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Affordable Care Act – Expanding Access to Care and Coverage. Overview of the Law. The Patient Protection and Affordable Care Act (ACA) was signed into law on March 23, 2010.

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Affordable Care Act – Expanding Access to Care and Coverage


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Presentation Transcript
overview of the law
Overview of the Law

The Patient Protection and Affordable Care Act (ACA) was signed into law on March 23, 2010.

The law makes reforms that will expand consumer protections and help more Rhode Islanders have high-quality, affordable health coverage.

Changes have already started to take effect, with more coming in 2014.

consumer protections
Consumer Protections

Young adults can stay on their parents’ health insurance plan until they are 26.

Children cannot be denied coverage because of pre-existing or chronic conditions, like cancer or diabetes. Starting in 2014, this also will include adults.

People cannot be dropped from coverage when they become sick or because they have spent too much on their coverage in their lifetime.

consumer protections1
Consumer Protections

Women can not be charged more for their coverage than men.

No cost-sharing for certain preventive services including: regular well-child visits (birth – age 21); annual well-women visit; vaccinations, including HPV vaccine for women and girls under age 26; FDA approved prescription contraceptives…

expanding access to coverage
Expanding Access to Coverage

Most people will be required to have some form of health insurance coverage by 2014.

The ACA creates a system where nearly all legally residing individuals can obtain some form of coverage

Most people will continue to be enrolled in their employer-sponsored coverage. Small businesses will be eligible for tax credits to help with the cost of coverage.

Medicaidwill expand to provide coverage to individuals with income less than 138% FPL ($15,500 for an individual).

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Expanding Access to Coverage

  • Individuals without access to employer-sponsored coverage will be able to purchase coverage through a new marketplace called a Health Insurance Exchange. Individuals with income between 100% and 400% FPL ($76,400 for a family of 3) will be eligible for tax credits to help pay for premiums and if income is below 250% FPL will be eligible for cost-sharing subsidies.
  • The state may implement a Basic Health Programwhich would be a RIteCare-like health plan for individuals with income below 200% of the federal poverty level.
expanding access to coverage1
Expanding Access to Coverage
  • Rhode Island must continue to provide RIte Care to teenagers under age 19 in families (or on their own) with income less than 250% FPL ($48,000 for a family of 3). Includes all lawfully present non-citizens. No waiting period for legal permanent residents.
  • At age 19, young adults will be eligible for Medicaid if income is less than 138% FPL ($15,500). Only certain categories of lawfully present non-citizens are eligible. Five year waiting period for legal permanent residents.
  • At age 19, young adults ineligible for Medicaid with income below 400% FPL are eligible for premium tax credits to help pay for coverage through the Exchange.
  • Rhode Island can extend Medicaid coverage to Rhode Islanders under age 26 who were in foster care at age 18.
expanding access to coverage2
Expanding Access to Coverage

Currently, parents in families with income below 175% FPL are eligible for Rite Care. Rhode Island could “roll back” parent eligibility to 138% FPL (the new minimum Medicaid level). Young parents could lose RIte Care coverage.

Example: A young single parent with one child who earns $8/hr would have income above the lower Medicaid limit. She would lose RIte Care and could purchase coverage through the Exchange. Her child would be eligible for RIte Care.

Young adults who have aged out of foster care are currently eligible for Medicaid until age 21. Beginning in 2014, they will be eligible until age 26.

putting it all together insurance affordability programs now and in 2014
Putting It All TogetherInsurance Affordability ProgramsNow and in 2014

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*Note: Parents’ eligibility guidelines for Medicaid in 2014 are yet to be determined by the State

for more information please visit
For more information, please visit:

www.economicprogressri.org/rihealthcoverageproject