1. WHAT EVERY FAMILY LAW PRACTITIONER SHOULD KNOW THE AFFORDABLE CARE ACT 1

2. The Patient Protection and Affordable Care Act, commonly referred to as Obamacare or the ACA, was signed into law on March 23, 2010 2

3. THE ACA REFORMS ACCESS TO INSURANCE The primary objective of the ACA is to increase access to healthcare by: Requiring most people to obtain coverage Limiting insurance providers ability to cancel or deny coverage Increasing financial assistance to get coverage Expanding public program eligibility Anticipated Outcomes: Improve health and health outcomes Lower costs Increase individual financial stability 3

4. CHANGES TO HEALTH INSURANCE Children up to age 26 can stay on parent’s insurance Cannot be refused because of pre-existing conditions No life-time or annual coverage limits Coverage for preventative care without deductible or co-pay Women’s preventive health care – such as mammograms, screenings for cervical cancer, prenatal care, and other services – is covered with no cost sharing for new health plans. 4

5. CHANGES TO HEALTH INSURANCE Health plans will be allowed to adjust premiums based only on the following factors: Individual vs. family enrollment (i.e., individual + spouse, individual + dependent(s), etc.) Geographic area Age (but cannot vary by more than three times among adults) Tobacco use (the rate cannot vary by more than 1.5 to 1) Individual mandate Increased support: Expansion of programs such as MA Premium tax credits for people with incomes up to 400% FPG Cost-sharing subsidies 5

6. THE INDIVIDUAL MANDATE What is the individual mandate? The Individual Mandate requires you, your children and anyone else that you claim as a dependent on your taxes to have health insurance beginning January 1, 2014 or pay a penalty 6

7. THE INDIVIDUAL MANDATE 7

8. The following people are exempt from the individual mandate requirement: Those with incomes below the tax filing threshold Undocumented immigrants who are not allowed to use the exchange People who have been uninsured for less than 3 months Native Americans Those who are approved under the “economic hardship” or “religious objection” exemption Those who are incarcerated 8

9. MINIMUM ESSENTIAL COVERAGE Examples of minimum essential coverage: Employer-sponsored coverage COBRA/Retiree coverage Coverage purchased in the individual market Medical Assistance and MinnesotaCare Medicare Part A and Medicare Advantage plans 9

10. MAKING INSURANCE AFFORDABLE Making insurance affordable is a key feature of the Affordable Care Act. Financial Assistance is available to families and individuals with incomes below 400% of federal poverty guidelines. Individual:$45,960 Family of 4:$94,200 10

11. FINANCIAL ASSISTANCE Types of Assistance include: Advanced Premium Tax Credits for the purchase of private plans through the Exchange Cost sharing Subsidies to reduce the percentage of out-of- pocket costs paid by the insured Expanded eligibility for public programs such as MinnesotaCare and Medical Assistance (Minnesota’s Medicaid program) 11

12. FINANCIAL ASSISTANCE Eligibility is based on Household Size and Income People in Household Annual Income (up to) 133% FPL Annual Income (up to) 200% FPL Annual Income (up to) 275% FPL Annual Income (up to) 400% FPL Annual Income (above) 400% FPL 1$15,521$23,340$32,092$46,680 2$20,920$31,460$43,257$62,920 3$26,320$39,580$54,422$79,160 4$31,720$47,700$65,587$95,400 5$37,120$55,820$76,752$111,640 6$42,520$63,940$87,917$127,880 7$47,919$72,060$99,082$144,120 8$53,319$80,180$110,247$160,360 For each add’l person add $5,399$8,120$11,165$16,240 MA for adultsMCRE for adultsTax Credits for private coverage for some adults Private coverage without financial help MA for children ages 0-18 and pregnant women (slightly higher limits for infants under 2 and pregnant women Tax Credits for some children 12

13. HOUSEHOLD SIZE Household is the term that applies to people who are considered a unit for purposes of determining eligibility – it may or may not include people who live together. It is the income of the people in the household that counts toward eligibility For this reason, household size is necessary to determine the Federal Poverty Level (FPL) 13

14. 14 DETERMINING HOUSEHOLD SIZE FOR MINNESOTACARE AND ADVANCED PREMIUM TAX CREDITS

15. HOUSEHOLD = TAX FILING UNIT Household = tax filing unit = Taxpayer + Spouse + Dependents Married couple must file taxes as married filing jointly Dependents: Children and other relatives who meet certain requirements Person can be a dependent even if they file their own tax return as long as they do not claim their own personal exemption 15

16. EXAMPLE: MARRIED COUPLE WITH CHILDREN Cliff and Claire Huxtable are married with children Sondra, Denise, Theo, Vanessa and Rudy. Sondra is away attending college. The rest of the children live at home. Cliff and Claire file a joint tax return and claim all 5 of the children as dependents. Who is in the householdHH size CliffClaire5 kids Cliff Claire Sondra 4 kids X X X 7 16

17. EXAMPLE: MULTI-GENERATIONAL FAMILY 17  Richard Castle is a tax-filer. He claims his daughter Alexis and his mother Martha as dependents. Who is in householdHH size RichardAlexisMartha Richard Alexis Martha X X X 3

18. EXAMPLE: UNMARRIED PARENTS Brad and Angelina are unmarried parents with 6 children. They each file taxes. Angelina claims 4 of the kids. Brad claims the other 2. Who is in the householdHH size BradAngelina4 kids2 kids Brad Angelina 4 kids 2 kids X X 3 X X 5 X X 3 18

19. EXAMPLE: DIVORCED PARENTS 19  Kate Gosslin and ex-husband Jon have 8 children who all live with Kate. Jon claims the children as dependents on his taxes. Who is in the householdHH size Kate8 kidsJon Kate 8 kids X 1 X X 9

20. 20 DETERMINING HOUSEHOLD SIZE FOR MEDICAL ASSISTANCE DETERMINING HOUSEHOLD SIZE FOR MEDICAL ASSISTANCE (MA)

21. MA HOUSEHOLD COMPOSITION RULES Three categories of individuals: Tax-filers (not claimed as a tax dependent by anyone else) Tax dependents Non-filers and those not claimed as a tax dependent by anyone 21

22. MA RULE FOR TAX-FILERS Household = Tax Filing Unit = Taxpayer + Spouse (if living together) + Dependents Includes both spouses if taxpayer is married and lives with spouse And all individuals the taxpayer expects to claim as a tax dependent Remember, married people do not have to file jointly for MA. Regardless, if they live with each other, they are in each other’s household. 22

23. MA RULE FOR TAX DEPENDENTS Household for tax dependent = household of the tax filer claiming the dependent 3 exceptions: Tax dependent who is not the child or spouse of the taxpayer Children living with both parents who are unmarried Children claimed as a tax dependent by non-custodial parent People meeting an exception are treated as non- filers, non-dependents 23

24. MA RULE FOR NON-FILERS, NON- DEPENDENTS Adults: Household = individual + spouse living with individual + children living with individual Children (under age 19): Household = child + siblings living with child + parents living with child 24

25. EXAMPLE: MARRIED COUPLE WITH CHILDREN Cliff and Claire Huxtable are married with children Sondra, Denise, Theo, Vanessa and Rudy. Sondra is away attending college. The rest of the children live at home. Cliff and Claire file a joint tax return and claim all 5 of the children as dependents. Who is in the householdHH size CliffClaire5 kids Cliff Claire Sondra 4 kids X X X 7 25

26. EXAMPLE: MULTI-GENERATIONAL FAMILY 26  Richard Castle is a tax-filer. He claims his daughter Alexis and his mother Martha as dependents. Who is in householdHH size RichardAlexisMartha Richard Alexis Martha X X X 3 X 1

27. EXAMPLE: UNMARRIED PARENTS Brad and Angelina are unmarried parents with 6 children. They each file taxes. Angelina claims 4 of the kids. Brad claims the other 2. Who is in the householdHH size BradAngelina4 kids2 kids Brad Angelina 4 kids 2 kids X X 3 X X 5 X X X X 8 27

28. EXAMPLE: DIVORCED PARENTS 28  Kate Gosslin and ex-husband Jon have 8 children who all live with Kate. Jon claims the children as dependents on his taxes. Kate is also a tax filer. Who is in the householdHH size Kate8 kidsJon Kate 8 kids X 1 X X 9

29. EXAMPLE: DIVORCED PARENTS 29  Kate Gosslin and ex-husband Jon have 8 children who all live with Kate. Jon claims the children as dependents on his taxes. Kate does not file taxes. Who is in the householdHH size Kate8 kidsJon Kate 8 kids X X 9

30. EXAMPLE: DIVORCED PARENTS 30  Kate Gosslin and ex-husband Jon have 8 children who all live with Kate. Jon claims 5 of the children as dependents on his taxes. Kate claims 3 of the children on her taxes. Who is in the householdHH size Kate5 kids3 kidsJon Kate 5 kids 3 kids X X 4 X X X 9 X X 4

31. MA RULE FOR NON-MAGI APPLICANTS 31 SeniorsBlind or Disabled Household composition for Non-MAGI applicants will continue to follow MA rules in place prior to 2014

32. MA RULE FOR NON-MAGI SENIORS Household includes the following people who live with the applicant: Applicant Spouse Children under age 21 Exception: Applicant is a HH of 1 if the applicant qualifies for long-term care benefits 32

33. MA RULE FOR NON-MAGI BLIND OR DISABLED Household includes the following people who live with the adult applicant Applicant Spouse Children under age 21 Exception: Applicant is a HH of 1 if the applicant qualifies for long-term care benefits Household of child under age 18 includes the following people who live with the child Applicant Parents Siblings Exception: Parents are not included in HH for Child(ren) on Supplemental Security Income (SSI) 33

34. SUMMARY OF ALL HOUSEHOLD COMPOSITION RULES APTCS and MinnesotaCare: Household = Taxpayer + Spouse (filing jointly) + Dependents Medical Assistance Tax Filers: Household = Taxpayer + Spouse (if living together) + Dependents Medical Assistance Tax Dependents: Household = Household of tax filer claiming the dependent However, watch for the exceptions: Dependents who are not the child or spouse of the tax filer Children who live with unmarried parents Children who are claimed as a dependent by the noncustodial parent 34

35. SUMMARY OF ALL HOUSEHOLD COMPOSITION RULES Medical Assistance for Non-Filers, Non-Dependents Household for adults = Individual + Spouse (if living with individual) + Children (if living with individual) Household for children (under 19) = Child + Parents (if living with child) + Siblings (if living with child) Medical Assistance for non- MAGI Seniors Household = Individual + Spouse (if living with individual) + children under age 21 (if living with individual) Medical Assistance for non-MAGI Blind or Disabled Household for adults = Individual + Spouse (if living with individual) + children under age 21 (if living with individual) Household for children under age 18 = child + parents (if living with child) + siblings (if living with child) 35

36. Head shot of the trainer Ralonda Mason Supervising Attorney Mid-Minnesota Legal Aid 110 6 th Ave. S., Suite 200 St. Cloud, MN 56301 (320)257-4866 rmason@mylegalaid.org CONTACT INFORMATION