Affordable Care Act Implementation in NYS Noilyn Abesamis-Mendoza, MPH Director, Project CHARGE (Coalition for Health Access to Reach Greater Equity) New York City
Overview of Presentation Project CHARGE The Case for Health Care Access NYS Health Benefit Exchange Timeline State Updates Next Up Resources
Formed in 2007 16 organizational partners Purpose: Increase the capacity of community based organizations to do policy/advocacy Goal: Ensure access to health care
THE CASE FOR HEALTH CARE ACCESS
47 million uninsured individuals nationally. 2.6 million New Yorkers are uninsured. 50% of uninsured adults in NYS work full-time jobs. 1 in 5 people have trouble paying medical bills. 60% of all bankruptcieswere a result of medical debt In NYS, premiums rose 92% between 2000-2009. While median earnings rose by only 14%. Employers are cutting back on health coverage altogether. 58%of New York workers were covered by employer-sponsoredinsurance in 2009, down from 69% in 2003. Sources: Families USA (2008). Trust for America s Health, Center for Financing (2000 and 2006). Himmelstein et al. (2000). Community Service Society (2013). The Affordable Care Act: What is it? & What Does It Mean for New York? New York State Health Foundation. The State of New York s Health.
Full Implementation Impact of Exchange and Reforms in NY One million people will gain insurance Exchange enrollment is estimated to be 1.1 million people Source: Urban Institute simulation of coverage as if ACA fully implemented in 2012 using 2008-2010 American Community Survey Data
Enrollee Characteristics, by Income
Enrollee Characteristics, by Language
Enrollee Characteristics, by Race
NEW YORK HEALTH BENEFIT EXCHANGE
ACA became law On March 23, 2010, President Obama signed the Affordable Care Act. The law puts in place comprehensive health insurance reformsthat will roll out over four years and beyond.
With ACA, New coverage options and standard benefits New way to shop and buy insurance (marketplace) New timeline, mandates, and tax changes for individuals and businesses
What is an Exchange? Organized Marketplace Easily compare health plan options Get tax credits Enroll through a single, streamline application Two Programs Individual Exchange Employer Exchange called the Small Business Health Options Program (SHOP) Source: New York State Health Benefit Exchange
Functions of the Exchange Eligibility and Enrollment Toll-free telephone hotline Web portal for eligibility determination and enrollment Ability to calculate the actual cost of coverage after individual tax credits and cost sharing reductions Certify individuals as exempt from individual responsibility Certify Qualified Health Plans Make available qualified health and dental plans to eligible individuals and employers Assign quality rating and actuarial value to each QHP offered through Exchange Require QHPs to offer Essential Health Benefits Ensure adequacy of plan networks Source: New York State Health Benefit Exchange
10 standard health care benefits Preventive and Wellness Services & Chronic Disease Management Outpatient Services Mental Health & Substance Abuse Services Emergency Services Maternity & Newborn Care Prescription Drugs Hospitalization Physical & Occupational Therapy Services and Supports Laboratory & Imaging Services Pediatric Services including oral and vision care Source: New York City Human Resources Administration s Office of Citywide Health Insurance Access (OCHIA)
New Coverage Options A health consumer can choose from 4 options all include 10 health benefits Platinum (Highest premium, lowest cost-sharing) Gold Silver Bronze(Lowest premium, highest cost-sharing) Source: New York City Human Resources Administration s Office of Citywide Health Insurance Access (OCHIA)
Who Can Enroll in the Exchange? NYS Resident Under the age of 65 years (unless you are a caretaker or a parent) Citizen, legal permanent resident or lawfully present in the US Do not have access to adequate or affordable employer sponsored coverage Own or work for a small business with 2 to 50 employees Source: New York State Health Benefit Exchange
The Exchange, Medicaid & Modified Adjusted Gross Income (MAGI) MAGI Medicaid groups Go to NYS Exchange Pregnant Women Children Parents/Caretaker Relatives Adults under age 65, not on Medicare Non-MAGI Medicaid groups Go to NYC HRA or NYS DOH Categorically eligible (e.g., TANF, SSI, Foster Care) & former foster care youth Individuals 65+ (age a condition of eligibility) Individuals whose eligibility is based on being blind or disabled Individuals who request coverage for longterm care services Medicare Savings Medically Needy Medicaid Buy-In for Working Persons with Disabilities Cancer Services Program Residents of adult homes, residential treatment centers/community residences operated by OMH Source: New York City Human Resources Administration s Office of Citywide Health Insurance Access (OCHIA)
State Updates Awarded nearly $370 M in federal funds for Exchange establishment activities Convened 5 Regional Advisory Committees Conducted background research on key policy decisions Contracted with System Integrator to build IT System Contracted with customer services organization Invited health plans to participate in the Exchange Invited organizations to apply to be In-Person Assistors/Navigators Received conditional certification from HHS in December 2012 Source: New York State Health Benefit Exchange
How Has ACA Helped NY So Far? Parents can keep their children on their health insurance until age 26 Medicare donut hole is phasing out Preventive care services are free Ban on lifetime limits on health benefits Small businesses can get tax credits to cover up to 35% of providing health insurance to employees. Source: New York City Human Resources Administration s Office of Citywide Health Insurance Access (OCHIA)
Heesoo s Story
Potri s Story
CBWCHC s Story
TIMELINE: Health Care Reform in New York 2013 Jan Feb March April May Jun July Aug Sep Oct Nov e Dec Federal & State insurance expansion programs close or end Dec. 31, 2013 - Family Health Plus, NY Bridge Plan & Healthy NY for individuals & sole proprietors NY Health Benefit Exchange opens for nonelderly Individuals (subsidies for adults & children without jobbased coverage) & small businesses. Public & private coverage starts Jan. 2014 Individual and small group plans outside of exchange provide essential health benefit package coverage Source: New York City Human Resources Administration s Office of Citywide Health Insurance Access (OCHIA) 25
TIMELINE: Health Care Reform in New York 2014 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec Open enrollment in & out of Exchange ends Mar. 31, 2014 for individuals. Subsidies only in Exchange. -Exchange open for public coverage. -Individuals who have a change in circumstances can enroll during the special enrollment period into private coverage in & out of the Exchange. Open enrollment in & out of Exchange for individuals: Oct 1 Dec 7 Exchange open for special enrollment & public coverage Year-round open enrollment in & out of SHOP Exchange for small businesses with fewer than 50 employees. *Choice of plans for workers + single bill for the employer. Some small businesses eligible for tax credit up to 50% of their premium costs. *these services must start no later than 2015 Large businesses (> 50 FTE workers) must offer coverage that is affordable and adequate to all fulltime employees (working 30 or more hours a week) and their dependent children or else face a financial penalty if these workers get subsidized Exchange coverage Individual mandate begins taxpayers will have to pay a penalty when they file their income taxes in 2015 for every month they or a tax dependent is uninsured unless they can claim an exemption. Source: New York City Human Resources Administration s Office of Citywide Health Insurance Access (OCHIA) 26
TIMELINE: Health Care Reform in New York 2015 Jan Feb March April May June July Aug Sep Oct Nov Dec Exchange open for public coverage Only individuals elgible for a special enrollment because of a change in circumstances can enroll in private coverage in or out of the Exchange Open enrollment in & out of Exchange for individuals: Oct 1 Dec 7 Exchange open for special enrollment & public coverage Year-round open enrollment in & out of SHOP Exchange for small businesses with fewer than 50 employees. Choice of plans for workers + single bill for the employer. Some small businesses eligible for tax credit up to 50% of premium costs. Large businesses (> 50 FTE workers) must offer coverage that is affordable and adequate to full-time workers (30 + hours/week) and their dependent children or else face a financial penalty if these workers get subsidized Exchange coverage Individual mandate taxpayers will have to pay a penalty when they file their income taxes next year for every month they or a tax dependent is uninsured unless they can claim an exemption. By April 15th, taxpayers pay a penalty if they or their dependents were uninsured in 2014 & can t claim an exemption. Penalty phases in starts out low If insured & got a subsidy, most must repay some or all of any overpayment - or, they can claim a credit if they did not get all of the credit they are due in advance (subsidy reconcilied ) 27 Source: New York City Human Resources Administration s Office of Citywide Health Insurance Access (OCHIA)
DETAIL: Individual Mandate Jan Feb March April May June July Aug Sep Oct Nov Dec By April 15th, 2017, taxpayers pay a (fully phased in) penalty if they or their dependents were uninsured in 2016. Penalty increases each year to reflect cost-ofliving increases. If eligible, can claim an exemption. If insured & got a subsidy, most must repay some or all of any overpayment - or, they can claim a credit if they did not get all of the credit they are due in advance (subsidy reconcilied ) Maximum annual penalty when fully phased in: No more than the cost of a Bronze plan but could be as high as about $2,000/year or 2.5% of household income. Exemptions: Uninsured individuals will not face a penalty if they: Were uninsured for a short period of time Earn too little to file taxes Were in jail or not in the country, including here with undocumented status Have a religious objection Had a hardship (e.g.: job-based family coverage is not affordable) Are a member of an Indian Tribe Cannot find affordable coverage Source: New York City Human Resources Administration s Office of Citywide Health Insurance Access (OCHIA) 28
Next Up Grassroots outreach activities begin April 2013 Health plans selected for participation in 2014 July 2013 In-person Assistor/Navigators announced and training July 2013 & Aug 2013 In-Person Assistor/Navigator Program begins Sept 2013 Customer Service opens for business Sept 2013 Advertising campaign launched Sept 2013 Open enrollment begins Oct 1, 2013 (thru March 31, 2013) Coverage starts Jan 2014 Source: New York Health Benefit Exchange
Regional Advisory Committee Thursday, May 30 11:00am to 2:00pm Baruch College Newman Vertical Campus, Room 14-220 One Bernard Baruch Way 55 Lexington Avenue New York, NY http://www.surveymonkey.com/s/may2013rac
Useful Websites Federal Health Reform www.healthcare.gov/ New York State Health Benefit Exchange www.healthbenefitexchange.ny.gov NYC Health Insurance Link www.nyc.gov/hilink
Noilyn Abesamis-Mendoza Director, Project CHARGE namendoza@cacf.org 212-809-4675 x. 106 http://bit.ly/projectcharge http://www.facebook.com/projectcharge twitter: @projectcharge