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Albert Schweitzer Fellowship Monthly Meeting September 11, 2013 The Affordable Care Act: How it will Affect the Patients We Serve 1.

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Presentation on theme: "Albert Schweitzer Fellowship Monthly Meeting September 11, 2013 The Affordable Care Act: How it will Affect the Patients We Serve 1."— Presentation transcript:

1 Albert Schweitzer Fellowship Monthly Meeting September 11, 2013 The Affordable Care Act: How it will Affect the Patients We Serve 1

2 Topics Covered Today Overview of the Affordable Care Act Private Health Insurance Public Health Insurance Covered Services 2

3 Implementation of the Affordable Care Act Quick Overview! video/ 3

4 The Marketplace: Private Health Insurance What is a Health Insurance Marketplace? - A virtual portal available to consumers to figure out what insurance coverage they are eligible for, review and compare insurance plans, and enroll in health coverage. How will Illinois consumers apply for health coverage? - Consumers in Illinois will apply for health coverage through the Illinois Health Insurance Marketplace, that is a partnership between the state and federal government. - Marketplace will be accessible through a website, phone or paper application. - Timeframe for enrollment: October 1, 2013- May 31, 2014 4

5 Medicaid: Public Health Insurance What is Medicaid? -A public health insurance option administered jointly by the states and the federal government. - Participation in the program is voluntary, Congress has instituted a number of eligibility and coverage requirements for states that wish to participate. - States retain significant power in crafting coverage and eligibility provisions, which vary significantly from state to state. 5

6 How is Medicaid Changing Under the Affordable Care Act?  Federal & Illinois Medicaid Policy - A national Medicaid minimum eligibility level of 133% of the federal poverty level ($29,700 for a family of four in 2011/($14,484 for an individual in 2011) for nearly all Americans under age 65. - New mandatory eligibility group consisting of non-pregnant adults between 19-65 with incomes at or below $133% FPL. -This Medicaid eligibility expansion goes into effect on January 1, 2014 but states can choose to expand coverage with Federal support anytime before this date. - Approximately 500, 000 to 800,000 Illinois residents will be covered under this restructured Medicaid program at little or no cost to individuals. 6

7 New Eligibility Standards: Modified Adjusted Gross Income (MAGI) Federal Agency Regulation & Enforcement - Internal Revenue Service - Department of Health & Human Services - State Agency: Illinois Department of Healthcare and Family Services Income Calculation- Countable Income + 5% Universal Income Deduction - up to 138% FPL All other forms of income deductions formerly included will be disregarded. 7

8 Traditional Medicaid and Medicaid Expansion Under the Affordable Care Act  Traditional Medicaid Plans - Eligibility based on individual’s aid category + State Financial Test - Pregnant women, Children, Parents, Seniors, Individuals with Disabilities - Medicaid beneficiaries receive wide range of benefits not covered in plans on the private market.  Alternative Benefit Plans (ABPs) - Medicaid Benchmark Equivalent Plans, must cover the Essential Health Benefits (EHBs) specified in the ACA. - Newly Eligible Individuals will receive benefits through this plan.  Churning - Medicaid and Marketplace Eligibility standards will significantly effect individuals with varying income levels. 8

9 Individuals Affected by Medicaid Expansion  Women - Pregnant Women: more women would qualify for Medicaid after pregnancy - Non-Pregnant Women: Entitled to 22 Preventive Care Services without cost sharing or deductibles.  Children - All children between the ages of 0-19 are eligible for Medicaid as long as they fall at or below the 133%-138% FPL.  Families (Parents/Caretaker Relatives) - All former income deductions will be disregarded to determine eligibility.  Homeless Youths - Eligible for traditional Medicaid or newly eligible Medicaid, depending on age. - Lack of awareness is the main concern. 9

10 Services Required Under the Affordable Care Act Autism Screening Behavioral Assessments Depression Screening Developmental Screening Iron Supplements Hematocrit or Hemoglobin Screening Immunization Vaccines Height, Weight & BMI Measurements Lead Screening Obesity Counseling PKU Screening STI Prevention Counseling Vision & Hearing Screening Well Women Visits Breast Cancer Genetic Test and Mammography Screening Cervical Cancer Screening FDA approved Contraception Domestic Violence Counseling HIV Screening & Counseling HPV DNA Test Osteoporosis Screening Rh Incompatibility Screening Sexually Transmitted Infections Counseling Abdominal Aortic Aneurysm one-time screening Alcohol Misuse Counseling Blood Pressure Screening Cholesterol Screening Colorectal Cancer Screening Depression Screening Diabetes (Type 2 Screening) HIV Screening Immunization Vaccines Obesity Counseling Syphilis Screening Essential Health Benefits (EHBs) Preventive Care Services - Adults Preventive Care Services – Children Preventive Care Services – Women 10

11 Illinois Programs to Facilitate Implementation  Illinois CountyCare (1115 State Waiver) - CountyCare is a federally-funded demonstration project, waiving traditional Medicaid requirements for many uninsured adults in Cook County. - Early implementation of the Medicaid Expansion under the Affordable Care Act for select patients and providers. - Cook County HHS estimates that at least 115,000 and as many as 250,000 residents may be eligible for CountyCare.  ABE (Application for Benefits Eligibility) - Streamline Access to Enrollment Process: The client facing portal that individuals can use to apply to several public benefits programs: TANF, SNAP and other medical benefits. - Question/Answer format brings the applicant to the correct page for either the Health Insurance Marketplace or Medicaid. - Not real time eligibility, but ABE will help to assess potential eligibility and provide guidance to the correct program. 11

12 Sources for Health Reform Information & Updates United States Department of Health & Human Services Centers for Medicare & Medicaid Services Keeping America Healthy American Public Health Association American College of Obstetricians & Gynecologists Illinois Department of Healthcare & Family Services 12

13 Loyola University Chicago School of Law Public Interest Law Reporter Annual Law Journal Symposium Increased Access to Healthcare: The Impact of the Affordable Care Act’s Medicaid Expansion on Underserved Communities November 8, 2013 9:30am- 4pm Philip Corboy Law Center, 25 E. Pearson St., Chicago IL Invitation! 13

14 “In the Health Justice Project, doctors, social workers, lawyers and students of each profession are partnering to address the social and environmental causes — like unhealthy housing conditions and improperly denied food stamps — at the root of poor health.” Emily A. Benfer, clinical professor of law, director of the Health Justice Project, Loyola University Chicago School of Law, Beazley Institute for Health Law & Policy Chicago Tribune, October 5, 2011 Health Justice Project 14

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