Presentation on theme: "Affordable Care Act: Implementation in Illinois Implications for Low Income Populations and Legal Services Attorneys."— Presentation transcript:
Affordable Care Act: Implementation in Illinois Implications for Low Income Populations and Legal Services Attorneys
The Affordable Care Act: Quick Review Medicaid Expansion to 138% FPL for adults (CountyCare Early Implementation) Marketplace Insurance with Financial Help including Premium Tax Credits to 400% FPL and Cost-Sharing Subsidies to 250% FPL Insurance Reforms: Guaranteed Issue, Rating, Pre-existing Conditions Individual and Employer Mandates
Recall the uninsured who qualify for the Marketplace 3
Important Timelines Open Enrollment for Marketplace = October 1, March 31, 2014 Purchase insurance on Marketplace by December 15, 2013 to ensure coverage by January 1, Enroll in Medicaid anytime but outside of Cook County, new adult group begins coverage January 1, 2013.
Who helps navigate the Marketplace? Marketplace Individuals Illinois Assister Program Navigators, In-Person Counselors, Certified Application Counselors Registered Agents & Brokers Resource Center 5
Illinois Landing Page Illinois Health Insurance Marketplace Assess Medicaid/CHIP Eligibility Application for APTC/CSR Eligibility Determination for APTC/CSR Select and enroll in Quality Health Plan without APTC/CSR Select and enroll in Quality Health Plan with APTC/CSR ABE Application available to state office State worker Processes Application Eligibility Determination If denied for Medicaid/CHIP refer to Marketplace If eligible, enroll in Medicaid/CHIP If potentially eligible referred to Medicaid/CHIP Where to Begin the Path to Coverage
Potentially eligible: for Premium Tax Credit/ Marketplace Potentially eligible: AllKidsMarketplace Potentially eligible: Moms and Babies (Pregnant or child under 1) Marketplace Potentially eligible: ACA Adult Medical or Family Care Marketplace Household Size 100%* 133% 150%200%250% 300%400% 1$11,490$15,282$17,235$22,980 $28,725 $34,470$45, ,510 20,62823,265 31,020 38,775 46,53062, ,530 25,97529,295 39,060 48,825 58,59078, ,550 31,32235,325 47,100 58,875 70,65094, ,570 36,66841,355 55, ,710110, ,590 42,01547,385 63,180 78,975 94,770126, ,610 47,36153,415 71,220 89, ,830142, ,630 52,70859,445 79,260 99, ,890158,520 For each additional person, add $4,020 $5,347$6,030 $8,040 $10,050 $12,060$16,080 7 * lawfully present residents below 100% FPL and ineligible for Medicaid may qualify
What Benefits Can a Person Apply for Through ABE? ABE Medicaid Coverage ACA Adult, Family Care, AllKids, Moms and Babies AABD Medical, Medically Needy /Spend down and HBWD Cash TANFAABD Cash Food SNAP Medicare Savings Program 8
New Medicaid and Marketplace Methodology For New Adult Group, All Kids and Family Health Plans: Use Modified Adjusted Gross Income Test and no asset test. For Existing AABD Medicaid: Use existing Medicaid income methodology with asset test. MAGI combines tax status, household, income and existing Medicaid rules.
Non-Citizen Eligibility Medicaid eligibility remains the same: LPR over 5 years, refugee/asylee, children, pregnant women, emergency. Marketplace eligibility is more liberal: lawfully residing may buy at any income level and receive financial assistance.
Shared Responsibility (the mandate) Most individuals without insurance will pay a penalty (with their federal income tax return). Employer Penalty delayed for one year. Individuals must maintain Minimum Essential Coverage (MEC) for themselves and dependents. Taxpayers filing a joint return are jointly liable for penalties. Medicaid=MEC. Some individuals will be exempt from the penalty, others may be eligible for financial help on Marketplace. 11
Exemptions from the mandate Hardship or domestic circumstances Lacks coverage for less than three months (one 3- month period per year) Household income below threshold for federal taxes Contribution for single coverage exceeds 8% of household income Income or Affordability Religious conscience Membership in a health care ministry Member of an Indian tribe Membership/ Affiliation Incarceration Not lawfully present in the U.S. or non-resident aliens U.S. citizens living abroad for 330+ days in 12-months Residents of U.S. territories Legal or Residential 12
Contact Information and Resources Stephanie Altman Health & Disability Advocates