The Affordable Care Act: Implementation in Illinois

Transcription

1 The Affordable Care Act: Implementation in Illinois Stephanie F. Altman, J.D. Programs and Policy Director Health & Disability Advocates November 2013

2 ACA 101 ACA signed into law on March 23, 2010 with major provisions to start January 1, Health Insurance Marketplaces opened October 1, 2013: Get Covered Illinois operates the marketplace and enrollment for Medicaid expansion. Individuals are responsible to obtain health coverage through an employer, directly from an insurance company or through the Marketplace, Medicaid or Medicare. Employers over 50 FTE are responsible for providing coverage but employer penalty delayed for one year. Connecting Communities to Coverage

3 ACA 101: Key Components Available Now Extended dependent coverage to age 26 No pre-existing condition exclusion for children Preventive services without cost sharing CountyCare-the early expansion of Medicaid in Cook County No lifetime limits on care Small business tax credits No insurance rescissions except in cases of fraud/intentional misrepresentation 2014 and Beyond New Marketplace to buy insurance and receive financial help to pay for it New Medicaid Adult Group available to adults under 138% FPL (state option) Financial Assistance to purchase private insurance Medicaid available to former foster children up to age 26 at any income level No pre-existing condition exclusion for adults All plans must cover Essential Health Benefits No annual limits on care No gender rating Closing Medicare Part D donut hole Individual and Employer Responsibility (but employer penalty delayed) 3

4 ACA 101: Essential Health Benefits All health plans in the Marketplace, individual & small group, are qualified health plans (QHP). Illinois Benchmark Federal VIP for vision for children Supplemented by All Kids for dental for children BCBS Blue Advantage Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services including chronic disease management Pediatric services including oral and vision care 4

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6 ACA 101: New Pathways to Coverage 6

7 Get Covered Illinois Media and Marketing Campaign Administered by Governor s Office Marketplace Team in partnership with DOI, HFS, DPH and DHS as well as other state agencies. Community enrollment assistance. Includes both insurance and Medicaid. 7

8 Important Dates OCTOBER 1, Open Enrollment in the Marketplace/New Medicaid Begins. DECEMBER 15, Must be enrolled by this date for Marketplace health coverage to begin by 1/1/14 JANUARY 1, New Medicaid Adult Group Coverage begins. (No backdating before this date.) MARCH 31, Open Enrollment for Marketplace ends (Medicaid is always open). 8

9 In Person Assistance Navigators Federally funded (Just over $3 million via 11 awards in IL) Duties: Outreach, Facilitate Enrollment, Provide Ongoing Support Who: Cannot be a health insurance provider or someone paid by an health insurance provider to enroll individuals In Person Counselors (IPCs) State funded (just over $28 million via 44 awards in IL) Duties: Outreach, Facilitate Enrollment, Provide Ongoing Support Who: Cannot be a health insurance provider or someone paid by an health insurance provider to enroll individuals Certified Application Counselors (CACs) Volunteers no funding Will participate in a training to provide application assistance Who: Anyone that submits an application to the federal government and is approved. You must demonstrate that you have procedures in place to protect personal information.

10 THE UNINSURED 10

11 1.5 million uninsured non-elderly adults in Illinois 11

12 Young adults in Illinois are the most likely to be uninsured 3,500,000 35% 3,000,000 2,500,000 29% 25% 30% 25% 2,000,000 1,500,000 19% 16% 13% 20% 15% 1,000,000 10% 500,000 4% 1% 5% - Under to to to to to and over with HI w/o HI % Not Covered 0% 12

13 The Uninsured: Past Experiences 44% have shopped for insurance outside their job 67% have been uninsured for 2 years or more Connecting Communities to Coverage

14 The Uninsured: Understanding of Law Do you feel you have enough information about the health reform law to understand how it will impact you personally, or not? NOTE: Don t know/refused answers not shown. SOURCE: Kaiser Family Foundation Health Tracking Poll (conducted March 5-10, 2013)

15 ILLINOIS MEDICAID EXPANSION

16 Medicaid in IL: New Programs Pre-ACA Post-ACA FamilyCare for parents and other caretaker relatives of children under 19 All Kids Moms and Babies Aid to the Aged Blind and Disabled (AABD) Health Benefits for Workers with Disabilities (HBWD) Health Benefits for Persons with Breast and Cervical Cancer (apply with Illinois Dept. of Public Health) ACA Adult Former Illinois Foster Child FamilyCare for parents and other caretakers of children under 18 All Kids Moms and Babies Aid to the Aged Blind and Disabled (AABD) Health Benefits for Workers with Disabilities (HBWD) Health Benefits for Persons with Breast and Cervical Cancer (apply with Illinois Dept. of Public Health) 16

17 Medicaid Expansion and not eligible for other Medicaid category No asset or disability test Under 138% FPL State currently seeking input from stakeholders in coverage package called ABP Waiver programs and LTSS 17

18 Medicaid in IL: Managed Care Connecting Communities to Coverage

19 ILLINOIS MARKETPLACE 19

20 Marketplace Overview Get Covered Illinois is a web-based portal for individuals and small businesses to enroll in coverage. Can also access by mail, on phone, or in person. Enroll in public and private health insurance, as well as access financial assistance to pay for coverage. Federally Facilitated Marketplace is linked to Get Covered Illinois Gives consumers the tools and power to have control over their insurance decisions Apples-to-apples comparison of plans Plan Finder and Individual Pricing 20

21 2014 Open Enrollment Enrollment Date/Period Effective Coverage Begins Oct. 1 Dec. 15, 2013 Jan. 1, st 15 th of month (Jan. March) 16 th last day of month (Dec. March) 1 st of following month 1 st of second following month Initial Open Enrollment Ends March 31, 2014 ***Those who are eligible for Medicaid can apply for coverage any day of the year! Note: Coverage is not retroactive 21

22 Insurance Rating and Pricing Demographics Age (3:1) Household Income Family size Tobacco use Location/Zip code (13 rating areas) Plan factors Out-of-Pocket limits Benefit levels Insurance Affordability Programs Premium tax credits Cost-Sharing Reductions (CSR) 22

23 Cost: Two Types of New Financial Assistance Premium Tax Credits Helps people pay the monthly cost to have a plan Cost- Sharing Reductions Decrease the charges (e.g., copays, deductibles) enrollees must pay when receiving health care services covered by the plan 23

24 Who Is Eligible for Tax Credits/Subsidy? A U.S. Citizen and Unable to obtain affordable minimum essential coverage, such as coverage provided through an employer, Medicaid or the Marketplace Eligible to enroll in a QHP through the Marketplace Part of a tax filing unit Has household income between 100% and 400% FPL A non-citizen who is lawfully present and Unable to obtain affordable minimum essential coverage, such as coverage provided through an employer, Medicaid or the Marketplace Eligible to enroll in a QHP through the Marketplace Part of a tax filing unit Has household income between 0-400% FPL Cost sharing subsidies are provided if eligible for a tax credit with an income between 100%-250% FPL and enrolled in a silver plan through the Marketplace 24

25 Potentially eligible: for Premium Tax Credit/ Marketplace Potentially eligible: AllKids Marketplace Potentially eligible: Moms and Babies (Pregnant or child under 1) Marketplace Household Size Potentially eligible: ACA Adult Medical or Family Care Marketplace 100%* 133% 138% 200% 250% 300% 400% 1 $11,490 $15,282 $15,856 $22,980 $28,725 $34,470 $45, ,510 20,628 $21,404 31,020 38,775 46,530 62, ,530 25,975 $26,951 39,060 48,825 58,590 78, ,550 31,322 $32,499 47,100 58,875 70,650 94, ,570 36,668 $38,047 55, , , ,590 42,015 $43,594 63,180 78,975 94, , ,610 47,361 $49,142 71,220 89, , , ,630 52,708 $54,689 79,260 99, , ,520 For each additional person, add $4,020 $5,347 $5,548 $8,040 $10,050 $12,060 $16,080 * lawfully present residents below 100% FPL and ineligible for Medicaid may qualify Connecting Communities to Coverage

26 Impact of Marketplace Financial Help on People with Employer Insurance Not intended for those with employer coverage. Provisions in place to discourage those with employer offer buying into exchange with financial help. Employer offer to employee is not more than 9.5 % of the HH income. Dependent coverage glitch 26

27 Determining the penalty Greater of 1) Percentage applied to applicable income Applicable income = excess above filing threshold that tax year. 1.0% in 2014, 2.0% in 2015, and 2.5% in 2016 OR 2) Flat dollar amount Assessed on each taxpayer and any dependents (family) $95 in 2014, $325 in 2015, and $695 in 2016 Adjustments: Family and Dependents (under age 18) Flat dollar amount (FDA) reduced by 50% for dependents < 18 Family penalty cap: 300% of the annual FDA Penalty capped At the national average premium for bronze QHPs in Marketplace (for the family size). 27

28 Income or Affordability Exemptions from Shared Responsibility Hardship or domestic circumstances Lacks coverage for less than three months (one 3- month period per year) Household income below threshold for federal taxes Contribution for single coverage exceeds 8% of household income Membership/ Affiliation Religious conscience Membership in a health care ministry Member of an Indian tribe Legal or Residential Incarceration Not lawfully present in the U.S. or non-resident aliens U.S. citizens living abroad for 330+ days in 12-months Residents of U.S. territories 28

29 Individual Penalty for 2014 Although the law takes effect Jan. 1, the initial enrollment period continues through March 31. Since people are exempted for a short coverage gap less than three months individuals that obtain coverage before the end of March will be exempt from the payment for that period. Need to have coverage for at least 1 day in March 2014 in order to qualify for the Short Coverage Gap exemption but if delay in enrollment is cause, may be able to claim hardship exemption. After 2014, enrollment period will end in December. Tax Penalty only: No garnishment, liens, etc. 29

30 How To Stay Informed in Illinois Bookmark To Enroll: Sign up for IHM newsletter, Linkedin, Facebook page, Twitter and Blog Questions? Contact: Stephanie Altman Phone: