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Affordable Care Act Overview. Session 1 Presented by Tokie Moriel & John Tvedt. What is ACA?. The Affordable Care Act (ACA) Comprehensive reforms that: Improve access to affordable health Protect consumers. ACA Key Facts. Stronger Consumer Rights and Protections

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affordable care act overview

Affordable Care ActOverview

Session 1

Presented by Tokie Moriel & John Tvedt

DHS/DFO/IMTA/2013-07-15

what is aca
What is ACA?
  • The Affordable Care Act (ACA)
  • Comprehensive reforms that:
    • Improve access to affordable health
    • Protect consumers

DHS/DFO/IMTA/2013-07-15

aca key facts
ACA Key Facts
  • Stronger Consumer Rights and Protections
  • More Affordable Coverage
  • Better Access To Care
  • Stronger Medicare

DHS/DFO/IMTA/2013-07-15

consumer rights protections
Consumer Rights & Protections
  • End to Pre-Existing Condition Discrimination
  • End to Limits on Care
  • End to Coverage Cancellations

DHS/DFO/IMTA/2013-07-15

more affordable coverage
More Affordable Coverage
  • Value for Your Premium Dollar
  • Stopping Unreasonable Rate Increases
  • Small Business Tax Credits

DHS/DFO/IMTA/2013-07-15

better access to care
Better Access to Care
  • Free Prevention Benefits
  • Coverage for Young Adults
  • Coverage for Americans with Pre-Existing Conditions
  • Affordable Insurance

DHS/DFO/IMTA/2013-07-15

strengthening medicare
Strengthening Medicare
  • Lower Cost Prescription Drugs
  • Free Preventive Services
  • Fighting Fraud
  • Providing Choices while Lowering Costs

DHS/DFO/IMTA/2013-07-15

federal rules
Federal Rules
  • The Department of Health and Human Services (HHS) and the Internal Revenue Service (IRS) issued federal rules that included changes and alignment to eligibility:
    • Requirements
    • Methods and processes

DHS/DFO/IMTA/2013-07-15

eligibility requirement changes
Eligibility Requirement Changes
  • Modified Adjusted Gross Income (MAGI) based income standards
    • Medicaid uses current monthly income
    • Cost Sharing Reductions (CSR) and Advanced Premium Tax Credits (APTC) use projected annual income
  • Redefines household composition

DHS/DFO/IMTA/2013-07-15

eligibility requirement changes1
Eligibility Requirement Changes
  • Income Changes.
    • Non-recurring Lump sums
    • Scholarships and grants
    • Income of American Indians and Alaska Natives
    • Child Support
    • Worker Compensation
    • Veteran’s Benefits
    • Depreciation of business expenses

DHS/DFO/IMTA/2013-07-15

eligibility requirement changes2
Eligibility Requirement Changes
  • Federal Poverty Level (FPL)
  • Determining proper coverage

DHS/DFO/IMTA/2013-07-15

a seamless system of coverage
A Seamless System of Coverage

Qualified Health Plans without Financial Assistance

Qualified Health Plan w/ Premium

Tax Credits

250%-400% FPL

Medicaid/CHIP

Children

Qualified Health Plan w/ Premium

Tax Credits and

Cost-sharing reductions between

100% - 250% FPL

Iowa Health and Wellness Plan

101% - 133% FPL

DHS/DFO/IMTA/2013-07-15

ffm plan levels of coverage
FFM Plan Levels of Coverage

DHS/DFO/IMTA/2013-07-15

a seamless path to affordable coverage
A Seamless Path to Affordable Coverage
  • The Affordable Care Act:
    • Expands access to affordable coverage
    • Simplifies Medicaid & CHIP
    • Ensures a seamless system of coverage

DHS/DFO/IMTA/2013-07-15

expanding access to coverage
Expanding Access to Coverage
  • Enrollment in the new income-based category without having to first screen for other eligibility groups
  • Enables people with disabilities and those needing long-term care services & supports to enroll in the group that best meets their needs

DHS/DFO/IMTA/2013-07-15

expanding access to coverage1
Expanding Access to Coverage
  • Creates new coverage group for former foster care children
  • Expansion of Presumptive Medicaid increases the number of providers allowed to make presumptive determinations for more populations.

DHS/DFO/IMTA/2013-07-15

simplifying medicaid chip
Simplifying Medicaid & CHIP
  • Switch to MAGI methodology
  • Modernize verification process
  • Federal data matches
  • Renewals at least every 12 months

DHS/DFO/IMTA/2013-07-15

coordination a seamless system of coverage
Coordination: A Seamless System of Coverage
  • Single, streamlined application for all insurance affordability programs
  • Website that provides program information and facilitates enrollment in all insurance affordability programs
  • Coordinated verification policies across Medicaid, CHIP and the FFM
  • Standards and guidelines for eligibility determinations and information transfers

DHS/DFO/IMTA/2013-07-15

coordination key provisions of aca
Coordination: Key Provisions of ACA
  • The Medicaid/CHIP agency:
    • Determines eligibility for individuals transferred from another insurance affordability program
    • Evaluates an individual for potential eligibility for other insurance affordability programs
    • Certifies for the FFM/other programs the criteria applied in determining Medicaid eligibility

DHS/DFO/IMTA/2013-07-15

coordination key provisions of aca1
Coordination: Key Provisions of ACA
  • Medicaid/CHIP agencies have established agreements with the FFM that clearly delineate the responsibility of each program to:
    • Minimize burden on individuals
    • Ensure compliance with the other eligibility coordination requirements of the provision (i.e., MAGI screen)
    • Ensure prompt determinations of eligibility and enrollment consistent with timeliness standards

DHS/DFO/IMTA/2013-07-15

state responsibilities potential eligibility for other programs
State Responsibilities: Potential Eligibility for Other Programs
  • For individuals determined as not eligible for Medicaid/CHIP, the agency:
    • Evaluates the individual for potential eligibility for other insurance affordability programs
    • Transfers the individual’s electronic account to the FFM for CSR/APTC determinations for insurance plan enrollment

DHS/DFO/IMTA/2013-07-15

coordinated eligibility determinations with ffm
Coordinated Eligibility Determinations with FFM
  • The Federally Facilitated Marketplace makes initial assessment of Medicaid/CHIP eligibility; State make the final eligibility determination
  • Assessments made using the applicable Medicaid/CHIP income standards, citizenship and immigration status, using verification rules and procedures consistent with Medicaid and CHIP regulations
  • The FFM and Iowa have entered into an agreement outlining each entities responsibilities ensuring a seamless and coordinated process

DHS/DFO/IMTA/2013-07-15

coordinated eligibility determinations with ffm1
Coordinated Eligibility Determinations with FFM
  • When the FFM makes an initial assessment, Iowa:
    • Accepts the electronic account
    • Does not request duplicative information/documentation
    • Promptly determines Medicaid/CHIP eligibility without requiring a new application
    • Accepts any findings made by another program, no further verification
    • Notifies the other program of the receipt of the electronic account and Medicaid’s final eligibility determination if the individual is receiving coverage through another program

DHS/DFO/IMTA/2013-07-15

non magi populations applying through ffm
Non-MAGI Populations Applying through FFM
  • The FFM will transfer applications to Iowa for a determination of Medicaid on a basis other than MAGI
  • Iowa will:
    • Notify the FFM of the final determination of eligibility for those individuals who are participating in an insurance affordability program

DHS/DFO/IMTA/2013-07-15

non magi populations applying through iowa
Non-MAGI Populations Applying through Iowa
  • Evaluating eligibility for other insurance affordability programs for individuals undergoing a Medicaid determination on a basis other than MAGI
  • Iowa:
    • Determines potential eligibility other insurance affordability programs
    • Transfers the individual’s account to the FFM
    • Provides timely notice to the FFM

DHS/DFO/IMTA/2013-07-15

continuation of coverage
Continuation of Coverage
  • Coverage renewal
    • FFM
    • State

DHS/DFO/IMTA/2013-07-15

a new approach
A New Approach
  • Shifts verification responsibilities
  • Less reliance on paper
  • “Which coverage is right for you?”

DHS/DFO/IMTA/2013-07-15

time frames
Time Frames
  • October 1, 2013
    • Open enrollment for insurance affordability programs
    • Must accept single streamlined applications and apply new rules
    • Must be able to transmit information to Marketplace
    • Evaluate under current rules for eligibility prior to 1/1/14
  • January 1, 2014
    • Coverage under insurance affordability programs can begin

DHS/DFO/IMTA/2013-07-15

conclusion
Conclusion
  • Additional ACA webinars
  • Session review – Income Maintenance Workers ONLY

DHS/DFO/IMTA/2013-07-15