1. ACA Update 2014-2015 – Denver County December 2014

2. Historic Opportunities with the ACA “Sick Care” System Exclusionary Episodic High-cost Uninsured in Denver: 2012: 17% (American Community Survey) “Health Care” System Inclusive Comprehensive Preventive Lower-Cost 2018 Projected: 6% Wellness & Prevention Sick Care

3. ACA Improvements in Coverage - 2010 Insurance companies can no longer refuse to cover children with pre-existing conditions or drop coverage from people who get sick. Children can stay on parents’ insurance until age 26. Free preventive services without co-pays, even if deductible has not been met.

4. Examples of Free Preventive Services Selected Free Preventive Services Pregnancy and Newborns Screening for anemia and infections; vitamin supplementation; breastfeeding support and counseling; newborn screening Well Child Care Screening for autism, hearing, vision, depression, obesity, lead; all recommended vaccinations Bone Health Osteoporosis screening Sexual Health Screening for STDs and intimate partner violence; STD prevention counseling; Contraception Infections Hepatitis C & HIV testing; all recommended vaccinations for adults Mental Health Depression screening Cardiovascular Disease Screening for high blood pressure, diabetes, high cholesterol and obesity; dietary and obesity counseling Cancer Screening for breast, cervical and colon cancer; counseling about sun exposure Substance Use Tobacco use screening and cessation services; alcohol misuse screening and counseling More information available at www.Healthcare.gov

5. Who Lacked Insurance in Denver? 1 in 5 Denver residents were uninsured prior to 2014: Source: American Community Survey, 2011 104,178 Uninsured 17% overall

6. Where were Denver’s Uninsured? Source: American Community Survey, 2008-2012

7. ACA Expansion of Coverage - 2014 Based solely on income Enrollment is year-round! 0-133% of FPL: $15,282 for single $31,322 for family of 4 (2014 scale) Assistance to Purchase Insurance No Denials for Pre-Existing Conditions Enrollment in Open Enrollment Period, 10/1/2013- 3/31/2014 and after certain life events 133-400% of FPL: $45,900 for single $94,200 for family of 4 Ave. Subsidy: $277/mo (2014 scale) Key Exclusion for All New Coverage: Undocumented persons and some legal residents. Individual Insurance Mandate: Everyone must have health coverage or pay a penalty - $95 or 1% of annual income when filing 2014 tax return, increases in later years. Two New Forms of Subsidized Coverage: 91% of eligible uninsured prior to 2014 estimated to qualify (ACS 2012)

8. The Promise of Expanded Health Coverage Improved health for Denver residents – more preventive services, better control of chronic illnesses Funds to support the expansion of clinical care for the newly- insured Less cost-shifting to government and employer-sponsored health insurance Promotes price transparency and health care system collaboration

9. Denver’s Community Health Improvement Plan (CHIP), 2013-2018 5-Year Access to Care Goal: By December 2018, at least 95% of Denver residents will have access to primary medical care, including behavioral health care. Available at: BeHealthyDenver.org

10. Denver’s CHIP Objectives Objective A1: Increase the number of Denver residents with health care coverage by supporting implementation of the Affordable Care Act (ACA). 40,000 Denver residents enroll in Medicaid and subsidized insurance by July 1, 2014. 94% have health care coverage by December 31, 2018. Objective A3: Create a health alliance of important stakeholder organizations in Denver, to increase access to care, better coordinate health care services, and decrease health care costs. Mile High Health Alliance, 2014 First Access to Care Working Group

11. Denver ACA Enrollment, 2014

12. Where are People Accessing Care? Jan-Sept 2013 compared to Jan-Sept 2014 Denver Health Outpatient Visits

13. 33,0000 New Medicaid patients Jan-Sept 2014 Increased revenue in 2014 Waiting list to get into primary care reduced by more than half: 10,000 (October 2013) >> 4000 (2014) Adding 20 new provider teams (15 medical, 5 dental) Expanded specialty care visits Expanded hours at some clinics Favorable bond market rating: New Southwest Clinic opening 11/2015, renovation of Westside Clinic More patients with a payer source Increased revenue Increased capacity to provide services to low-income persons ACA Impact on Denver Health

14. ACA Update 2015 0-133% of FPL: $15,521 for single $31,721 for family of 4 (2015 scale) 133-400% of FPL: $46,680 for single $95,400 for family of 4 (2015 scale) Second Open Enrollment Period Shorter! 11/15/2014 - 2/15/2015 Enrollment is Year- Round! Penalties Increasing! Tax YearFinancial Incentive: Whichever is Greater 2014$95 per adult, $47.50 per child (up to $285) OR 1.0% of family income 2015$325 per adult + $162.50 per child (up to $975) OR 2.0% of family income 2016 and Beyond $695 per adult + $347.50 per child (up to $2,085) OR 2.5% of family income

15. Who Still Needs Insurance in Denver? Sources: 2012 American Community Survey, HCPF, Connect for Health Colorado, Kaiser Family Foundation (2014) Survey of Non-Group Insurance Enrollees The Big Work Ahead: Connect for Health Colorado Enrollment! Remaining Uninsured 82.3% of those eligible to purchase plans at C4HCO are expected to qualify for financial assistance! Subsidies are substantial - 2013-2014 C4HCO average $277/family

16. Potential Barriers to Enrollment Negative media coverage about the ACA Continued access to CICP, although it does not satisfy the individual mandate to have insurance Lack of knowledge about: new forms of coverage – Medicaid and Connect for Health CO – and eligibility availability of financial assistance to purchase insurance generous size of the subsidies (average $277/family, C4HCO 2013-2014) Insurance generally – what it is, how to use it, why have it? Perception of unaffordability of insurance Unwillingness to pay for insurance, even with subsidies Many plans to choose from - 176 plans at Connect for Health Colorado in 2014-15

17. Overcoming the Barriers People do want insurance – 84% of those who did not enroll in 2013-2014 want it (Enroll America survey). Accurate and widely available information about the benefits of health insurance and how the ACA helps people get covered. Assistance to sign up for Medicaid and insurance plans. CICP does NOT satisfy the individual mandate – holders will pay penalty. They can use CICP as secondary coverage to help with co-pays. Tax penalty going up – from $95 to $325 per adult or 1% to 2% of family income in 2015. Connect for Health CO is working – individual plans went up by only 0.71% on average statewide this year. Medicaid is free, good coverage for those who qualify. Many others are getting it - 42,351 new adults got Medicaid in Denver in 2014, up 79% from 2013. 1/5 people in CO have it now!

18. Identify: Most uninsured people in Denver will qualify for Medicaid subsidies at C4 Nearly all people with CICP will qualify for Medicaid (CICP E rating or lower and some with F rating) or subsidies + CICP does not cover the individual insurance mandate Parents whose children have Medicaid or CHP+ are likely to qualify for the new coverage programs Inform: Importance of health insurance - better health, regular source of care, free preventive services! New sources of coverage – Medicaid and Connect for Health Colorado Provide brochures and information about how and where to enroll – importance of in-person assistance and where to get it! What You Can Do to Help Get People Enrolled

19. Piton Foundation: For copies contact mviola@piton.org Denver Health: For copies contact Betty.Rueda@dhha.org Provide Brochures!

20. What You Can Do to Help Get People Enrolled Refer to Phone and Online Enrollment Sites Give patients and clients information about how to check their eligibility and sign up for Medicaid or subsidized insurance by phone or online Phone:Toll-free: 1-800-221-3943 TDD: 1-800-659-2656 Apply Online: Colorado.gov/PEAKColorado.gov/PEAK Phone:Toll-free: 1-855-PLANS4YOU Toll-free: 1-855-752-6749 Apply Online:ConnectforHealthCO.comConnectforHealthCO.com

21. What You Can Do to Help Get People Enrolled Refer to In-Person Enrollment Assistance Sites! Refer clients to organizations that can assist with enrollment in Medicaid or purchasing insurance on the insurance exchange. Sites may have interpreters to help clients enroll. Lists of sites available at: colorado.gov/apps/maps/hcpf.map colorado.gov/apps/maps/hcpf.map List of sites available at: connectforhealthco.com/let-us- help/assistance-network/

22. Medicaid and Connect for Health Colorado Enrollment Assistance Sites in Denver

23. Summary - Key messages for 2014-2015 Health insurance is important for physical and financial well-being. Most of Denver’s pre-ACA uninsured (91%) will qualify for assistance to get covered. The level of support is significant: $277/mo in 2013-14. The penalty increases to 2% of income, $325/person. The open enrollment period is only 3 months – 2/15/15. The marketplace is keeping costs contained - average increase in cost for plans in CO was 0.71%.

24. Questions? Contact Information: Dr. Lisa McCann Advisor to the Denver Access to Care Task Force and Mile High Health Alliance Lisa.McCann@dhha.org