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Affordable Care Act Update

Affordable Care Act Update. Allison Rice Duke AIDS Policy Project Region 7 -- June 13, 2013. Affordable Care Act: The original concept. Affordable Care Act: Supreme Court’s Concept. Affordable Care Act: North Carolina’s Reality. *except documented immigrants in US less than 5 years.

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Affordable Care Act Update

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  1. Affordable Care Act Update Allison Rice Duke AIDS Policy Project Region 7 -- June 13, 2013

  2. Affordable Care Act: The original concept

  3. Affordable Care Act: Supreme Court’s Concept

  4. Affordable Care Act: North Carolina’s Reality *except documented immigrants in US less than 5 years

  5. ACA implementation • No Medicaid expansion in 2014 • Coming soon: Insurance Marketplace, with subsidies for uninsured people/families with incomes 100-400% FPL • Open enrollment 10/1/2013 – 3/31/2014 • Coverage begins 1/1/2014

  6. Empty or Full?

  7. 2014 Landscape

  8. Health Reform & ADAP/Ryan White

  9. NC Insurance marketplace: Basics • Run by Federal Govt. • Open to people* without access to adequate, affordable insurance (public or private) • *Except undocumented • “Mandate”: You must have insurance if income is over 133% FPL ($15,282) • Some exemptions; penalty low to start

  10. Which clients can enroll? • Must be citizen or legal resident to purchase marketplace insurance • Can’t be eligible for Medicaid, Medicare, other public coverage • Client can’t drop employer-sponsored insurance to get subsidies in marketplace • To get subsidies, must have income 100-400% FPL

  11. What will the insurance cover? • Standardized plans – • Will follow Blue Cross Blue Shield Blue Options plan • Comprehensive drug formulary • Essential Health Benefits • Free Preventive Services – • Well woman’s exam, mammogram, immunizations, STI prevention counseling, smoking screening & cessation, etc.

  12. Plan selection considerations

  13. Sliding Scale Subsidies

  14. Numbers to remember

  15. How are subsidies paid?

  16. How will people enroll? • Online & paper applications • Website: • Checks eligibility for Medicaid, CHIP, insurance subsidies • Provides plan comparison • Enrollment online

  17. Verification of eligibility Diagram from NC Institute of Medicine, Examining the Impact of the Patient Protection and Affordable Care Act in North Carolina: Draft Final Report Pending US Supreme Court Decision, p. 64, May 2012

  18. Consumer Assistance

  19. Funding for consumer assistance

  20. Training for In-person assisters

  21. Enrollment – What’s the plan?

  22. Triage – Prioritizing uninsured

  23. Some Challenges

  24. Using Ryan White funds to assist clients in enrollment • RW Funds can be used for benefits counseling & enrollment • Early Intervention • Medical Case Management • Non-medical Case Management • Health Education/Risk Reduction services • Referral for Health Care/Supportive Services • HRSA has put a chart online: • http://hab.hrsa.gov/affordablecareact/outreachenrollment.html

  25. Information & Resources • Duke Legal Project Health Reform Information site (coming soon) • Hivhealthreform.org • Healthcare.gov • http://kff.org/health-reform/ • http://marketplace.cms.gov/

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