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+ ACA and Vets & Families NASW IL Conference Oct 28 2013.

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Presentation on theme: "+ ACA and Vets & Families NASW IL Conference Oct 28 2013."— Presentation transcript:

1 + ACA and Vets & Families NASW IL Conference Oct 28 2013

2 + ACA 101 2

3 ACA signed into law on March 23, 2010 with major provisions to start January 1, 2014 “Health Insurance Marketplaces” have been established and will open October 1, 2013 Individuals are responsible to obtain health coverage through an employer, directly from an insurance company or through the Marketplace 3

4 ACA 101: Key Components Extended dependent coverage to age 26 No pre-existing condition exclusion for children Preventive services without cost sharing CountyCare-the early expansion of Medicaid in Cook County No lifetime limits on care Small business tax credits No insurance rescissions except in cases of fraud/intentional misrepresentation New Marketplace to buy insurance and receive financial help to pay for it New Medicaid Adult Group available to adults under 138% FPL Financial Assistance to purchase private insurance Medicaid available to former foster children up to age 26 at any income level No pre-existing condition exclusion for adults All plans must cover Essential Health Benefits No annual limits on care No gender rating Closing Medicare Part D donut hole Individual and Employer Responsibility Available Now…2014 and Beyond… 4

5 ACA 101: Preventive Care No Cost Sharing for certain preventive services, if provided in-network. However, there may still be some costs for the doctor’s visit if the visit includes other services besides the preventive service. List of covered services the same for all plans and includes immunizations, cancer screenings, access to birth control, and a range of other services. The full list is available at 5

6 26 Covered Preventive Services-- Highlights Alcohol & Drug Use AssessmentsBehavioral Health Assessments Depression for adolescentsDevelopmental Screening & Surveillance Immunizations – birth to age 18Obesity screening & counseling Hearing, Vision screeningsSTI – screening & counseling Oral health screening & assessment for birth – 10 HIV screening -- adolescents Autism screening at 18 & 24 monthsBlood Pressure screening for children for full list and more details ACA 101: Highlights of Preventive Care 6

7 ACA 101: Essential Health Benefits Federal VIP for vision for children Supplemented by All Kids for dental for children BCBS Blue Advantage 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 health plans in the Marketplace, individual & small group, are qualified health plans (QHP). 7 Illinois’ Benchmark

8 8 ACA 101: New Pathways to Coverage

9 + Healthcare Coverage Pathways for Veterans and their Families VA Tricare Marketplace and Medicaid 9

10 Important Dates OCTOBER 1, 2013 - Open Enrollment in the Marketplace/New Medicaid Begins. DECEMBER 15, 2013 - Must be enrolled by this date for Marketplace health coverage to begin by 1/1/14 JANUARY 1, 2014 - New Medicaid Adult Group Coverage begins. (No backdating before this date.) MARCH 31, 2014 - Open Enrollment for Marketplace ends (Medicaid is always open). 10

11 + Marketplace in IL 11

12 Marketplace in IL: Overview 12  Web shopping tool for individuals and small business to purchase private and public health insurance.  Gives consumers the tools and power to have control over their insurance decisions  Apples-to-apples comparison of plans  Find the right fit! 

13 Marketplace in IL: Eligibility & Application The applications for Medicaid and Financial Assistance in the Marketplace will ask for information about: Illinois Residency Citizenship/immigration status Income/Tax filing status Dependents and household composition Information will be electronically verified. 13

14 + Eligibility: Income Modified adjusted gross income (MAGI) guides paths to health coverage Why MAGI? It will standardize the calculation of income across all insurance affordability programs It is used both by the Marketplace and Medicaid to determine eligibility. Income is compared to program limits to determine source of health coverage MAGI is an income counting methodology, it is not a number on a tax form When using MAGI, resources/assets are not a consideration Veterans benefits are not counted 14

15 + Application: Household Composition How a household is determined is different for the Marketplace and Medicaid The information collected affects the person’s benefits so it must be entered correctly. 15

16 + Application: Household Composition Household information is provided to the Marketplace based on whether a person files taxes, plans to file taxes or is claimed as a dependent Tax information is used to determine the group size to compare income to the FPL and determine eligibility and amount of tax credits and subsidy Application for health coverage can be for all persons who file taxes together Medicaid programs use tax information to determine the group size and income eligibility for Medicaid benefits Eligibility for Medicaid is determined by income limits for the type of Medicaid program considered Application for health coverage is generally for persons living in the house together MarketplaceMedicaid 16

17 + Veterans and their Families 17

18 + VA Health Care Information Veterans who obtain health care through the USVA meet the requirements for minimum essential health benefits Veterans may be able to blend other health coverage with USVA coverage to increase access to providers Veterans enrolled in USVA health coverage are eligible to enroll in Medicaid if the individual qualifies for the benefit Veterans enrolled in USVA health coverage are able to access this benefit as well as Medicare if the individual qualifies for Medicare Veterans who have private insurance through an employer can be enrolled in USVA health coverage as well as private insurance If enrolled in USVA healthcare coverage the veteran is not eligible for tax credits and subsidy through the Marketplace 18

19 + VA and Families Families members of Vets enrolled in VA health care cannot receive VA health benefits Exception: Civilian Health and Medical Program (CHAMPVA); Spina Bifida Health Care Program Options for families: Tricare, Marketplace (Medicaid) 19

20 + CHAMPVA Eligibility Definitions TermDefinition BeneficiaryA CHAMPVA-eligible spouse, widow(er), or child. ChildIncludes birth, adopted, stepchild, or helpless child as determined by a VA regional office (see the “Rules that Impact CHAMPVA Eligibility” section of the CHAMVPA handbook).CHAMVPA handbook DependentsA child, spouse, or widow(er) of a qualifying sponsor. Qualifying SponsorA Veteran who is permanently and totally disabled from a service- connected condition, died as a result of a service-connected condition, was rated permanently and totally disabled from a service-connected condition at the time of death, or died on active duty and whose dependents are not otherwise entitled to DoD TRICARE benefits. Service-ConnectedA VA regional office determination that a Veteran's illness or injury is related to military service. SpouseThe wife or husband of a qualifying sponsor. Widow(er)The surviving spouse of a qualifying sponsor. 20

21 + Tricare and ACA Two Beneficiary categories: Sponsor (SM) and Dependents (family members) Some Tricare Plans qualify for Minimum Essential Coverage (MEC) and others don’t Tricare Prime; Reserve Select; Young Adult = yes Tricare for dependent parents and in-laws = no If electing Tricare, then no tax credit or subsidy through the marketplace 21

22 + Tricare Eligibility Eligibility depends on military status Active Duty Reserve/National Guard SMs and Families are eligible so long as the SM is attending drills Families Survivors’ remaining eligible when a sponsor dies depends on If the sponsor was AD or not If the survivor is a spouse or child 22

23 + Tricare’s differences Tricare Young Adult Tricare’s current age limit for children: 21 or age 23 if in school full-time Young Adult is a Tricare option that the child (or parent) may purchase for additional coverage Mental health and substance use disorder coverage limits may not meet the requirements for parity Other costs 23

24 + Medicaid Expansion in 2014 In 2014, anyone up to 138% (133% plus 5% income disregard) FPL is eligible for Medicaid, called “newly eligible” Medicaid. No disability requirement. Must be under 65, not entitled to or enrolled in Medicare A or enrolled in Part B. Modified gross income (MAGI) and no asset test, which is different from current Medicaid and All Kids Programs. Federal government pays for much greater percentage of this expansion. Veterans Benefits are not countable income 24

25 + Additional information and Resources Visit http://getcoveredillinois.gov Talk to a navigator: help/ help/ 25

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