Health Care Reform: An Update on California. Kerry Landry, MPH Coverage Programs Specialist February 24 th, 2012

Transcription

1 Health Care Reform: An Update on California Kerry Landry, MPH Coverage Programs Specialist February 24 th,

2 Agenda 1. Overview of the Affordable Care Act 2. Focus on Medicaid and Public Coverage 3. California Health Benefit Exchange & Cal-HEERS 4. Implications from the Supreme Court Ruling 2

3 What is the Affordable Care Act? The Patient Protection and Affordable Care Act (ACA) was signed March 24, 2010 Kaiser Health Reform Hits Main Street video - 3

4 What is the Affordable Care Act? Main objectives of the law: 1. Patient and Consumer Protections 2. Affordability of Private Coverage 3. Strengthening Medicaid and Public Coverage 4. Improving Public Health 4

5 Affordable Care Act (ACA) Timeline Changes Implemented Starting in 2010 Dependent coverage to age 26 No cost sharing for preventive services No more lifetime limits, and restrictions on annual limits No pre-existing condition exclusions for kids Small employer tax credits Pre-existing Condition Insurance Plan (PCIP) 5

6 Affordable Care Act (ACA) Timeline Required by 2014 Health Benefit Exchanges SHOP exchanges Medicaid eligibility expansion Seamless enrollment and eligibility determinations No pre-existing condition exclusions for ALL Everyone must have health insurance Large employer penalty for not offering coverage 6

7 Strengthening Medicaid & Public Coverage 1. Medicaid Expansion 2. Premium subsidies to purchase insurance in the Exchange 3. State option to create a Basic Health Program 4. Enrollment & Eligibility Simplification 7

8 ACA Coverage Expansions Income Level ACA Provision 0-138% FPL Medicaid Expansion for ALL % FPL Basic Health Plan (state opt-in) %FPL Tax credit for premium assistance in the Exchange 8

9 Medicaid Expansion National expansion to 138%FPL National standard eliminates highly variable eligibility limits amongst states Arkansas working parent: 17% of FPL California working gparent: 106% of FPL Wisconsin working parent: 200% of FPL Except for the elderly and programmatically linked such as SSI, dual eligibles States get 100%FMAP for newly eligible in 2014, decreasing to 90% by 2020 National standard for determining income called MAGI and no asset test 9

10 Premium Subsidies Tax credits for people %FPL Only eligible for tax credit if: Not eligible for public coverage (Medi-Cal, Medicare) Not eligible for employer coverage Employee contribution for employer sponsored insurance exceeds 9.5% of income Tax credit is advanceable a e Amount determined using annual income Subsidy tied to cost of 2 nd lowest cost silver level plan in the Exchange 10

11 Basic Health Program State opt-in for %FPL State Legislature has to authorize If no BHP, this group would get subsidies to purchase through the Exchange In CA, could be administered through the Exchange, DHCS or MRMIB State would get 95% of the subsidy that person would have received ed in the Exchange to provide coverage Waiting on more federal guidance and clarification on use of funds 11

12 Enrollment & Eligibility Simplification No Wrong Door : Online eligibility and enrollment system Will still have phone and in-person Single statewide enrollment form for Medi- Cal, HFP Income determinations: MAGI used to determine income will be from tax return Will have non-magi elderly & disabled whose eligibility will be determined with current Medi-Cal rules No asset test 12

13 No Wrong Door Providers County Community based organizations CalHEERS web site 13

14 Summary of Impacts in California Medi-Cal: Move over 2 million newly eligible into Medi-Cal in Exchange: Enroll 2.5 million people starting Basic Health Plan:????? 14

15 Summary of Impacts in San Francisco ,000 residents 105,000 in Medi-Cal 146,000 in Medi-Cal 55,000 HSF/SF PATH 89,000 uninsured 90,000 in Exchange 41,000 new Medi-Cal 41,000 individual exchange w/subsidy 21,000 individual exchange no subsidy 28,000 in SHOP ~40, uninsured 15

16 2014 Eligibility Groups in California <106% FPL Children* Pregnant Women Parents Childless Adults % FPL % FPL Medi Cal Medi Cal Medi Cal Medi Cal Basic Health Plan % FPL Healthy Families % FPL Healthy Kids Exchange subsidy Exchange subsidy Exchange subsidy % FPL Exchange subsidy 401+% FPL Exchange No subsidy Exchange No subsidy Exchange No subsidy Exchange No subsidy *Medi Cal income guidelines vary depending on the age of the child. Children above the income requirements for Medi Cal can still qualify for Healthy Families (up to 250%FPL) and Healthy Kids (up to 300%FPL). 16

17 State Exchanges 17

18 Monthly Board Meetings open to the public Always accepting written public comment Sign up for HBEX at 18

19 19 Source: Peter Lee presentation - California_Health_Benefit_Exchange_2012_Planning_Overview.pdf

20 Supreme Court Ruling 20 Source: Peter Lee presentation - California_Health_Benefit_Exchange_2012_Planning_Overview.pdf

21 21 Source: Peter Lee presentation - California_Health_Benefit_Exchange_2012_Planning_Overview.pdf

22 HBEX Relevant Updates 1. IT vendor solicitation released on January 18, 2012 for the development of the California s Health Eligibility Enrollment and Retention System (Cal-HEERS) Is collaborative effort between een HBEX, DHCS and MRMIB 2. Marketing & Outreach vendor solicitation released December 27, 2011 Includes development of outreach campaign and Assisters Program Will be informed by stakeholder input 22

23 But what about that lawsuit? In November, the Supreme Court agreed to hear arguments on the constitutionality of the ACA. They have allotted a total of 6 hours over 3 days in March for arguments on four issues. The final ruling is expected in June. 23

24 Supreme Court Schedule March 26, hours The applicability of the Anti-Injunction Act to the lawsuit Prohibits anyone from suing the collection of a federal tax before the tax has been imposed. If the mandate is considered a federal tax, plaintiffs could be barred from suing against the mandate until the tax is imposed. March 27, hours The constitutionality of the individual mandate Whether Congress has the power to enforce a minimum coverage provision i 24

25 Supreme Court Schedule March 28, hours The severability of the mandate Whether the mandate can be separated from the rest of the law (1hour) The constitutionality of the Medicaid expansion Whether Congress has the power to impose restrictions on state Medicaid programs 25

26 Potential outcomes from the Supreme Court ruling Medicaid expansion ruled Individual mandate ruled Law ruled to be constitutional? constitutional? severable? Then YES YES YES or NO ACA is upheld and fully implemented YES NO YES Mandate is struck down, but rest of law is upheld and implemented YES NO NO Entire law is struck down NO YES YES Medicaid expansion is struck down, but rest of law is upheld and implemented NO YES NO Entire law is struck down NO NO YES Medicaid expansion and mandate are struck down, but rest of law is upheld and implemented NO NO NO Entire law is struck down 26

27 But there s still an election Still possible that the ACA could be upheld by the Supreme Court, but later repealed. 27

28 For now, full steam ahead! 28

29 Questions? Kerry Landry Coverage Programs Specialist 29