1. Affordable Care Act Overview Session 1 Presented by Tokie Moriel & John Tvedt 1DHS/DFO/IMTA/2013-07-15

2. What is ACA? The Affordable Care Act (ACA) Comprehensive reforms that: –Improve access to affordable health –Protect consumers DHS/DFO/IMTA/2013-07-152

3. ACA Key Facts Stronger Consumer Rights and Protections More Affordable Coverage Better Access To Care Stronger Medicare DHS/DFO/IMTA/2013-07-153

4. Consumer Rights & Protections End to Pre-Existing Condition Discrimination End to Limits on Care End to Coverage Cancellations DHS/DFO/IMTA/2013-07-154

5. More Affordable Coverage Value for Your Premium Dollar Stopping Unreasonable Rate Increases Small Business Tax Credits DHS/DFO/IMTA/2013-07-155

6. Better Access to Care Free Prevention Benefits Coverage for Young Adults Coverage for Americans with Pre-Existing Conditions Affordable Insurance DHS/DFO/IMTA/2013-07-156

7. Strengthening Medicare Lower Cost Prescription Drugs Free Preventive Services Fighting Fraud Providing Choices while Lowering Costs DHS/DFO/IMTA/2013-07-157

8. Federal Rules The Department of Health and Human Services (HHS) and the Internal Revenue Service (IRS) issued federal rules that included changes and alignment to eligibility: –Requirements –Methods and processes DHS/DFO/IMTA/2013-07-158

9. Eligibility Requirement Changes Modified Adjusted Gross Income (MAGI) based income standards –Medicaid uses current monthly income –Cost Sharing Reductions (CSR) and Advanced Premium Tax Credits (APTC) use projected annual income Redefines household composition DHS/DFO/IMTA/2013-07-159

10. Eligibility Requirement Changes Income Changes. –Non-recurring Lump sums –Scholarships and grants –Income of American Indians and Alaska Natives –Child Support –Worker Compensation –Veteran’s Benefits –Depreciation of business expenses DHS/DFO/IMTA/2013-07-1510

11. Eligibility Requirement Changes Federal Poverty Level (FPL) Determining proper coverage DHS/DFO/IMTA/2013-07-1511

12. Seamless, Streamlined System of Eligibility and Enrollment Submit single, streamlined application to the FFM or the State Eligibility is verified and determined Enroll in affordable coverage Online Phone Mail In Person Other electronic means Supported, in part, by the Federally- managed data services hub Eligibility for: Medicaid and CHIP Enrollment in a QHP Advance payments of the premium tax credit and cost- sharing reductions Online plan comparison tool available to inform QHP selection Advance payment of the premium tax credit is transferred to the QHP Enrollment in Medicaid/CHIP or QHP 12DHS/DFO/IMTA/2013-07-15

13. A Seamless System of Coverage 400% CHIP/Medicaid for Children FPL Varies by State (average 241% FPL) FPL 250% FPL 133% FPL 100% FPL Qualified Health Plans without Financial Assistance Qualified Health Plan w/ Premium Tax Credits 250%-400% FPL Medicaid/CHIP Children Qualified Health Plan w/ Premium Tax Credits and Cost-sharing reductions between 100% - 250% FPL 13DHS/DFO/IMTA/2013-07-15 Iowa Health and Wellness Plan 101% - 133% FPL

14. FFM Plan Levels of Coverage Levels of Coverage Bronze Silver Gold Platinum Plan Pays On Average 60 % 70% 80% 90% Enrollees Pay On Average*(In addition to monthly premium) 40% 30% 20% 10% 14DHS/DFO/IMTA/2013-07-15

15. A Seamless Path to Affordable Coverage The Affordable Care Act: –Expands access to affordable coverage –Simplifies Medicaid & CHIP –Ensures a seamless system of coverage DHS/DFO/IMTA/2013-07-1515

16. Expanding Access to Coverage Enrollment in the new income-based category without having to first screen for other eligibility groups Enables people with disabilities and those needing long- term care services & supports to enroll in the group that best meets their needs DHS/DFO/IMTA/2013-07-1516

17. Expanding Access to Coverage Creates new coverage group for former foster care children Expansion of Presumptive Medicaid increases the number of providers allowed to make presumptive determinations for more populations. DHS/DFO/IMTA/2013-07-1517

18. Simplifying Medicaid & CHIP Switch to MAGI methodology Modernize verification process Federal data matches Renewals at least every 12 months DHS/DFO/IMTA/2013-07-1518

19. Coordination: A Seamless System of Coverage Single, streamlined application for all insurance affordability programs Website that provides program information and facilitates enrollment in all insurance affordability programs Coordinated verification policies across Medicaid, CHIP and the FFM Standards and guidelines for eligibility determinations and information transfers DHS/DFO/IMTA/2013-07-1519

20. Coordination: Key Provisions of ACA The Medicaid/CHIP agency: –Determines eligibility for individuals transferred from another insurance affordability program –Evaluates an individual for potential eligibility for other insurance affordability programs –Certifies for the FFM/other programs the criteria applied in determining Medicaid eligibility DHS/DFO/IMTA/2013-07-1520

21. Coordination: Key Provisions of ACA Medicaid/CHIP agencies have established agreements with the FFM that clearly delineate the responsibility of each program to: –Minimize burden on individuals –Ensure compliance with the other eligibility coordination requirements of the provision (i.e., MAGI screen) –Ensure prompt determinations of eligibility and enrollment consistent with timeliness standards DHS/DFO/IMTA/2013-07-1521

22. State Responsibilities: Potential Eligibility for Other Programs For individuals determined as not eligible for Medicaid/CHIP, the agency: –Evaluates the individual for potential eligibility for other insurance affordability programs –Transfers the individual’s electronic account to the FFM for CSR/APTC determinations for insurance plan enrollment DHS/DFO/IMTA/2013-07-1522

23. Coordinated Eligibility Determinations with FFM The Federally Facilitated Marketplace makes initial assessment of Medicaid/CHIP eligibility; State make the final eligibility determination Assessments made using the applicable Medicaid/CHIP income standards, citizenship and immigration status, using verification rules and procedures consistent with Medicaid and CHIP regulations The FFM and Iowa have entered into an agreement outlining each entities responsibilities ensuring a seamless and coordinated process DHS/DFO/IMTA/2013-07-1523

24. Coordinated Eligibility Determinations with FFM When the FFM makes an initial assessment, Iowa: –Accepts the electronic account –Does not request duplicative information/documentation –Promptly determines Medicaid/CHIP eligibility without requiring a new application –Accepts any findings made by another program, no further verification –Notifies the other program of the receipt of the electronic account and Medicaid’s final eligibility determination if the individual is receiving coverage through another program DHS/DFO/IMTA/2013-07-1524

25. Non-MAGI Populations Applying through FFM The FFM will transfer applications to Iowa for a determination of Medicaid on a basis other than MAGI Iowa will: –Notify the FFM of the final determination of eligibility for those individuals who are participating in an insurance affordability program DHS/DFO/IMTA/2013-07-1525

26. Non-MAGI Populations Applying through Iowa Evaluating eligibility for other insurance affordability programs for individuals undergoing a Medicaid determination on a basis other than MAGI Iowa: –Determines potential eligibility other insurance affordability programs –Transfers the individual’s account to the FFM –Provides timely notice to the FFM DHS/DFO/IMTA/2013-07-1526

27. Continuation of Coverage Coverage renewal –FFM –State DHS/DFO/IMTA/2013-07-1527

28. A New Approach Shifts verification responsibilities Less reliance on paper “Which coverage is right for you?” DHS/DFO/IMTA/2013-07-1528

29. Time Frames October 1, 2013 –Open enrollment for insurance affordability programs –Must accept single streamlined applications and apply new rules –Must be able to transmit information to Marketplace –Evaluate under current rules for eligibility prior to 1/1/14 January 1, 2014 –Coverage under insurance affordability programs can begin DHS/DFO/IMTA/2013-07-1529

30. Conclusion Additional ACA webinars Session review – Income Maintenance Workers ONLY DHS/DFO/IMTA/2013-07-1530