1. The Affordable Care Act (ACA): Training of Trainers (TOT) for Community-Based Organizations October 2013

2. Objectives At the end of this training, you will be able to: 1.Understand some of changes under the Affordable Care Act (ACA) and how health care coverage will expand through Medicaid and the new insurance exchange 2.Identify who may be eligible for Medicaid and insurance subsidies 3.Tell people how to sign up themselves or get help to do so

3. ACA: The Big Picture http://kff.org/health-reform/video/youtoons-obamacare-video/

4. Insurance through Employers 1/2 the Population If already covered by employer, not much is changing – still get coverage from employer New advantages: caps on out-of-pocket expenses, free preventative care, can’t inflate prices for sick employees Bigger changes for large companies (50+ employees) that don’t offer coverage now - must offer insurance or face penalty (but penalty is delayed to 2016) Smaller employers (<50 employees) – don’t have to offer coverage and don’t face penalties, but get incentives to do so – they purchase on the marketplace and get tax breaks

5. Coverage through Government 1/3 of the Population Seniors on Medicare – not much will change. Already have help with prescription drugs and preventative care Medicaid is expanding to cover more people, especially poor adults not currently eligible – both men and women, not just pregnant women and parents States have option to expand Medicaid or not – about half are expanding, including Colorado. Federal government pays almost all of the cost in the early years.

6. Buying Insurance on Your Own (1 in 10 people) If not covered by employer or employer’s coverage is too expensive, you can buy on marketplaces – Ours is Connect for Health Colorado. Insurers compete, you choose how much coverage you want and how much you want to pay for it (Bronze to Platinum Plans) All plans cover a set of services –e.g. hospital and doctor visits, maternity care, mental health care, prescription drugs. Tax credits to make the insurance more affordable if you don’t have other options and your income is below a certain level

7. Buying Insurance on Your Own (1 in 10 people) Catastrophic policies available until age 30 You can’t be denied or charged more based on pre-existing conditions Men and women will pay the same price, unlike today Most will pay less (e.g. older people), some more (e.g younger people) – but get better and more secure insurance. Must buy during open enrollment periods – through March 31, 2014 Pay fines if you don’t have insurance, waivers for special circumstances

8. Historic Opportunities with the ACA “Sick Care” System Exclusionary Episodic High-cost Uninsured in Denver: 2011: 17% (American Community Survey) “Health Care” System Inclusive Comprehensive Preventive Lower-Cost 2016: Reduced to 6% (Projections based on American Community Survey) Wellness & Prevention Sick Care (Before ACA)

9. Expansion of Health Coverage in 2014 under ACA Medicaid: Based solely on income 0-133% of FPL: $15,282 for single $31,322 for family of 4 Insurance: Subsidies for insurance purchased at Connect for Health Colorado: 133-400% of FPL: $45,900 for single $94,200 for family of 4 No Denials for Pre-Existing Conditions Key Exclusion for All New Coverage: Undocumented persons and some legal residents. Individual Insurance Mandate: Everyone must have health coverage or pay a penalty on 2014 federal tax return - $95 or 1% of annual income

11. Free Preventive Services without Co-Pays under ACA Selected Preventive Services Pregnancy and Newborns Screening for anemia and infections; vitamin supplementation; breastfeeding support and counseling; newborn screening Well Child Care Screening for autism, hearing, vision, depression, obesity, lead; all recommended vaccinations Bone Health Osteoporosis screening Sexual Health Screening for STDs and intimate partner violence; STD prevention counseling; Contraception Infections Hepatitis C & HIV testing; all recommended vaccinations for adults Mental Health Depression screening Cardiovascular Disease Screening for high blood pressure, diabetes, high cholesterol and obesity; dietary and obesity counseling Cancer Screening for breast, cervical and colon cancer; counseling about sun exposure Substance Use Tobacco use screening and cessation services; alcohol misuse screening and counseling More information available at www.Healthcare.gov

12. Uninsured in the Denver Metro Area Source: Colorado Health Access Survey, 2011

13. Who Lacks Insurance Now in Denver? Roughly 1 in 5 Denver residents are uninsured:

14. Where in Denver will More People Qualify for Coverage? In darker shaded areas more people will qualify for Medicaid and insurance exchange subsidies

15. How Will Expanded Coverage Affect Your Organization? Many uninsured patients and people with CICP who already receive care at your organization may be eligible for Medicaid or the Exchange Having more people covered will help your organization to continue providing services

16. Barriers to Enrollment Lack of knowledge of the ACA Political opposition to the ACA Uncertainty about the details of the ACA 150 plans to choose from on the Exchange Chance of higher co-pays for clinic visits and medications for those previously on CICP Z rating Minimal penalty for choosing not to enroll - $95 or 1% of household income in 2014.

17. Overcoming Barriers to Enrollment Assisting individuals to sign up for Medicaid and the Exchange Accurate and widely available information about how the ACA will help individuals Consistent public messages about the benefits of health insurance

18. What You Can Do to Help Get People Enrolled Identify Most uninsured people in Denver will qualify for Medicaid or Exchange subsidies Nearly all people with CICP will qualify for Medicaid (CICP E rating or lower and some with F rating) or Exchange subsidies Many parents whose children have Medicaid or CHP+ will be eligible for the new coverage programs. Household Size Medicaid: Up to 133% of FPL Subsidies on the Exchange: Up to 400% of FPL 1$15,282$45,960 2 20,62862,040 3 25,97578,120 4 31,32294,200 5 36,668110,280 6 42,015126,360 7 47,361142,440 8 52,708158,520 For each additional person, add $5,347$16,080

19. What You Can Do to Help Get People Enrolled Advise Tell patients and clients about the importance of health insurance Advise them what forms of coverage they might be eligible for

20. What You Can Do to Help Get People Enrolled Refer to Phone and Online Enrollment Sites Give patients and clients information about how to check their eligibility and sign up for Medicaid or subsidized insurance by phone or online Phone:Toll-free: 1-800-221-3943 TDD: 1-800-659-2656 Apply Online: Colorado.gov/PEAKColorado.gov/PEAK Phone:Toll-free: 1-855-PLANS4YOU Toll-free: 1-855-752-6749 Apply Online:ConnectforHealthCO.comConnectforHealthCO.com

21. What You Can Do to Help Get People Enrolled Refer to In-Person Enrollment Assistance Sites Refer clients to organizations that can assist with enrollment in Medicaid or purchasing insurance on the insurance exchange. Sites may have interpreters to help clients enroll. Lists of sites available at: colorado.gov/apps/maps/hcpf.map colorado.gov/apps/maps/hcpf.map List of sites available at: connectforhealthco.com/let-us- help/assistance-network/

22. What You Can Do to Help Get People Enrolled Tell People What Documents They Need Social Security numbers, or document numbers for legal immigrants (bring card if possible) Employer and income information for every member of the household who needs coverage (for example, from pay stubs or W-2 forms) Policy numbers for any current health insurance plans covering members of the household Information on job-based plans that anyone in the household is eligible for.

23. Medicaid and Connect for Health Colorado Enrollment Assistance Sites in Denver

24. Enrollment Services at Denver Health Denver Health and its Community Health Centers throughout Denver are in- person assistance sites for both Medicaid and the insurance exchange. A person may enroll at the main location or in other locations shown here. Call for an appointment: 303-602-2300 Main Location: Denver Health Pavilion M 723 Delaware St Denver, CO 80204 Same day walk-in appts are available at this location on first- come, first-serve basis Other Locations on Campus: Women’s Care Clinic, Pavilion C 790 Delaware St Davis Pavilion, Pavilion D 700 Delaware St TB and Immunization Clinic Registration, Denver Public Health, Pavilion H 605 Bannock St

25. Enrollment Locations at Denver Health Community Health Centers For appointments call 303-602-2310 after 2PM daily La Casa Health Center 4545 Navajo St. Denver, CO 80211 Park Hill Health Center 4995 E. 33rd Ave. Denver, CO 80207 Lowry Health Center 1001 Yosemite St. Denver, CO 80230 Westside Health Center 1100 Federal Blvd. Denver, CO 80204 Eastside Health Center 501 28th St. Denver, CO 80205 Montbello Health Center 12600 E. Albrook Dr. Denver, CO 80239 Westwood Health Center 4320 W. Alaska St. Denver, CO 80219

26. Summary ACA offers insurance coverage options for better access to care Insured people in Denver could increase to 94% Expanded coverage will help Denver’s safety net organizations continue to serve the needs of Denver residents There are many enrollment resources to help people get insurance You can help by letting people know about the benefits of insurance and telling them how to sign up or get help to sign up 83 % Had Coverage in 2011 83 % Had Coverage in 2011 % of Denver Residents Insured 11% Gain coverage through ACA 11% Gain coverage through ACA 94%