-to-face interviews No paper documentation No asset test 21

23. Timelines Enrollment begins October 1, 2013 If someone enrolls by the 15 th of the month, then coverage for Medicaid and qualified health plans begins the first day of the following month. Get people enrolled by December 15 th. If after the 16 th on the month, coverage begins on the first day two months later. 22

24. How Do We Enroll All These People? HHS will maintain a web site: And a call center: 800-318-2596 Can also enroll through the mail A number of entities will provide personal assistance 23 www.healthcare.gov

25. Personal Assistance Insurance agents and brokers Navigators Advanced Patient Advocacy/Hospitals WVU Healthy Starts TSG Consulting In-person assisters – 270 Maximus Placed in DHHR and SHIP offices so far. Community health center employees Certified Application Counselors DHHR Employees 24

26. How to Find Personal Assistance bewv.wvinsurance.gov: Click on Where Can I Find Local Help? Gives county level data The national web site has ZIP code level data, but doesnt filter information well. See 25 localhelp.healthcare.gov

27. Community Assisters Enroll uncomplicated cases, arrange for public education sessions, and connect the uninsured to navigators, in-person assisters, community health centers, etc. WVAHC is providing mini grants, training and on-going technical support to develop community assisters. 26

28. Community Assisters Are Throughout the State Eastern Panhandle EPFC Berkley County Health Department Morgan County Starting Points Mineral County FRN Future Generations 27

29. Community Assisters Are Throughout the State North Central West Virginia Tucker County FRN Taylor County FRN Milan Puskar Health Right Lewis County FRN 28

30. Community Assisters Are Throughout the State Northern Panhandle AIDS Task Force of the Upper Ohio Valley Brooke County Health Department Hancock County Health Department Wheeling Health Right 29

31. Community Assisters Are Throughout the State Mid-Ohio Valley Boys and Girls Club of Parkersburg Catholic Charities Good Samaritan Clinic Mid-Ohio Valley Regional Corrections 30

32. Community Assisters Are Throughout the State Kanawha/Cabell Covenant House West Virginia Health Right Marshall University (students) Partnership of African American Churches WV FREE WV Healthy Kids and Family Coalition 31

33. Community Assisters Are Throughout the State Southern West Virginia Beckley Health Right Big Creek People in Action (McDowell) Christian Help of Mingo County Community Connections Greenbrier County Health Department Nicholas County Starting Points Raleigh County Community Action Program SALS 32

34. Community Application Counselors Library employees can be certified application counselors. Guidance on CAC is available at http://www.cms.gov/CCIIO/Resource s/Regulations-and- Guidance/Downloads/CAC- guidance-7-12-2013.pdf http://www.cms.gov/CCIIO/Resource s/Regulations-and- Guidance/Downloads/CAC- guidance-7-12-2013.pdf 33

35. Certified Application Counselors Disadvantage: There is no federal or state funding for CAC. Advantages: Eligibility is a web based training for 5 hours and pass a test. Listed on HHS and OIC web sites as being certified. 34

36. How Can Libraries Be Involved Connect uninsured patrons to navigators, in-person assisters, community health centers, etc. so they can get covered. Host enrollment sessions at your library. 35

37. How Can Libraries Be Involved Post the names and contact information of navigators, in person assisters, community health centers, CAC, and community assisters in the library 36

38. How Can Libraries Be Involved Display material that objectively explains the Affordable Care Act and the new enrollment process Other suggestions? 37

39. Opportunity We have a once-in-a-lifetime opportunity to improve the lives of thousands of our friends and neighbors. I hope you will join WVAHC in this journey We need… 38

40. 39

41. Contact Information Perry Bryant perrybryant@sudddenlink.net 304-344-1673 (Office and Home) 304-533-7941 (Cell) www.wvahc.org 40

42. Web Sites www.wvahc.org bewv.wvinsurance.gov localhelp.healthcare.gov www.healthcare.gov www.marketplace.cms.gov www.kff.org www.enrollamerica.org 41