The Affordable Care Act and West Virginians Libraries West Virginia Library Commission Conference October 10, 2013

1. The Affordable Care Act and West Virginians LibrariesWest Virginia Library Commission Conference October 10, 2013

2. Today’s Presentation • Review the four major provisions of the Affordable Care Act (ACA) • Review the new enrollment process and who will be involved in enrollment • Discuss how libraries can be involved in the enrollment process

3. ACA Has Four Main Goals • New regulations of the insurance industry • Renewed emphasis on prevention • Cost containment, particularly for Medicare • Expands health insuranceto virtually all Americans

4. Health Insurance Coverage Is Expanded In Two Ways • Medicaid is expanded to cover everyone under 138% of the federal poverty level who is under age 65. • New Health Insurance Marketplaces are created where subsidized, private insurance products are sold.

5. New Coverage Options

6. Expanding Health Insurance • The Medicaid expansion is projected to cover an estimated 133,500 low-income West Virginians. • Federal government pays almost all of the costs.

7. Medicaid Expansion: Income Eligibility for a Family of Three

8. Medicaid Eligibility • Income • Household size • US citizenship • State Residency • Under age 65 <138% of FPL

9. Income Eligibility for Medicaid 138% applies to children over age one and adults. 155% applies to pregnant women and children under age one.

10. Changes in CHIP • With the increase in Medicaid eligibility, many children currently enrolled in CHIP will become Medicaid eligible and cannot remain on CHIP: • 10,800 CHIP kids transfer to Medicaid • 2,800 kids gain CHIP coverage under the new income eligibility rules

11. Health Insurance Marketplace

12. Health Insurance Marketplace • A marketplace allows consumers to compare and choose private health insurance policies that best suits their needs. Policies offered through a web site, 1-800 number, by mail or with personal assistance.

13. Health Insurance Marketplace • The marketplace is open to individuals who do not have employer sponsored health insurance and small businesses. • Significant tax credits for individuals between 100% and 400% of the FPL. • An estimated 99,000 West Virginians will qualify for premium tax credits in the exchange.

14. Subsidy for family of 4 earning $50,000 Policy Cost = $789 Family Pays = $282 Govt. Subsidy = $507 (64%) Additional assist with deductibles and copayments plus out-of-pocket maximum protection

15. FPL for Cost Sharing Subsidies and Premium Subsidies 250% of the FPL level is the eligibility threshold for cost sharing reductions and 400% of the FPL is the threshold for premium assistance

16. Health Insurance Marketplace • Highmark Blue Cross Blue Shield the only carrier to participate in 2014 • They are offering 11 different plans: 4 gold plans; 3 silver and 3 bronze plans; and one catastrophic plan. • Two additional ones from BCBS nationally, but appear to be identical to state offered plans.

17. Three Levels of Plan Options in West Virginia • Gold plan • Insurance company pays 80% of claims and consumers on average pay 20% of the claims. • Silver = 70/30 • Bronze = 60/40

18. Premiums in the Various Metal Levels • Premiums in a gold plan would be higher, while deductibles and copayments would be lower • Conversely, the premiums in a bronze plan will be lower, while the cost sharing would be higher

19. The Marketplace and Small Businesses • Eligibility for the SHOP marketplace is 50 or fewer employees, about 42,000 West Virginia businesses employing 280,000 people. • Highmark is offering 4 plans in the SHOP Marketplace in 2014

20. How Will the Enrollment Process Work?

21. The Enrollment Process • Simplified enrollment for Medicare, CHIP and premium tax credits in the health insurance marketplace • One enrollment form • No face-to-face interviews • No paper documentation • No asset test

22. Timelines • Enrollment begins October 1, 2013 • If someone enrolls by the 15th of the month, then coverage for Medicaid and qualified health plans begins the first day of the following month. Get people enrolled by December 15th. • If after the 16th on the month, coverage begins on the first day two months later.

23. How Do We Enroll All These People? • HHS will maintain a web site: And a call center: 800-318-2596 • Can also enroll through the mail • A number of entities will provide personal assistance www.healthcare.gov

24. Personal Assistance • Insurance agents and brokers • Navigators • Advanced Patient Advocacy/Hospitals • WVU Healthy Starts • TSG Consulting • In-person assisters – 270 • Maximus • Placed in DHHR and SHIP offices so far. • Community health center employees • Certified Application Counselors • DHHR Employees

25. How to Find Personal Assistance • bewv.wvinsurance.gov: Click on Where Can I Find Local Help? Gives county level data • The national web site has ZIP code level data, but doesn’t filter information well. See localhelp.healthcare.gov

26. Community Assisters • Enroll uncomplicated cases, arrange for public education sessions, and connect the uninsured to navigators, in-person assisters, community health centers, etc. • WVAHC is providing mini grants, training and on-going technical support to develop community assisters.

27. Community Assisters Are Throughout the State • Eastern Panhandle • EPFC • Berkley County Health Department • Morgan County Starting Points • Mineral County FRN • Future Generations

28. Community Assisters Are Throughout the State • North Central West Virginia • Tucker County FRN • Taylor County FRN • Milan Puskar Health Right • Lewis County FRN

29. Community Assisters Are Throughout the State • Northern Panhandle • AIDS Task Force of the Upper Ohio Valley • Brooke County Health Department • Hancock County Health Department • Wheeling Health Right

30. Community Assisters Are Throughout the State • Mid-Ohio Valley • Boys and Girls Club of Parkersburg • Catholic Charities • Good Samaritan Clinic • Mid-Ohio Valley Regional Corrections

31. Community Assisters Are Throughout the State • Kanawha/Cabell • Covenant House • West Virginia Health Right • Marshall University (students) • Partnership of African American Churches • WV FREE • WV Healthy Kids and Family Coalition

32. Community Assisters Are Throughout the State • Southern West Virginia • Beckley Health Right • Big Creek People in Action (McDowell) • Christian Help of Mingo County • Community Connections • Greenbrier County Health Department • Nicholas County Starting Points • Raleigh County Community Action Program • SALS

33. Community Application Counselors • Library employees can be certified application counselors. Guidance on CAC is available at http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/CAC-guidance-7-12-2013.pdf

34. Certified Application Counselors • Disadvantage: There is no federal or state funding for CAC. • Advantages: Eligibility is a web based training for 5 hours and pass a test. • Listed on HHS and OIC web sites as being certified.

35. How Can Libraries Be Involved • Connect uninsured patrons to navigators, in-person assisters, community health centers, etc. so they can get covered. • Host enrollment sessions at your library.

36. How Can Libraries Be Involved • Post the names and contact information of navigators, in person assisters, community health centers, CAC, and community assisters in the library

37. How Can Libraries Be Involved • Display material that objectively explains the Affordable Care Act and the new enrollment process • Other suggestions?

38. Opportunity • We have a once-in-a-lifetime opportunity to improve the lives of thousands of our friends and neighbors. I hope you will join WVAHC in this journey • We need…

40. Contact Information Perry Bryant perrybryant@sudddenlink.net 304-344-1673 (Office and Home) 304-533-7941 (Cell) www.wvahc.org

41. Web Sites www.wvahc.org bewv.wvinsurance.gov localhelp.healthcare.gov www.healthcare.gov www.marketplace.cms.gov www.kff.org www.enrollamerica.org