Affordable Care Act Overview and the Role of Schools

Transcription

1 Affordable Care Act Overview and the Role of Schools Stephanie Altman, Assistant Director of Healthcare Justice December 2014

2 About Us: The Shriver Center The Sargent Shriver National Center on Poverty Law provides national leadership in advancing laws and policies that secure justice to improve the lives and opportunities of people living in poverty. We specialize in practical solutions. Through our advocacy, communication, and training programs, we advocate for and serve clients directly, while also building the capacity of the nation s legal aid providers to advance justice and opportunity for their clients Like us on Facebook: Follow us on Twitter:

3 4 New Ways to Get Covered Under the ACA 1) Health Insurance Marketplaces new online marketplaces to compare and purchase insurance for individuals and small businesses under 50 employees. 2) Financial assistance available to many to purchase insurance through the Marketplace. 3) Medicaid Expansion to Adults ages up to 138% of the Federal Poverty Level (around $1,342 per month for a single individual). 4) Young adults years old can join, remain, or return to their parent s health plan. 3

4 Uninsured in Illinois (2012) 1,772, % of Illinoisans (Age 0-64)Uninsured 6.6% of Children = 215,900 24% of young adults (18-25) were uninsured 69% made less than 200% FPL 21% of working adults were uninsured Asian 5% African- American 19% Hispanic 33% Unknown 2% White (Nonhispanic) 41%

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6 First Stop to Get Covered in Illinois First stop for health coverage in Illinois Screening tool directs consumers to the Health Insurance Marketplace or Medicaid Answers questions on health coverage options Allows consumers to search for in-person assistance near them

7 Income Greater than 138% FPL Income 138% FPL or below

8 Questions to Ask Families Do you have insurance? Is anyone in the family uninsured even if the child has Medicaid or insurance such as parents, grandparents, other siblings? Do they want a referral to free in person assistance to see if they are eligible for Medicaid or financial assistance to buy insurance?

9 Where can you refer a family? Getcoveredillinois.gov In addition to the screening tool, there is a Get Help button Refers to free in person assistance in many languages and neighborhoods Also, you could have a Navigator provide information on site at a school or jointly sponsor a family night or health fair.

10 Medicaid Programs in Illinois Before the ACA Medicaid eligibility is organized by category or population, each of which has different rules for how much income and resources you can have. For the most part, only citizens and qualified immigrants can qualify. Children under age 19 All Kids Parents and caretaker relatives of children up to age 19 FamilyCare Pregnant women Moms & Babies People with Disabilities, Seniors (age 65+) or Blind AABD Medicaid including AABD Spenddown Employed person with a disability, age (HBWD Health Benefits for Workers with Disabilities) 10

11 Medicaid Programs in Illinois After the ACA Adults without minor children ACA Adult Group Former Illinois Foster Children up to age 26 Children under age 19 All Kids Parents and caretaker relatives of children up to age 19 FamilyCare Pregnant women Moms & Babies People with Disabilities, Seniors (age 65+) or Blind AABD Medicaid including AABD Spenddown Employed person with a disability, age HBWD Health Benefits for Workers with Disabilities 11

12 2014 & 2015 Open Enrollment 2014 Open Enrollment Oct. 1, 2013 March 31, 2014 (April 15 for those in line ) 2015 Open Enrollment Nov. 15, 2014 Feb. 15, 2015 Auto Renewals Enrollment Date/Period December 15, 2014: Consumers who are already on Marketplace plans will be auto-renewed for coverage beginning January 1, 2015 Effective Coverage Begins 12 1 st 15 th of month 1 st of following month 16 th last day of month 1 st of second following month Qualifying Life Events (such as moving to a new state, marriage, or having a baby) open a Special Enrollment Period (SEP) Complex Cases during 2014 Open Enrollment also can open a SEP. Medicaid is always open!

13 What s Covered? Essential Health Benefits 13 13

14 Cost: Two Types of New Financial Assistance Premium Tax Credits Helps people pay the monthly cost (premium) 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 14 14

15 Preventive Services 15 Complete listing for adults, women, and children:

16 Non Citizens Pregnant women and children up to age 19 do not need to meet citizenship or immigration requirements in Illinois to qualify for Moms & Babies or All Kids Medicaid programs. Emergency Medicaid In general, lawfully residing non-citizens who are not eligible for Medicaid will be eligible for financial help in the Marketplace if income requirements are met. 16

17 IMPACT OF THE ACA ON THE UNINSURED, TO DATE 17

18 20 Million Have Gained Coverage Due to ACA 18

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20 9,000,000 8,000,000 7,000,000 6,000,000 5,000,000 4,000,000 3,000,000 2,000,000 National Marketplace Enrollment - 54% are female and 46% are male; - 34% are under age 35; - 28% are between the ages of 18 and 34; - 65% selected a Silver plan, while 20% selected a Bronze plan; and, - 85% selected a plan with financial assistance 2,153,421 3,299,492 4,242,325 8,019,763 1,000, , ,682 Oct. Nov. Dec. Feb. Mar. April 19th ASPE HEALTH INSURANCE MARKETPLACE: SUMMARY ENROLLMENT REPORT FOR THE INITIAL ANNUAL OPEN ENROLLMENT PERIOD For the period: October 1, 2013 March 31, 2014 (Including Additional Special Enrollment Period Activity Reported through ) May 1,

21 Illinois Marketplace Enrollment 250, , , ,000-53% are female and 47% are male; - 34% are under age 35; - 28% are between the ages of 18 and 34-56% selected a Silver plan, while 29% selected a Bronze plan; and, - 77% selected a plan with financial assistance. 86, , ,492 50,000 61, ,370 7,043 Oct. Nov. Dec. Feb. Mar. April 19th ASPE via Kaiser: 21

22 ACA Medicaid 451,880 Enrolled in ACA Medicaid (August 2014) Source: Transparency/Pages/AffordableCa reactenrollment.aspx 22

23 Over 600,000 enrollees in Illinois 23 Source: Get Covered Illinois, Annual Report. August

24 24 Source: July 2014 PerryUndem Research & Communication and Enroll America

25 25 25 Source: July 2014 PerryUndem Research & Communication and Enroll America

26 Source: Voices from the Newly Enrolled And Still Uninsured: A Survey about the Affordable Care Act s First Open Enrollment Period; PerryUndem Research/Communication commissioned by Enroll America, July

27 27 Helpful ACA Resources Get Covered Illinois Illinois Health Matters: Illinois Health Resources a directory of useful websites, fact sheets, and other resources on a variety of different topics for navigators and other assisters: HelpHub is an online community where ACA enrollment specialists in Illinois can share their experiences helping consumers enroll & ask questions to each other and policy experts. To request an invite, helphub@illinoishealthmatters.org with your name, the name of your organization & details of your ACA involvement. Starting Strong Webinars: Starting Strong is a collaborative of health policy and advocacy groups working together to promote successful implementation of the Affordable Care Act in Illinois. Webinars are held monthly on ACA topics:

28 Questions? Stephanie Altman Ext. 279 Sign up for Helphub.illinoishealthmatters.org Where you can get help to answer questions for the families you serve