Affordable Care Act (ACA) The Affordable Care Act

What is the Affordable Care Act? Patient Protection and Affordable Care Act (PPACA), a.k.a. ACA –Federal health care reform law –March 23, 2010 signed into law by President Obama –Goals: Expand coverage Control health care costs Improve health care delivery system 2 The Affordable Care Act

What does it do? Requires coverage regardless of pre-existing conditions or gender Intended to increase rate of individuals covered by insurance through: –Creation of insurance exchanges and expansion of Medicaid eligibility –Mandates on employers and individuals –Premium subsidies –Tax credits Intended to decrease number of uninsured individuals 3 The Affordable Care Act

What does it establish? Facilitates provision of qualified health coverage Mandates health benefit exchanges (also known as Marketplaces) by January 2014 in every state Regulatory overhaul of the U.S. healthcare system 4 The Affordable Care Act

State Requirements – Insurance Exchanges Choose an Insurance Exchange Option by December 14, options: State Based State Based Exchange (SBE) Built and maintained by each state State Example: Washington35% of states State Partnership Partnership Exchange Hybrid Model; state assumes certain responsibilities State Example: Delaware14% of states Federally Based Federally Facilitated Marketplace (FFM) Built by Federal government, each state establishes an interface with the FFE State Example: Pennsylvania51% of states 5 The Affordable Care Act

What role will be played by the FFM? The federally facilitated exchange is also referred to as the FFE or federally facilitated marketplace (FFM). Individuals may apply for insurance through the Exchange. The Exchange will determine eligibility for: –Advanced Premium Tax Credit (APTC) –Cost Sharing Reductions (CSR) 6 The Affordable Care Act

What are APTC and CSR? Advance Premium Tax Credit (APTC): A new tax credit to help individuals and families afford health coverage purchased through the Exchange. Cost Sharing Reduction (CSR): A discount that lowers the amount paid out-of-pocket for deductibles, coinsurance, and copayments. 7 The Affordable Care Act

How does ACA affect DPW? What Has DPW Already Done Related to ACA? Extended Medicaid Drug Rebates to drugs paid by Medicaid Managed Care Organizations. Implemented several new program integrity and provider enrollment screening processes. Began paying increased payments to Medicaid primary care providers. Implemented a recovery audit contract to identify payment issues and recoup overpayments. Implemented payment policies for hospitals that prohibited payment for a Health-Care Acquired Condition, such as infections acquired at the hospital. 8 The Affordable Care Act

How does ACA affect DPW? One goal of ACA is to provide a seamless and simplified enrollment process for all Insurance Affordability programs. Pennsylvania will accomplish this requirement for simplified enrollment by providing multiple ways to apply, including: Exchange –Electronic Application –Paper Application New Pennsylvania paper application form called the PA 600HC COMPASS – Updated to comply with ACA Phone Applications There is ‘no wrong door’ when applying for Medical Assistance and other Health Care Plans! 9 The Affordable Care Act

How does ACA affect DPW? The Modified Adjusted Gross Income (MAGI) standard will now be used for Medicaid eligibility. –MAGI will apply to adults, children, pregnant women, parents, caretaker relatives, and individuals eligible for family planning services. –MAGI does NOT apply to SSI recipients; children in foster care; individuals eligible based on being aged, blind, or disabled; working disabled; or individuals in a facility/eligible for home and community based care. 10 The Affordable Care Act

What is Early MAGI? PA applied for an Early MAGI waiver to start MAGI October 1, 2013 rather than January 1, Early MAGI will increase efficiency and reduce duplicative processes in the County Assistance Offices. 11 The Affordable Care Act

How does ACA affect DPW? Medicaid Eligibility Changes: –Children ages Income up to 133% of Federal Poverty Level (FPL) –Former foster care children up to age 26 ACA will NOT change eligibility or benefits for our waiver programs for individuals with physical and intellectual disabilities. 12 The Affordable Care Act

System Updates and Enhancements COMPASS –System design, screening, eligibility questions and routing –Ability to link to Federal Exchange –Ability to obtain information from data matches in “real time” CIS/eCIS/PROMISe –Medicaid eligibility rules under ACA –System design and screen changes 13 The Affordable Care Act

Consumer Service Center (CSC) The Commonwealth has taken steps to ensure that the needs of its citizens are met under the new Federal ACA mandate. CMS mandates the availability of a call center to take applications on the phone for ACA. The CSC opened on October 1, 2013 to answer questions about ACA and take COMPASS applications for health care only. 14 The Affordable Care Act

Critical Milestones October 2013 Enrollment applications under the new Modified Adjusted Gross Income (MAGI) eligibility rules begin to be accepted January 2014 Exchange coverage begins for Pennsylvania 15 The Affordable Care Act

Questions and Comments More information on Pennsylvania’s implementation of the Affordable Care Act is available at 16 The Affordable Care Act