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Navigating the Changes Megan Holt, LCSW. Key Points I am One of You… I Did Not Write This Law… I Often Do Not Understand It Either... I am Not the Expert…

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Presentation on theme: "Navigating the Changes Megan Holt, LCSW. Key Points I am One of You… I Did Not Write This Law… I Often Do Not Understand It Either... I am Not the Expert…"— Presentation transcript:

1 Navigating the Changes Megan Holt, LCSW

2 Key Points I am One of You… I Did Not Write This Law… I Often Do Not Understand It Either... I am Not the Expert…

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4 Primary Payors Medicare Medicaid Private Payors (Insurance) Self-Pay / Uninsured

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6 Eligibility & Rules (ACA) For the Uninsured Up to 400% FPL Qualified Health Plans Must Meet All Essential Elements of ACA Subsidized by Federal Government States May Choose Medicaid Expansion States Must Establish Marketplaces

7 Essential Health Benefits (ACA) Ambulatory SvcsPrescription Drugs Emergency SvcsPreventive/Wellness HospitalizationMaternity & Newborn Rehabilitative & Habilitative Services/Devices Pediatric Services (Oral & Vision) Mental Health & Substance Abuse Disorder Svcs

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9 Avenues for the Uninsured (ACA) Option One: Insurance – New Marketplace Up to 400% FPL Subsidized – Income-Based Requires at least 2 Providers per County Metallic Plans – Must Be Fairly Issued Option Two: Tax Penalty Increases Each Year if Remain Uninsured

10 Avenues for the Uninsured (Ark) Medicaid Traditional Methods (17%FPL or Below) Disabled… Medically Frail (Includes SMI) Medicaid Expansion PRIVATE OPTION (up to 138% FPL) Insurance Marketplace (ACA) Exchange Plans (139% - 400% FPL)

11 Marketplace in Arkansas Blue Cross/Blue Shield of Arkansas Blue Cross/Blue Shield –Multi-State QualChoice Ambetter (Novasys) Will Come Back to These….

12 Private Option (Arkansas) Arkansas’s Version of Medicaid Expansion (But Not Medicaid) Childless Adults (19-65) With Incomes ≤138% Federal Poverty Level Parents (19-65) With Incomes 17% - 138% Federal Poverty Level (FPL) Not on Medicare and Not Disabled

13 Private Option (Arkansas) “Purchase” Insurance Plans in the New Marketplace – Subsidized by Federal Government Must be Silver Metallic Plan or Better Estimated 225,000 ≤138% FPL Should Enroll IMD Exclusion Does Not Apply…so The BridgeWay Can Accept PO Patients

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15 Marketplace in Arkansas Blue Cross/Blue Shield of Arkansas Blue Cross/Blue Shield –Multi-State QualChoice Ambetter (Novasys)

16 Blue Cross Plans Only Only Blue Cross Plans QualChoice Blue Cross Plans AmbetterQualChoice Only Only Blue Cross Plans AmbetterQualChoice QualChoice Blue Cross Plans AmbetterQualChoice

17 Marketplace in Arkansas Metallic Plan Options Bronze (Covers 60% of Expenses) Bronze (Covers 60% of Expenses) Silver (Covers 70% of Expenses) Silver (Covers 70% of Expenses) Gold (Covers 80% of Expenses) Gold (Covers 80% of Expenses) Platinum (Covers 90% of Expenses) Platinum (Covers 90% of Expenses)

18 Marketplace in Arkansas Outside of Private Option… Deductibles and Co-Pays Apply to Most Plans Deductibles and Co-Pays Apply to Most Plans Some are as High as $6,500 Individual and $12,000 Family Some are as High as $6,500 Individual and $12,000 Family Subsidies Only Impact Monthly Premium Subsidies Only Impact Monthly Premium

19 Marketplace in Arkansas Opened October 1, 2013 Federal Plans Closed March 31, 2014 Private Option Remains OPEN Coverage Began January 1, 2014 Expected 500,000 Arkansans are Uninsured Estimated 225,000+ Will Meet Private Option or Medicaid Qualifications

20 Marketplace in Arkansas Outreach & Education Signing Up… More Info at Certified Application Counselors (CAC) Several at The BridgeWay

21 Summary Uninsured in Arkansas Medicaid (Must Qualify) Marketplace Insurance Plans Private Option (Fully Subsidized) ACA (Patient and Government Shared) Four (4) Qualified Health Plan Companies in Arkansas Only 2 (BC/BS) Cover All of Arkansas Enrollment Ends March 31, 2014

22 Summary Private Option is Technically Not Medicaid Expansion (But Uses Federal Dollars the Same Way) Private Option “Insurance” Is Accepted at The BridgeWay Adult Medicaid Payments to Free- Standing Facilities are Still Denied

23 Working Together… Sign People Up… Call Us for Help ( ) Work With State Legislators…

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