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Health Reform and Health Coverage: Changes Ahead for Kids and Families. Kim VanPelt St. Luke’s Health Initiatives September 16, 2013. Coverage Expansion . Employer-based coverage. Medicaid. The “Exchange”. Medicaid Expansion . Over 300,000 Arizonans will benefit

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health reform and health coverage changes ahead for kids and families

Health Reform and Health Coverage: Changes Ahead for Kids and Families

Kim VanPelt

St. Luke’s Health Initiatives

September 16, 2013

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Coverage Expansion

Employer-based coverage

Medicaid

The “Exchange”

medicaid expansion
Medicaid Expansion
  • Over 300,000 Arizonans will benefit
  • Provides coverage up to 138% of the federal poverty level (approximately $32,500 for a family of four)
  • Supported by the Governor, passed by the Legislature
  • Restores the will of the voters
  • Approximately 60 percent of voters support restoration or expansion
  • Eligibility screening begins in October, coverage begins on January 1, 2014
improvements to coverage
Improvements to Coverage
  • Prevents discrimination in pricing based on pre-existing conditions
  • Essential benefits chosen by Arizona allows for coverage of many services
  • Those who have self-insured or grandfathered plans will not benefit from essential benefits, elimination of cost-sharing
essential benefits
Essential Benefits
  • 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
  • Chronic disease management
  • Pediatric services, including oral and vision care
essential benefits1
Essential Benefits
  • Arizona picked state employee plan, administered by United Health Care, as benchmark
  • www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/arizona-ehb-benchmark-plan.pdf
the marketplace
The Marketplace
  • Exchange now called the Marketplace
  • Arizona deferring to the federal government to run
  • Online site for individuals and small businesses to compare and purchase health coverage
  • Intended to simplify and structure health insurance choices for individuals, families and small businesses
  • Exclusive mechanism for receiving federal subsidies and plans with cost-sharing limits
the marketplace1
The Marketplace
  • Open enrollment begins October 1
  • Open enrollment will occur through the end of March
  • 1.3 million Arizonans predicted to eventually receive coverage through the marketplace
the marketplace2
The Marketplace

Expected Enrollment by Type

  • Individual Exchange: 496,000
  • AHCCCS (assuming Medicaid expansion): 343,000
catastrophic plans
Catastrophic Plans
  • Eligible to adults under 30 years of age
  • Also available to those who obtain a hardship waiver from the marketplace
  • Includes plans with high deductibles, lower premiums
  • Includes coverage or three primary care visits and preventive services
premium subsidies
Premium Subsidies
  • Tax credit is advanceable or refundable
  • Eligibility is based on
    • Projected household income and family size
    • 100 – 400% FPL ($23,550 -$94,200 for a family of four in 2013)
    • Obtaining qualified coverage through the marketplace
    • Ineligible for government-sponsored coverage, affordable-sponsored insurance, or certain other minimum essential coverage
  • Tax credits available to immigrants who are lawfully present
cost sharing reduction
Cost Sharing Reduction
  • Eligibility for reduced cost sharing is based on
    • Incomes at or below 250% of FPL ($58,875 annually for a family of four in 2013)
    • Receiving the new premium tax credit
    • Enrolling in a marketplace silver-level plan
    • No cost sharing for members of Tribes
individual mandate
Individual Mandate
  • Beginning in 2014, most people must have health coverage or pay a fee when you file your tax return
  • Some people may qualify for an exemption
cover arizona
Cover Arizona
  • Builds off of the successful outreach efforts for the Pre-Existing Conditions Insurance Pool
  • More than 300 members
  • Two goals:
    • Maximize enrollment of individuals and families in the new insurance marketplace and Medicaid
    • Identify and assess outreach efforts so that we can build on our successes
local action needed to ensure success
Local Action Needed to Ensure Success
  • Awareness
  • Outreach
  • Enrollment Assistance
enrollment assistance
Enrollment Assistance
  • Navigators
  • Certified Application Counselors
  • Toll Free Hotline
  • Brokers
special issues for kids and families
Special Issues for Kids and Families
  • Members of the same family may qualify for different programs
  • KidsCare II disappears in 2014
  • Businesses may begin dropping family coverage
two doors
Two Doors
  • Health E Arizona Plus
  • Marketplace
timeline
Timeline
  • August – Navigator grants awarded
  • August – September – Navigators and certified enrollment assisters trained
  • October – Determination of which plans will participate in the exchange
  • October - Open enrollment in the exchange begins
  • October - Media campaign begins, driving people to Healthcare.gov
  • January 1, 2014 – Coverage purchased through exchanges takes effect
need more information
Need more information
  • www.healthcare.gov
  • Marketplace Call Center (Consumers) - 24/7 English and Spanish and 150 Languages 1-800-318-2596, 1-855-889-4325 (TTY)
  • www.marketplace.cms.gov
  • www.coveraz.org