1. The Affordable Care Act: Implementation in Illinois Impact on People with Disabilities and Special Health Care Needs Stephanie F. Altman, J.D. December 2013

2. ACA 101 ACA signed into law on March 23, 2010 with major provisions to start January 1, 2014. “Health Insurance Marketplaces” opened October 1, 2013: Get Covered Illinois operates the marketplace and enrollment for Medicaid expansion. Individuals are responsible to obtain health coverage through an employer, directly from an insurance company or through the Marketplace, Medicaid or Medicare. Employers over 50 FTE are responsible for providing coverage but employer penalty delayed for one year. 2

3. ACA 101: Key Components Available Now… 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 2014 and Beyond… 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 (exception for some current plans) No annual limits on care No gender rating Closing Medicare Part D donut hole Individual and Employer Responsibility (but employer penalty delayed) 3

4. ACA 101: Essential Health Benefits All health plans in the Marketplace, individual & small group, are qualified health plans (QHP). 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 4 Illinois’ Benchmark

6. 6 ACA 101: New Pathways to Coverage

7. Get Covered Illinois www.getcoveredillinois.gov Media and Marketing Campaign Administered by Governor’s Office Marketplace Team in partnership with DOI, HFS, DPH and DHS as well as other state agencies. Community enrollment assistance. Includes both insurance and Medicaid. 7

8. Important Dates OCTOBER 1, 2013 - Open Enrollment in the Marketplace/New Medicaid Begins. DECEMBER 23, 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). 8

9. In Person Assistance Federally funded (Just over $3 million via 11 awards in IL) Duties: Outreach, Facilitate Enrollment, Provide Ongoing Support Who: Cannot be a health insurance provider or someone paid by an health insurance provider to enroll individuals Navigators State funded (just over $28 million via 44 awards in IL) Duties: Outreach, Facilitate Enrollment, Provide Ongoing Support Who: Cannot be a health insurance provider or someone paid by an health insurance provider to enroll individuals In Person Counselors (IPCs) Volunteers—no funding Will participate in a training to provide application assistance Who: Anyone that submits an application to the federal government and is approved. You must demonstrate that you have procedures in place to protect personal information. Certified Application Counselors (CACs)

10. THE UNINSURED 10

11. 1.5 million uninsured non-elderly adults in Illinois 11

12. Young adults in Illinois are the most likely to be uninsured 12

13. have shopped for insurance outside their job 44% have been uninsured for 2 years or more have been uninsured for 2 years or more 67% The Uninsured: Past Experiences Connecting Communities to Coverage 2013 13

14. The Uninsured: Understanding of Law NOTE: Don’t know/Refused answers not shown. SOURCE: Kaiser Family Foundation Health Tracking Poll (conducted March 5-10, 2013) Do you feel you have enough information about the health reform law to understand how it will impact you personally, or not?

15. ILLINOIS MEDICAID EXPANSION

16. Medicaid in IL: New Programs Pre-ACA FamilyCare for parents and other caretaker relatives of children under 19 All Kids Moms and Babies Aid to the Aged Blind and Disabled (AABD) Health Benefits for Workers with Disabilities (HBWD) Health Benefits for Persons with Breast and Cervical Cancer (apply with Illinois Dept. of Public Health) Post-ACA ACA Adult Former Illinois Foster Child FamilyCare for parents and other caretakers of children under 18 All Kids Moms and Babies Aid to the Aged Blind and Disabled (AABD) Health Benefits for Workers with Disabilities (HBWD) Health Benefits for Persons with Breast and Cervical Cancer (apply with Illinois Dept. of Public Health) 16

17. Medicaid Expansion 19-64 and not eligible for other Medicaid category No asset or disability test Under 138% FPL State currently seeking input from stakeholders in coverage package called ABP Waiver programs and LTSS Managed Care Roll Out Interaction with Medicare 17

18. ILLINOIS MARKETPLACE 18

19. Marketplace Overview 19  Get Covered Illinois is a web-based portal for individuals and small businesses to enroll in coverage. Can also access by mail, on phone, or in person.  Enroll in public and private health insurance, as well as access financial assistance to pay for coverage.  Federally Facilitated Marketplace is linked to Get Covered Illinois  Gives consumers the tools and power to have control over their insurance decisions  Apples-to-apples comparison of plans  Plan Finder and Individual Pricing

20. 2014 Open Enrollment Enrollment Date/PeriodEffective Coverage Begins Oct. 1 – Dec. 23, 2013Jan. 1, 2014 1 st – 15 th of month (Jan. – March) 1 st of following month 16 th – last day of month (Dec. – March) 1 st of second following month Initial Open Enrollment Ends March 31, 2014 20 Note: Coverage is not retroactive ***Those who are eligible for Medicaid can apply for coverage any day of the year!

21. Insurance Rating and Pricing Demographics Age (3:1) Household Income Family size Tobacco use Location/Zip code (13 rating areas) Plan factors Out-of-Pocket limits Benefit levels Insurance Affordability Programs – Premium tax credits – Cost-Sharing Reductions (CSR) 21

22. Cost: Two Types of New Financial Assistance Helps people pay the monthly cost to have a plan Premium Tax Credits Decrease the charges (e.g., copays, deductibles) enrollees must pay when receiving health care services covered by the plan Cost- Sharing Reductions 22

23. Who Is Eligible for Tax Credits/Subsidy? A U.S. Citizen and Unable to obtain affordable minimum essential coverage, such as coverage provided through an employer, Medicaid or the Marketplace Eligible to enroll in a QHP through the Marketplace Part of a tax filing unit Has household income between 100% and 400% FPL A non-citizen who is lawfully present and Unable to obtain affordable minimum essential coverage, such as coverage provided through an employer, Medicaid or the Marketplace Eligible to enroll in a QHP through the Marketplace Part of a tax filing unit Has household income between 0-400% FPL Cost sharing subsidies are provided if eligible for a tax credit with an income between 100%-250% FPL and enrolled in a silver plan through the Marketplace 23

24. 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% 138%200%250% 300%400% 1$11,490$15,282 $15,856 $22,980 $28,725 $34,470$45,960 215,510 20,628 $21,404 31,020 38,775 46,53062,040 319,530 25,975 $26,951 39,060 48,825 58,59078,120 423,550 31,322 $32,499 47,100 58,875 70,65094,200 527,570 36,668 $38,047 55,140 68925 82,710110,280 631,590 42,015 $43,594 63,180 78,975 94,770126,360 735,610 47,361 $49,142 71,220 89,025 106,830142,440 839,630 52,708 $54,689 79,260 99,075 118,890158,520 For each additional person, add $4,020 $5,347$5,548 $8,040 $10,050 $12,060$16,080 Connecting Communities to Coverage 2013 24 * lawfully present residents below 100% FPL and ineligible for Medicaid may qualify

25. Impact of Marketplace Financial Help on People with Employer Insurance Not intended for those with employer coverage. Provisions in place to discourage those with employer offer buying into exchange with financial help. Employer offer to employee is not more than 9.5 % of the HH income. Dependent coverage “glitch” 25

26. Exemptions from Shared Responsibility 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 26

27. How To Stay Informed in Illinois Bookmark www.illinoishealthmatters.orgwww.illinoishealthmatters.org To Enroll: www.getcoveredillinois.govwww.getcoveredillinois.gov Sign up for IHM newsletter, Linkedin, Facebook page, Twitter (@ILHealthMatters), and Blog