1. 1 A nonprofit service and advocacy organization © 2012 National Council on Aging October 9, 2012 – StateWide’s Annual Conference Health Care Reform: Past, Present, and the Road Ahead Nora Dowd Eisenhower Director, National Center for Benefits Access at NCOA

2. 2 A nonprofit service and advocacy organization © 2012 National Council on Aging NCOA - National Council on Aging NCOA is a nonprofit service and advocacy organization. Our mission is to improve the lives of millions of older adults, especially those who are vulnerable and disadvantaged.

3. 3 A nonprofit service and advocacy organization © 2012 National Council on Aging What we’ll cover  Recap the health reform law changes  Review June 2012 Supreme Court decision  Discuss what’s to come with health care reform: Medicaid: How/Will my state choose to expand Medicaid? Health Insurance Exchanges: How could my NY’s work?  Information on how to maximize the change  Resources

4. 4 A nonprofit service and advocacy organization © 2012 National Council on Aging What’s the impact of health care reform?  Affordable Care Act (ACA) signed into law on March 23, 2010  Key components of ACA are designed to: Strengthen consumers’ health care choices and protections Offer a wide-range of coverage options Make health care affordable and accessible for all Americans  Many changes, varying effective dates, bigger components in place by 2014

5. 5 A nonprofit service and advocacy organization © 2012 National Council on Aging Highlights of ACA that impact your Medicare clients Closes Part D Coverage Gap, started in 2010 with $250 rebate check, followed by increasing discounts to 2020 Starting with the 2012 plan year, moved and extended annual Part D and Medicare Advantage open enrollment period (Oct 15-Dec 7) As of 2011, provides new and free preventive benefits under Medicare

6. 6 A nonprofit service and advocacy organization © 2012 National Council on Aging Highlights of ACA that impact your clients with Medicare and/or Medicaid Tests new models for better care, better coordination of services (www.innovations.cms.gov)www.innovations.cms.gov Give states more flexibility to offer Home and Community Based Services (HCBS)

7. 7 A nonprofit service and advocacy organization © 2012 National Council on Aging Highlights of ACA that impact those in need of health insurance As of July 2010, establishes Pre-Existing Condition Insurance Plan (PCIP), helps people that could not get or afford insurance due to pre-existing conditions Allows states option to expand Medicaid to those not traditionally covered beginning as soon as 2010 For 2014, establishes the Health Insurance Exchanges And more (see healthcare.gov for complete list)…

8. 8 A nonprofit service and advocacy organization © 2012 National Council on Aging Supreme Court June 2012 ruling – What about it?  After health reform law was passed, 26 states filed a lawsuit against: Individual Mandate Medicaid Expansion  June 28, 2012, the Supreme Court: Upheld that individual mandate is not unconstitutional However, States cannot be “coerced” (lose current Medicaid funding) into expanding Medicaid

9. 9 A nonprofit service and advocacy organization © 2012 National Council on Aging Medicaid Expansion - What changes?  Will cover many of those not previously eligible: Ages 19-65 and Income under 133% of federal poverty level (FPL) No resource test Does not cover undocumented immigrants  By 2019, Medicaid expansion estimated to cover ~16 million people who otherwise would be uninsured

10. 10 A nonprofit service and advocacy organization © 2012 National Council on Aging Will states choose to expand Medicaid? As of September 12, 2012:  Participating (12 states and DC)  Leaning toward participating (2 states)  Undecided/no comment (25 states)  Leaning toward not participating (5 states)  Will not participate (6 states) Had filed ACA lawsuit

11. 11 A nonprofit service and advocacy organization © 2012 National Council on Aging What is at stake if states do not expand Medicaid?  State decisions to expand Medicaid will affect approximately: Millions of uninsured adults with incomes below 133% of FPL, who would be newly eligible under ACA o 11.5 million have income under 100% of FPL would not be eligible for tax credits/cost sharing to get insurance coverage under the ACA if their state does not expand its Medicaid program Over 10% of the uninsured adults are between the ages of 55 and 64 Source: http://www.urban.org/UploadedPDF/412630-opting-in-medicaid.pdf

12. 12 A nonprofit service and advocacy organization © 2012 National Council on Aging Medicaid Expansion – What are states considering?  Factors affecting states’ decision: o Pressure from stakeholders within the state o Spending cuts, deficit reduction efforts o Incentive to expand Medicaid (i.e., 100% federal funding from 2014 through 2016) o November 2012 elections o No deadline to decide

13. 13 A nonprofit service and advocacy organization © 2012 National Council on Aging Now, let’s talk about…

14. 14 A nonprofit service and advocacy organization © 2012 National Council on Aging What are benefits of the Health Insurance Exchanges?  One-stop shopping – single application for Exchange, Medicaid, and CHIP  Affordable options for people with limited income (tax credits, reduced cost-sharing)  Can’t be denied insurance even with pre-existing conditions (Guaranteed Issue)  Standard offering of health benefits (“Essential Health Benefits”)

15. 15 A nonprofit service and advocacy organization © 2012 National Council on Aging Exchanges: Individual versus SHOP  Individual Exchanges - qualifications: U.S. citizen or legal resident, Not incarcerated, and Do not have access to affordable employer coverage  SHOP Exchanges Small Business Health Options Program (SHOP) Exchanges available to businesses with 100 or fewer employees States can limit enrollment to business with fewer than 50 employees during the first year SHOP must offer coverage to all full-time employees In state where business is located Businesses receive tax credits in 2014 and 2015 as an incentive to offset costs

16. 16 A nonprofit service and advocacy organization © 2012 National Council on Aging How are Exchanges run?  Exchanges: Must be a government agency or non-profit Must serve both individual and businesses Can form regional Exchanges, or have multiple exchanges operating in one state  States can choose from three models : State-based exchange State-federal partnership Federally-facilitated exchange (FFE)

17. 17 A nonprofit service and advocacy organization © 2012 National Council on Aging What are the three Exchange models?  State-based exchange State runs its own exchange May have an Exchange Board to settle on policy decisions (i.e., model type, benefits package, IT structure, contracts)  State-federal partnership State works with federal government, likely help with plan management functions such as certifying qualified health plans, oversight, etc.  Federally-facilitated exchange (FFE) Federal government ensures state has Exchange in place, will still need help from states Default model if states do not choose a model by Jan 1, 2013

18. 18 A nonprofit service and advocacy organization © 2012 National Council on Aging Where are states at re: deciding on an Exchange?

19. 19 A nonprofit service and advocacy organization © 2012 National Council on Aging New York Moves Ahead to Develop a State-Based Exchange  New York has received $87.6 million in grants for research, planning, information technology development, and implementation of Affordable Insurance Exchanges. $1 million in Planning Grants o Grant provides resources to conduct research and planning to build a better health insurance marketplace and determine how the state’s exchange will be operated and governed. $27.4 million in Early Innovator Grants o Grant used to design and implement the information technology (IT) infrastructure needed to operate the Exchanges. $59.2 million in Exchange Establishment Grants o Grant helps to implement key provisions of the Affordable Care Act.

20. 20 A nonprofit service and advocacy organization © 2012 National Council on Aging Streamlined, Dynamic Application Process  Streamlined application can be used to apply for: Insurance through the Individual or SHOP Exchanges Medicaid SCHIP  Applications can be submitted: Online via the Exchange Website Call Center By Mail In-Person  Information collected includes: Baseline information Income information (for Medicaid or tax credits) Program Specific Information

21. 21 A nonprofit service and advocacy organization © 2012 National Council on Aging Who will help consumers of the Exchange?  Exchanges will contract with Navigators Similar to SHIP/HIICAP model – objective, trustworthy for uptake States encouraged to contract with at least two agencies/organizations, with one being a community-based partner Receive grant funding by the Exchange  Exchanges will also have Assisters For example, brokers and agents can continue to help people with the health insurance marketplace and enroll in health plans

22. 22 A nonprofit service and advocacy organization © 2012 National Council on Aging Key Enrollment Dates through the Exchanges  Initial Open Enrollment Period: October 1, 2013-March 31, 2014 Coverage effective no sooner than January 1, 2014  Annual Open Enrollment Period (starting in 2015) October 15 – December 7, coverage effective following January 1  Also, Special Enrollment Periods (SEP) for exceptional situations * Note: Medicaid & CHIP apps can go through the Exchange or through Medicaid offices, and anytime of the year

23. 23 A nonprofit service and advocacy organization © 2012 National Council on Aging What might an Exchange website look like?  Example, Colorado’s Exchange website at: www.getcoveredco.org

24. 24 A nonprofit service and advocacy organization © 2012 National Council on Aging In New York… Since ACA became a law, people with Medicare saved over $322 million on prescription drugs  In 2012…  On average, people who hit the Medicare “donut hole” have saved $663  More than 1.1 million people with original Medicare received at least one preventive service at no cost to them  More than 120,00 people received the Annual Wellness Visit

25. 25 A nonprofit service and advocacy organization © 2012 National Council on Aging What does this mean for you?  Still a lot unknown, stay tuned for updates  Consider the benefits already in place, take advantage  Use online resources to stay up-to-date on changes, updates in your state

26. 26 A nonprofit service and advocacy organization © 2012 National Council on Aging Resources  Medicare Rights Center: http://www.medicarerights.org/issues-actions/health- reform-and-medicare.php.http://www.medicarerights.org/issues-actions/health- reform-and-medicare.php  Where states stand on Medicaid expansion: http://ahlalerts.com/2012/07/03/medicaid-where-each-state-stands-on-the- medicaid-expansion/ http://ahlalerts.com/2012/07/03/medicaid-where-each-state-stands-on-the- medicaid-expansion/  Health Insurance Exchanges: http://www.healthcare.gov/news/factsheets/2011/05/exchanges05232011a.h tml http://www.healthcare.gov/news/factsheets/2011/05/exchanges05232011a.h tml  State Exchange Profiles (KFF): http://healthreform.kff.org/State-Exchange- Profiles-Page.aspxhttp://healthreform.kff.org/State-Exchange- Profiles-Page.aspx  Center for Consumer Information and Insurance Oversight (CCIIO): http://cciio.cms.gov/ http://cciio.cms.gov/  National Association of Insurance Commissioners (NAIC): http://naic.org/index_health_reform_section.htm http://naic.org/index_health_reform_section.htm

27. 27 A nonprofit service and advocacy organization © 2012 National Council on Aging Stay in touch Visit us on the web at: www.CenterforBenefits.org And for your clients: www.MyMedicareMatters.org www.BenefitsCheckUp.org Contact today’s presenters: Nora.Eisenhower@ncoa.org