The Impact of the Affordable Care Act on Safety Net Providers and their Patients: Opportunities for Outreach and Education

What We’ll Cover Expansion of Health Insurance Coverage Application and Eligibility Consumer Assistance Resources What Providers Can do to Help Resources for Consumers and Providers

Expansion of Insurance Coverage Many uninsured patients will become eligible for affordable health care coverage beginning in The Affordable Care Act: Strengthens private insurance for consumers. Creates a Marketplace in each state where individuals and small businesses can shop for insurance. Provides financial help for many people to better afford insurance through the Marketplace. Gives states the opportunity to expand Medicaid coverage to low-income adults.

Health Insurance Marketplace Every state will have a Marketplace (aka Exchange) where individuals and small businesses can shop for and purchase private health insurance. All options will be in one place, with clear language and apples-to-apples comparisons about prices and benefits. Plans offered through the Marketplace are called Qualified Health Plans (QHPs). Enrollment starts October 1, 2013 Coverage starts January 1, 2014 Enrollment starts October 1, 2013 Coverage begins as early as January 1, 2014 Enrollment starts October 1, 2013 Coverage begins as early as January 1, 2014

Advantages of the Marketplace Helps enhance competition in the health insurance market. Increases Affordability through premium tax credits, cost sharing reductions, or public insurance programs. Ensures Quality through QHPs that must meet basic standards, including quality standards, consumer protections, and access to an adequate range of clinicians. Makes Costs Clear by providing information about prices and benefits in simple terms consumers can understand, so they don’t have to guess about costs.

Marketplace Establishment Source: Kaiser Family Foundation. Status of State Health Insurance Exchange Decision, as of July 1, 2013, available at reform/state-indicator/state-decisions-for-creating-health-insurance-exchanges-and-expanding-medicaid/# reform/state-indicator/state-decisions-for-creating-health-insurance-exchanges-and-expanding-medicaid/# State-Based (SBM):16 States & DC are setting up & managing their own Marketplaces. State Partnership (SPM): 7 States are working in partnership with the federal government. Federally-Facilitated (FFM): In 27 States the federal government is setting up the Marketplace.

Help to Pay for Qualified Health Plan Costs 90% of the uninsured will qualify for some form of financial assistance based on family income and size. Eligible persons can get premium tax credits and/or purchase plans with lower cost-sharing (e.g., co-pays and deductibles). % of Federal Poverty Level (FPL) Individuals household income* Family of 4 household income* –Discounted Premiums – % –$11,490 - $45,960 –$23,550 - $94,200 –Reduced Cost-sharing – % –$11,490 - $28,725 –$23,550-$58,875 % of Federal Poverty Level (FPL) Individuals household income* Family of 4 household income* Premium Tax Credits % $11,490 - $45,960 $23,550 - $94,200 Reduced Cost- sharing % $11,490 - $28,725 $23,550- $58,875 *Based on 2013 Federal Poverty Guidelines

Medicaid Expansion States have the option to expand Medicaid eligibility to adults ages with incomes up to 133% of the Federal Poverty Level (FPL)*. One streamlined application for Medicaid and Marketplace private health plans. Shifts to simplified way of calculating income (MAGI) to determine Medicaid/CHIP eligibility. 100% federal funding for newly Medicaid eligible phased down to 90% by States have no deadline to decide if they are going to expand. * ($15,282/year for an individual, $31,322/year for a family of 4)

Expanding Medicaid Source: Kaiser Family Foundation. Status of State Medicaid Expansion Decision, as of August 28, 2013, available at

What If a State Does Not Expand Medicaid? Individuals whose income is more than 100% of the federal poverty level* will be able to buy health insurance in the Marketplace and may be eligible for subsidies to help pay for coverage. Individuals whose income is less than 100% of the federal poverty level* will be able to get insurance in the Marketplace, but are not eligible for financial assistance. –These individuals may be able to get an exemption from having to pay a fee for not having health insurance coverage. Even if a state is not expanding Medicaid, individuals should apply for coverage to see if they qualify. Find out if your state is expanding Medicaid at HealthCare.gov. * $11,500 per year as a single person (about $23,500 for a family of 4

Eligibility Cheat Sheet Income level % FPL Eligible : For Medicaid? To purchase insurance through Market- places? For insurance purchased through the Marketplace: Premium Tax Credits Reduced cost- sharing 0 to 100% Currently eligible people will generally remain eligible. Individuals with incomes up to 138% FPL will be able to enroll in Medicaid in states that implement Medicaid expansion Yes No (Exception: legal immigrants) 100% - 138%Yes Yes* 138% - 250% Generally not (although some States cover some individuals) Yes 250% - 400%NoYesYes*No Above 400%NoYesNo Not lawfully presentNo (except emergency Medicaid)No * unless eligible for other minimum essential coverage as defined in IRC 5000A(f)

Outreach and Enrollment National Snapshot 41 million eligible uninsured 17.8 million years old –58% male –26% Latino –18% African American CBO projects 7 million to enroll in Marketplaces in HHS has primary responsibility for outreach in 29 states Poverty Level 20% have not graduated High School 3.8 million rely on Spanish One million rely on some other language

Who will Remain Uninsured? After these new options are implemented, there may still be up to 31 million uninsured persons in the U.S in 2023, including: Citizens under 100% FPL in states that don’t expand Medicaid. Individuals who are not “lawfully present”. Persons who are exempt from the Individual Responsibility Payment (e.g., members of Indian Tribes, those with religious objections). Persons who choose to pay the Individual Responsibility Payment.

Application and Eligibility One streamlined application to apply for Medicaid, the Children’s Health Insurance Program (CHIP), the new Health Insurance Marketplace, and tax credits that will help pay for premiums in the Marketplace. Submit single, streamlined application to the Marketplace Verify and determine eligibility Online Phone Mail In Person Supported by Data Services Hub Eligible for Marketplace or Medicaid/CHIP Enroll (Marketplace) Enroll (Medicaid/CHIP)

Timelines for Enrolling Initial Open Enrollment starts October 1, 2013 and ends March 31, 2014 with QHP coverage effective as early as January 1, Annual Open Enrollment: October 15, 20xx-December 7, 20xx Special Enrollment Periods available. Medicaid enrollment will continue to occur throughout the year.

Enrollment Assistance Call 24x7 Support for 150 Languages In Person Medicaid/CHIP Online/phone/in person Written Applications in English/Spanish Notices & letters Plans Payment online/phone Ongoing customer service Mobile 24x7 & text updates Online 24x7 Webchat English/Spanish site User Account Assistance API available for other sites Syndicated content

In-Person Consumer Assistance Framework Two categories of in-person consumer assistance are available : Marketplace Assisters Marketplace Educators

Marketplace Assisters Navigators In-person Assisters SBM (optional) Consumer SPM (required) Certified Application Counselors (CACs) Agents/Brokers Call Center Representatives Listed on in Local Help & Customer Service Referralswww.HealthCare.gov Listed on in Local Help & Customer Service Referralswww.HealthCare.gov

Navigator Grant program sponsored by each Marketplace to provide consumer assistance. Navigators have a number of responsibilities including, but not limited to: –Maintaining expertise in eligibility, enrollment, and program specifications and conduct public education activities. –Providing accurate and impartial information about QHPs and other health programs such as Medicaid and CHIP. –Facilitating selection of a QHP. –Providing information in a manner that is culturally and linguistically appropriate and accessible for people with disabilities. Navigators must be trained and certified. Navigator Program

Transitional program to supplement Navigators. –Optional for State-based Marketplace. –Required for State- Partnership Marketplace. In-Person Assisters perform generally same functions as Navigators. –In most cases, have similar role and responsibilities. In-Person Assisters have comprehensive training and certification requirements similar to Navigator program. In-Person Assisters

CACs provide assistance in every Marketplace. –Educate consumers about insurance affordability programs and coverage options. –Help consumers apply for coverage through the Marketplace. –Have more limited role than other assisters. Do not receive federal Marketplace grant money –May receive other private, state, or federal funding Certified Application Counselors (CAC)

Marketplace designates organizations that may serve as CACs. –For example, community health centers, hospitals, other health care providers, social service agencies. FFM will designate certain types of organizations: –Must have processes to screen staff/volunteers to ensure they protect personally identifiable information. –Must engage in services that position them to help those they serve with health coverage issues. State-based Marketplace may follow FFM guidance for designating organizations or establish own processes.

May apply to be a designated organization for FFM or SPM: CAC Training is available at: –Link to CAC training: –Link to CAC training content: CAC Application & Training

Marketplace Educators Partners & Stakeholders Local government branches & employees School administration & staff Then Direct to Customer Service Website Call Center Assister Aren’t displayed in Find Local Help tool and aren’t consumer referral points – educators refer consumers

Champions for Coverage A new way to recognize organizations who are engaged in outreach and education efforts. Organizations can fill out an online form on marketplace.cms.gov/help-us/champion.html to become publically recognized as a “Champion.” marketplace.cms.gov/help-us/champion.html Outreach activities can include:  Sending s to their networks about the Marketplace.  Posting the HealthCare.gov widget on their website.  Recording and sending out PSAs about the Marketplace.  Hanging posters and/or giving out fact sheets and brochures about the Marketplace.  Hosting a conference call, webinar, or another educational event about the Marketplace.

Recap: Marketplace Consumer Assistance State-Based Marketplace Partnership Marketplace Federally- Facilitated Marketplace NavigatorsYes In-Person Assisters Only if state elects to YesNo Certified Application Counselors Yes EducatorsYes

What Providers Can Do 1. Educate patients: What the options are: Many individuals who stand to benefit under the expansion are not aware of their options. How insurance works: Many newly-eligible individuals would benefit from education on how insurance works (e.g., how cost-sharing works, what a provider network is). 2.Sign up to be a Champion for Coverage. 3.Partner with local organizations that provide application assistance to: Offer on-site application assistance. Develop a plan for referring patients to assistors.

What Providers Can Do 4.Assist patients with applying for and enrolling in health coverage: Apply to be a Certified Application Counselor. Accessing the eligibility and enrollment system (ideally through computer kiosks; also accessible via the phone or mail.) Working their way through the application. Understanding and evaluating factors they should consider when selecting a plan. For example: Does it cover the Rx I need? Does it include the provider(s) I want to see?

Healthcare.gov Healthcare.gov is where consumers can go to: –Learn about their health insurance options; –Get accurate information on different plans; –Apply for and enroll in coverage; and/or –Get directed to the Marketplace in their state. Assisters will be listed on the site so consumers can find local help. Facebook.com/Healthcare.gov

Marketplace.cms.gov Get the latest resources to help people apply, enroll, and get coverage in 2014

(TTY ) –Assistance available 24/7 –English, Spanish, and 150 languages June – September –Call Center will provide general information to consumers and employees of SHOP employers. Starting in October –Call Center will help with eligibility, enrollment, and referrals. State-based Marketplaces will have their own call center and consumers will be referred as appropriate National Marketplace Call Center

HRSA Affordable Care Act Website – Provider Marketplace Toolkit – HIV/AIDS Bureau Affordable Care Act Website – HRSA Resources

Key Points to Remember The Marketplace is a new way to find and buy health insurance. Consumers in all 50 states will have better health insurance choices when open enrollment begins on Oct. 1, There is financial help for working families and other people with limited income. There is assistance available to help consumers get the best coverage for their needs through HealthCare.gov, the call center, and in-person assistance.

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