Affordable Care Act (ACA) Learning Sessions for Social Sector Leaders & Community Advocates July 19, 2013 Coordinated by the Access HealthColumbus Community Advisory Committee Purpose Spread knowledge of federal health care reform in non-profit organizations to improve their ability to serve clients during the implementation of the Affordable Care Act (ACA). Today’s Objectives 1. Provide an update on ACA Health Benefit Exchanges and Navigators in Ohio. 2. Provide an update on Medicaid expansion and changes in Ohio. 3. Obtain input on shaping future Learning Sessions.
Today’s agenda 9:30 Welcome & ACA Introduction 9:35 Update on Health Benefit Exchanges 9:55 Update on Navigators 10:10 Update on Medicaid Expansion 10:30 Q&A 10:50 Future ACA Learning Sessions
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By 2020… not 1/1/2014
Health Benefit Exchanges
2014 Coverage Reform Overview •
In 2014, the following insurance market reforms take effect: – – – – – –
Guaranteed issuance of coverage Coverage must include essential benefits No pre-existing condition exclusions Plans can have deductibles, copayments and cost sharing requirements subject to limits. Premium vary only by age and smoking (3 to 1) Low income subsidies
Essential Health Benefits ACA requires items and services from the following 10 categories: 1.
Ambulatory patient services
2.
Emergency services
3.
Hospitalization
4.
Maternity and newborn care
5.
Mental health and substance use disorder services; including behavioral health treatment
6.
Prescription drugs
7.
Rehabilitative and habilitative services and devices
8.
Laboratory services
9.
Preventative and wellness services and chronic disease management
10.
Pediatric services, including oral and vision care
Metal Plans
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Plans offered in the individual and small group markets will have cost sharing, including deductibles, copays and other cost sharing. Out of network services will cost more for the consumer.
Plans must fall into metal tier which represent the extent to which the plan has higher cost sharing or lower cost sharing.
Metal tiers represent the average an insurer will pay for covered services for all policies issued within a metal tier.
–
Bronze = The carrier pays 60% of covered benefits; the individual pays 40%
–
Silver = The carrier pays 70% of covered benefits; the individual pays 30%
–
Gold = The carrier pays 80% of covered benefits; the individual pays 20%
–
Platinum = The carrier pays 90% of covered benefits; the individual pays 10%
Plans will also have out of pocket maximums no greater than $6,400/$12,800.
Catastrophic Plans
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For adults under 30 and people exempt from the individual mandate, carriers may also issue a catastrophic plans, which higher cost sharing. –
Catastrophic plans provide the essential health benefits after the insured has met a deductible which must be equal $6,400 for and individual and $12,800 per family in 2014.
–
The deductible does not apply to at least three primary care visits.
State Decisions on Health Insurance Exchanges
July = 27 May = 26 Source: Kaiser Family Foundation
July = 7 May = 7
July = 17 May = 18
Timeline of Exchange Plan Implementation Key Dates •
July 31 – Forms, rates, and QHP applications approved by ODI and HHS notified
•
August – Carriers can review data on the Marketplace plan preview and submit corrections
•
September 9 – Carriers must sign agreement with HHS to offer plans on the Marketplace, and can no longer withdraw approved plans
•
October 1 – Open emrollment begins
•
December 15 – Open enrollment deadline for coverage effective January 1, 2014
•
January 1, 2014 – Coverage becomes effective
•
March 13, 2014 – Initial open enrollment ends
“ODI expects work on 200 health exchange plans submitted by 14 insurance companies to be done by July 31, 2013” –Lt. Gov. Mary Taylor
Premium share AETNA - $3,500 deductible/$6,350 OOPM*
Annual premium 250% FPL price w/o subsidy ($28,725)
100% FPL ($11,490)
25-year-old tobacco user
$3,570.59
$3,626.27
$1,044.47
25-year-old non-tobacco user
$3,245.99
$2,812.30
$719.87
55-year-old tobacco user
$7,930.69
$5,230.72
$2,039.29
55-year-old non-tobacco user
$7,209.72
$3,422.81
$1,318.32
25-year-old tobacco user
$4,504.25
$3,127.03
$1,978.13
25-year-old non-tobacco user
$3,464.81
$2,802.43
$938.69
55-year-old tobacco user
$10,004.47
$4,121.85
$4,113.07
55-year-old non-tobacco user COORDINATED HEALTH MUTUAL (dba InHealth Mutual) - $2,000
$7,695.75
$3,400.88
$1,804.35
25-year-old tobacco user
$3,141.72
$2,698.16
$615.60
25-year-old non-tobacco user
$2,755.92
$2,312.36
$229.80
55-year-old tobacco user
$6,978.12
$3,169.28
$1,086.72
55-year-old non-tobacco user
$6,121.20
$2,312.36
$229.80
MEDICAL MUTUAL OF OHIO - $2,000 deductible/$6,350 OOPM *
deductible/$6,350 OOPM (BENCHMARK PLAN)
*Based on a silver benefit plan – rates and plans subject to change
Premium share AETNA - $3,500 deductible/$6,350 OOPM*
Annual premium 250% FPL price w/o subsidy ($28,725)
100% FPL ($11,490)
25-year-old tobacco user
$3,570.59
$3,626.27
$1,044.47
25-year-old non-tobacco user
$3,245.99
$2,812.30
$719.87
55-year-old tobacco user
$7,930.69
$5,230.72
$2,039.29
55-year-old non-tobacco user
$7,209.72
$3,422.81
$1,318.32
25-year-old tobacco user
$4,504.25
$3,127.03
$1,978.13
25-year-old non-tobacco user
$3,464.81
$2,802.43
$938.69
55-year-old tobacco user
$10,004.47
$4,121.85
$4,113.07
55-year-old non-tobacco user COORDINATED HEALTH MUTUAL (dba InHealth Mutual) - $2,000
$7,695.75
$3,400.88
$1,804.35
25-year-old tobacco user
$3,141.72
$2,698.16
$615.60
25-year-old non-tobacco user
$2,755.92
$2,312.36
$229.80
55-year-old tobacco user
$6,978.12
$3,169.28
$1,086.72
55-year-old non-tobacco user
$6,121.20
$2,312.36
$229.80
MEDICAL MUTUAL OF OHIO - $2,000 deductible/$6,350 OOPM *
deductible/$6,350 OOPM (BENCHMARK PLAN)
*Based on a silver benefit plan – rates and plans subject to change
Premium share AETNA - $3,500 deductible/$6,350 OOPM*
Annual premium 250% FPL price w/o subsidy ($28,725)
100% FPL ($11,490)
25-year-old tobacco user
$3,570.59
$3,626.27
$1,044.47
25-year-old non-tobacco user
$3,245.99
$2,812.30
$719.87
55-year-old tobacco user
$7,930.69
$5,230.72
$2,039.29
55-year-old non-tobacco user
$7,209.72
$3,422.81
$1,318.32
25-year-old tobacco user
$4,504.25
$3,127.03
$1,978.13
25-year-old non-tobacco user
$3,464.81
$2,802.43
$938.69
55-year-old tobacco user
$10,004.47
$4,121.85
$4,113.07
55-year-old non-tobacco user COORDINATED HEALTH MUTUAL (dba InHealth Mutual) - $2,000
$7,695.75
$3,400.88
$1,804.35
25-year-old tobacco user
$3,141.72
$2,698.16
$615.60
25-year-old non-tobacco user
$2,755.92
$2,312.36
$229.80
55-year-old tobacco user
$6,978.12
$3,169.28
$1,086.72
55-year-old non-tobacco user
$6,121.20
$2,312.36
$229.80
MEDICAL MUTUAL OF OHIO - $2,000 deductible/$6,350 OOPM *
deductible/$6,350 OOPM (BENCHMARK PLAN)
*Based on a silver benefit plan – rates and plans subject to change
Premium share AETNA - $3,500 deductible/$6,350 OOPM*
Annual premium 250% FPL price w/o subsidy ($28,725)
100% FPL ($11,490)
25-year-old tobacco user
$3,570.59
$3,626.27
$1,044.47
25-year-old non-tobacco user
$3,245.99
$2,812.30
$719.87
55-year-old tobacco user
$7,930.69
$5,230.72
$2,039.29
55-year-old non-tobacco user
$7,209.72
$3,422.81
$1,318.32
25-year-old tobacco user
$4,504.25
$3,127.03
$1,978.13
25-year-old non-tobacco user
$3,464.81
$2,802.43
$938.69
55-year-old tobacco user
$10,004.47
$4,121.85
$4,113.07
55-year-old non-tobacco user COORDINATED HEALTH MUTUAL (dba InHealth Mutual) - $2,000
$7,695.75
$3,400.88
$1,804.35
25-year-old tobacco user
$3,141.72
$2,698.16
$615.60
25-year-old non-tobacco user
$2,755.92
$2,312.36
$229.80
55-year-old tobacco user
$6,978.12
$3,169.28
$1,086.72
55-year-old non-tobacco user
$6,121.20
$2,312.36
$229.80
MEDICAL MUTUAL OF OHIO - $2,000 deductible/$6,350 OOPM *
deductible/$6,350 OOPM (BENCHMARK PLAN)
*Based on a silver benefit plan – rates and plans subject to change
Cost Sharing (out-of-pocket expenses to health care providers) Out-of-Pocket Spending Limits After Subsidies Income
Out-of-Pocket Limits (based on 2013 limits)
100 – 200% FPL
$2,083/individual; $4,167/family
200 – 300% FPL
$3,125/individual; $6,250/family
300 – 400% FPL
$4,167/individual; $8,333/family
Above 400% FPL
$6,250/individual; $12,500/family
Navigators
Navigators in Federally-facilitated and State Partnership Marketplaces
Defined by the ACA –
Conduct public education activities to raise awareness of the availability of qualified health plans
–
Distribute fair and impartial information concerning enrollment in qualified health plans, and the availability of premium tax credits and cost-sharing reductions
–
–
–
•
COLUMBUS NEIGHBORHOOD HEALTH CENTER = $230,369 HEART OF OHIO FAMILY HEALTH CENTER = $79,548
Facilitate enrollment in qualified health plans
LOWER LIGHTS CHRISTIAN HEALTH CENTER = $105,189
Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the exchange or exchanges. Provide referrals to the appropriate entity or agency for consumers with a grievance, question, or complaint.
7/10/13: 36 Ohio health centers in 183 locations awarded $3.9 million, hiring 75 additional workers to assist more than 84,400 Ohioans
SOUTHEAST COMMUNITY MENTAL HEALTH CENTER = $73,630 •
8/16/13: CMS navigator application awards totaling $2.2 million across Ohio. At least two organizations will be selected
Certified Application Counselors •
Exchange may designate organizations to certify staff or volunteers to perform the duties of certified application counselors
•
Perform many of the same roles as navigators including educating consumers and helping them complete an application.
•
Application available end of July—Visit Marketplace.cms.gov to sign up for email notifications and updates
•
May be opportunity to receive grant funding in the future
What kind of assistance will be available?
Medicaid Expansion
Medicaid Expansion Executive Activity
July = 15 May = 20 Source: Kaiser Family Foundation
July = 30 May = 29
July = 6 May = 2
History of Medicaid Participation by States 30 25
25 20 15
States 11
10
8
6
5 1 0 1965
1966
1967
1970
1982 Source: The Washington Post
2014 Federal Health Coverage Expansion 500%
Private Insurance Federal Poverty Level (FPL)
400%
$92,200* (family of 4)
Health Benefit Exchange 300%
Disabled Ohioans in this income range “spend down� their income to qualify for Medicaid
200% Optional ACA Medicaid Expansion to 138%
$31,809* (family of 4)
100%
Medicaid 0% Children 0-18 without coverage Current Ohio Medicaid Eligibility
Parents
Childless Adults
Federal Exchange Eligibility
Disabled Workers Other Aged, Blind and Disabled Not Covered by Ohio Medicaid or Federal Exchange
* The 2012 poverty threshold is $11,170 for an individual and $23,050 for a family of four.
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Legislation in Ohio •
HB 176 & HB 208 •
Seek to reform Medicaid by improving efficiency, lowering costs and providing greater links to training programs that could help the working poor find better jobs.
•
Gov. Kasich vetoed language in proposed budget that would have barred his office from expanding Medicaid coverage under the ACA.
•
Reminder no federal deadline for expanding Medicaid
Medicaid Expansion Scenarios and Implications to business, government, health care, and the social sectors of Franklin County ACA/Full Expansion • Welcome mat= ~28,000 + New eligible = ~41,000 in Franklin County • Strong revenue and economic benefit for Ohio and counties • Budget scenario = by midnight 6/30/13, full 3 years 100% federal funding • Post budget scenario = potential for partial loss of 100% federal funding • Ballot scenario = target of Fall 2014, partial loss of 100% federal funding Partial Expansion after Jan 2014 • Insured: welcome mat + some new eligibles • Ohio House and Senate sub-committees looking at “reform” versus “expansion” • Potential HHS waiver similar to Arkansas No Expansion • Welcome mat = ~28,000 in Franklin County currently eligible • Loss of $13 billion in additional federal dollars to the state over six years • $59 to $88 million yearly penalties statewide for employers with low-income workers • Loss of significant DSH/HCAP funding for hospitals that serve low-income people • Loss of $1.8-1.9 billion in new net savings and revenue for state budget • Loss of economic impact between $8.6-19.8 billion • Loss of sales tax revenues for counties ~$375 million
Q&A
Future ACA Learning Sessions •
Access HealthColumbus host’s monthly webinar to provide objective information about ACA implementation.
•
Sessions held the second Thursday of the month from 1:00-2:00PM
•
Will send you a link later today to register for future sessions
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2013-2014 Webinars •
September 12 1:00-2:00PM
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October 10 1:00-2:00PM
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November 14 1:00-2:00PM
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December 12 1:00-2:00PM
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January 9 1:00-2:00PM
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February 13 1:00-2:00PM
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March 13 1:00-2:00PM