1 CHOICE Regional Health Network In-Person Assister Program Helping individuals learn about and apply for health coverage through the new Washington Healthplanfinder

2 CHOICE Regional Health Network Topics Covered Who is CHOICE? Affordable Care Act (ACA) overview Implementation of the ACA in Washington State Health Benefit Exchange & In-Person Assistance Program overview In-Person Assisters and how they can help

3 CHOICE Regional Health Network Non-profit, collaborative organization, established in Dedicated to improving health in Central Western Washington through collective planning and action of health care leaders.

4 CHOICE Regional Health Network Emergency room visit reduction program Donated care programs for uninsured Dental access programs Collaborative health system improvements (focused on transitions of care, cardiac response) Headquarters in Olympia

5 CHOICE Regional Health Network Affordable Care Act (ACA) in Washington State W ASHINGTON H EALTH B ENEFIT E XCHANGE : The “Exchange” created in 2011 M EDICAID E XPANSION : Included in Biennial Budget signed by Governor Inslee on June 30, 2013

6 CHOICE Regional Health Network Consumer can't afford doctor Consumer delays care, goes to ER Consumer can't pay Providers shift cost to Insurers Insurers shift cost to consumer Consumer drops policy due to high price and is now uninsured After 100+ years, why now?

7 CHOICE Regional Health Network Goals of ACA Slows the rising health care costs on the Gross Domestic Product Expands health care coverage to 32 million uninsured Americans – Expands Medicaid – Offers affordable Qualified Health Plans In our region, the number of uninsured is estimated at 80,000 individuals.

8 CHOICE Regional Health Network Impact of the ACA Kids can’t be denied coverage if they are sick Young adults can stay on parents policies until age 26 Eliminates “pre-existing conditions” exclusions Prohibits lifetime limits Closes Medicare prescription doughnut hole Expands coverage by expanding Medicaid and by offering Qualified Health Plans

9 CHOICE Regional Health Network Ten Essential Health Benefits Ten essential Health benefits 1. Ambulatory services6. Prescription drugs 2. Emergency services7. Rehabilitative and habilitative services and devices 3. Hospitalization8. Laboratory services 4. Maternity and newborn care9. Preventive and wellness services and chronic disease management 5. Mental health and substance use disorder services, including behavioral health treatment 10. Pediatric services, including oral and vision care 9

10 CHOICE Regional Health Network Individual Mandate Require all citizens and legal residents (there are some exceptions) to have health coverage by January 1, There are a number of ways to meet the mandate. There are also exceptions. People will not go to jail if they do not meet the mandate! 10

11 CHOICE Regional Health Network S atisfying the Mandate You are insured through a combination of any of the following sources: Medicare TRICARE or veteran’s health program An employer-provided plan Medicaid/Apple Health Insurance you buy that is at least at the Bronze level A grandfathered health plan in existence before the health reform law was enacted 11 No Penalty

12 CHOICE Regional Health Network Mandate Exemptions Religious objections Undocumented immigrant Incarcerated American Indians and Alaskan Natives Income below the tax filing threshold The lowest cost plan option exceeds 8 percent of an individual’s income 12 No penalty for being without health insurance.

13 CHOICE Regional Health Network Penalties $95 per adult $47.50 per child (max. $285/family) or 1% of income whichever is greater 2015 $325 per adult $ per child (max. $975/family) or 2%of income whichever is greater 2016 $695 per adult $ per child (max. $2,085/family) or 2.5% of income whichever is greater

14 CHOICE Regional Health Network Uninsured in WA Estimated impact of ACA in Washington Data Source: Office of Financial Management, State Population Survey; compiled by CHOICE

15 CHOICE Regional Health Network *Urban Institute 15

16 CHOICE Regional Health Network Medicaid Expansion (WA Apple Health) Medicaid: now expanded to cover individuals 19 – 65 with incomes up to 138% FPL, meet citizenship requirements, are not incarcerated, are not entitled to Medicare. Presumptive SSI (aka DL-X) Medical Care Services Program Basic Health Program ADATSA BCCT Take Charge Family Planning Family Planning Extension CHIP Medicaid Standard Medicaid Alternative Benefit Plan CHIP Medicaid Standard Exchange with Subsidy Exchange without Subsidy 2014 Coverage Continuum through Insurance Affordability Programs (IAPs) Budgets Propose Various Eliminations

17 CHOICE Regional Health Network SSI SSI-related (Aged, Blind, Disabled) Medicare Savings Program Healthcare for Workers with Disabilities Nursing Homes Waiver Services Medical Care Services (+65 or immigration status) MCS ADATSA Aged, Blind, Disabled cash program (the old GA-X/DL-X Program). Classic MedicaidAuto-Converted

18 CHOICE Regional Health Network Current Medicaid who need to Reapply through WA Healthplanfinder Apple Health for Kids (Children’s Medicaid) Pregnancy Medical

19 CHOICE Regional Health Network Medicare The new insurance marketplace does not effect those on Medicare. – There are also no Medicare supplemental plans for purchase in new marketplace.

20 CHOICE Regional Health Network Washington Health Benefit Exchange The ACA establishes an Exchange in each state, to organize the new insurance marketplace. HBE responsible for: – Online enrollment tool development. – Contracting with organizations for customer support. – Determining eligibility and tax credits. – Aggregate premiums and send monthly payment to carriers. – Review and certify qualified health plans. To learn more:

21 CHOICE Regional Health Network Qualified Health Plan Qualified Health Plan (QHP): an insurance plan certified by the OIC/Exchange that provides 10 essential health benefits, follows rules on cost- sharing, and meets other requirements, like… – Network adequacy – Marketing – Include certain providers that serve low-income, underserved communities

22 CHOICE Regional Health Network Qualified Health Plan - Metal Tiers 22 Bronze LevelSilver LevelGold LevelPlatinum Level Bronze plan benefit coverage is equivalent to: 60% Silver plan benefit coverage is equivalent to: 70% Gold plan benefit coverage is equivalent to: 80% Platinum plan benefit coverage is equivalent to: 90% Actuarial Value: The amount (%) of the bill that the insurer pays

23 CHOICE Regional Health Network Approved Companies Offering Plans through WAHealthplanfinder.org Bridgespan Community Health Plan of Washington Coordinated Care Group Health Cooperative Lifewise Molina Healthcare Premera Blue Cross Kaiser Foundation Health Plan of the Northwest Pediatric Dental: Dental Dental of WA, Kaiser Foundation, Lifewise, Premera

24 CHOICE Regional Health Network Health Insurance Premium Tax Credits (HIPTC) Designed to make premiums affordable for individuals and families with lower incomes Only available to individuals and families with income up to 400% Federal Poverty Level (FPL) – Can be used to reduce monthly premiums – Can be claimed as a credit on annual tax return Must apply through Washington Healthplanfinder 24

25 CHOICE Regional Health Network Health Insurance Premium Tax Credit and Cost Sharing Reductions Income LevelPremium as Percent of Income Up to 133% FPL 2% of income % FPL3-4% of income % FPL4-6.3% of income % FPL % of income % FPL % of income % FPL9.5% of income Income Level Reduction in Out-of- Pocket Liability % FPL 94% of the actuarial value* % FPL 87% of the actuarial value % FPL 73% of the actuarial value Premium Tax Credits: Cost Sharing Reductions: *Of the second lowest cost Silver plan

26 CHOICE Regional Health Network 26 New Continuum of Affordable Options * Medicaid (Adult Coverage) Medicaid (Pregnancy Coverage) Apple Health for Kids (Medicaid/CHIP) Premium Tax Credits & Cost-Sharing Reductions for Exchange Health Plans Exchange Health Plans *138% 185% 300% 400% 0%100%200%300%400% % Federal Poverty Level * The ACA’s “133% of the FPL” is effectively 138% of the FPL because of a 5% across-the-board income disregard Health Care Coverage in 2014

27 CHOICE Regional Health Network How will people get coverage? Website Agent Broker Navigator In-person Assister Self- Directed Partner Customer Support Center

28 CHOICE Regional Health Network WAHealthplanfinder.org Details Single point of entry for individual, families and small businesses to apply for coverage. Tool provides on-the-spot eligibility results: – Interfaces with federal and state systems to verify info What if a user doesn’t have a computer or has questions about insurance coverage?

29 CHOICE Regional Health Network In-Person Assister Program Established to help consumers learn about, apply for and enroll in appropriate health insurance coverage. – Focused on reaching most vulnerable uninsured people who require assistance to enroll into the expanded health care options – Community awareness, outreach, and enrollment are program components. HBE contracting with “Lead Organizations” to develop a network of In-Person Assisters and referral partners to carry out this program. CHOICE was awarded contract in June.

30 CHOICE Regional Health Network CHOICE’s Seven County Region Clallam Grays Harbor Jefferson Lewis Mason Pacific Thurston

31 CHOICE Regional Health Network Lead Organization Responsibilities Build local network of community-based organizations Lead outreach and education activities for service area Train Assisters within the service area Financial agent for network partners Performance monitoring Reporting As defined by HBE

32 CHOICE Regional Health Network In-Person Assisters (IPAs) ClallamGrays HarborJeffersonLewisMasonPacificThurston Forks Community Hospital Grays Harbor Public Health Jefferson County Public Health Lewis Mason Thurston Area Agency on Aging Cowlitz Family Health Center Lewis Mason Thurston Area Agency on Aging Olympic Area Agency on Aging Jefferson Healthcare Providence Centralia Hospital Mason General Hospital Olympic Area Agency on Aging Family Support Center Olympic Medical Center Sea Mar Community Health Centers Olympic Area Agency on Aging Planned Parenthood Valley View Health Center Planned Parenthood Valley View Health Center Providence St. Peter Hospital VIMOSea Mar Community Health Centers Thurston County Food Bank

33 CHOICE Regional Health Network In-Person Assisters Responsibilities Community awareness & outreach Help answer questions about the new law and insurance Provide application-enrollment assistance – Using trained and certified staff – Impartial, objective information – Cannot offer QHPs outside of open enrollment Assist individuals to understand their benefits Provide effective follow-up services

34 CHOICE Regional Health Network Important Things to Remember If you are already insured, you don’t have to make any changes. If you are uninsured, you need to apply for coverage for 2014 or face a penalty. If you are uninsured and enroll, make sure to report your information accurately – you could qualify for different coverage depending on your reported income. If you enroll, and your income changes through the year, report it! If you need help enrolling, there are organizations in your community who are available to help!

35 CHOICE Regional Health Network Questions?

36 CHOICE Regional Health Network Libby Weisdepp Program Manager CHOICE Regional Health Network | (360) x120