Affordable Care Act (ACA) Webinar Series September 12, 2013
Purpose We will be sharing the latest information on the health care insurance exchange, exchange navigators, and efforts to expand Medicaid coverage. We strive to provide objective updates of useful information as the ACA moves into a key phase of its implementation over the coming months. Today’s Objectives 1. Provide an update on ACA Healthcare Insurance Exchanges 2. Provide an update on ACA Healthcare Insurance Navigators and Certified Application Counselors in Ohio. 3. Provide an update on Medicaid expansion and changes in Ohio. 1
Today’s agenda 1:00 Welcome & Introduction -Jeff Biehl, Access HealthColumbus
1:05 Update on Healthcare Insurance Exchanges -Doug Anderson, Bailey Cavalieri LLC
1:25 Update on Navigators and Certified Application Counselors (CAC) -Isi Ikharebha, Physicians CareConnection
1:45 Update on Medicaid Expansion -Jeff Biehl
1:50 Q&A
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By 2020… not 1/1/2014
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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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Healthcare Insurance Exchanges
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Healthcare Insurance Exchanges
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SHOP Exchange
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Individual Exchange
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www.healthcare.gov
Healthcare Insurance Exchanges October 1st: Exchanges open for business; people can shop for and enroll in coverage. January 1st: Coverage bought before Dec. 15 becomes effective
March 31st : Open enrollment for 2014 ends; after March 31st, coverage is not available until the next open enrollment period except for “special enrollments� (eg., loss of a employment and coverage) October. 15, 2014: Open enrollment for 2015 begins
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Companies in the Ohio Exchange
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SHOP Exchange – Anthem – Assurant – AultCare – HealthSpan – Kaiser – Medical Mutual – SummaCare
Individual Exchange – Anthem – Assurant – AultCare – Buckeye Community – CareSource – Coventry – HealthSpan – Humana – Kaiser – Medical Mutual – Molina – Paramount – SummaCare
Provider Networks
Medicaid plans entering commercial insurance exchanges – Buckeye – CareSource – Molina
Plans may be some of the most affordable
Nearly half of exchange plans in the 13 states with early fillings have narrow networks Modern Healthcare 8/19/13
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Delayed Rules
Employer mandate and employer reporting requirements
Employee choice of plans in the SHOP Exchange
Coordinated out-of-pocket spending limits for medical and dental plans sold by separate companies
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90 Day Grace Period
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ď Ź
CMS rule gives consumers a 90-day grace period if they do not pay their premium before their insurer can drop coverage
ď Ź
1-30 days insurance companies financially responsible
ď Ź
31-90 days providers financially responsible
Navigators and Certified Application Counselors (CAC)
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Navigators and Certified Application Counselors
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Source: Ohio Hospital Association, August 2013
Federal Awards
Navigator Organizations in Ohio –
Ohio Association of Foodbanks - $1,958,961 (Statewide)
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www.ohiofoodbanks.org/
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Children’s Hospital Medical Center - $124,419 (Cincinnati)
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Clermont Recovery Center, Inc. - $44,938 (Clermont County/Cincinnati)
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Helping Hands Community Outreach Center - $230,920 (Dayton)
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Neighborhood Health Association - $684,630 (NE Ohio)
FQHC Certified Application Counselor (CAC) in Columbus/Franklin County –
Columbus Neighborhood Health Center, Inc. – $230,369
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Heart of Ohio Family Health Centers – $79,548
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Lower Lights Christian Health Center – $105,189
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Southeast, Inc. - $73,630
Enrollment Collaboratives
ONCE (Ohio Network for Health Coverage and Enrollment) –
Collaborative coordinated by HPIO focused on coordinating enrollment efforts across the state
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To learn more: OhioONCE@gmail.com
Enroll America –
Ohio chapter is working to coordinate enrollment efforts across the state
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To learn more: www.enrollamerica.org
FQHC Counselor Collaborative –
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Collaborative coordinated by Access HealthColumbus focused on Medicaid enrollment with local FQHCs
Medicaid Expansion
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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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2014 Medicaid Expansion as of September
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1
4 Debate Ongoing
Source: Kaiser Family Foundation
History of Medicaid Participation by States 30 25
25 20 15
States 11
10
8
6
5 1 0 1965
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1966
1967
1970
1982 Source: The Washington Post
Medicaid Expansion Scenarios and Implications to business, government, health care, and the social sectors of Franklin County ACA/Full Medicaid Expansion • Welcome mat= ~28,000 + New eligible = ~41,000 in Franklin County • Strong revenue and economic benefit for Ohio and counties • Post January 1, 2014 scenario = partial loss of 100% federal funding • Ballot scenario = target of Fall 2014, partial loss of 100% federal funding Partial Medicaid 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 Medicaid 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
More Will Qualify for Medicaid Without Expansion
CMS adopts Modified Adjusted Gross Income (MAGI) Income Guidelines
5% Income Disregard
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Children / Pregnant Women up to 205% FPL
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Parents up to 95% FPL
New Income Exemptions –
New Household Formation Rules –
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Child Support / Social Security Income
Stepparents and their income included
Where does Medicaid expansion stand?
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House and Senate focused on reform not expansion
Ohio House Speaker predicting 12 bills to be introduced by early October
A coalition (Healthy Ohioans Work) of health-care providers, unions, businesses, religious organizations and other advocates for the uninsured announced the launch of a campaign for a November 2014 statewide ballot (1)
Speculation is mounting that any concrete action by the General Assembly won't occur until after the primary election filing deadline on Feb. 5 so as to protect incumbents from challenges on the right. (2)
Speculation that Governor could seek expanded appropriation authority through the Controlling Board (2)
Source: (1) The Columbus Dispatch, 9/4/13, (2) Gongwer Statehouse News Service, 9/2/13
Where does expansion stand?
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Current Medicaid Bills in House –
HB 125 (Carney, J., Antonio, N.)
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HB 176 (Sears, B.)
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HB 208 (Amstutz, R., Sykes, V.)
Current Medicaid Bills in Senate: –
SB 117 (Smith, S.)
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SB 145 (Burke, D.)
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SB 166 (Cafaro, C.)
Q&A
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Future ACA Learning Sessions
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Monthly webinar to provide objective information about ACA implementation.
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Sessions held the second Thursday of the month from 1:00-2:00PM
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2013-2014 Webinars •
October 10
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November 14
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December 12
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January 9
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February 13
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March 13