The Affordable Care Act & California August 27, 2013 - PowerPoint PPT Presentation

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The Affordable Care Act & California August 27, 2013

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  1. The Affordable Care Act & California August 27, 2013

  2. The Affordable Care Act Section I Presented by Carmen Burgos

  3. Introduction “ The YouToons Get Ready for Obamacare: Health Insurance Changes Coming Your Way Under the Affordable Care Act" Authorization to present granted by Kaiser on 8/1/2013

  4. The Affordable Care Act Does not apply to you if you have: • Medicare • Medi-Cal or the Children’s Health Insurance Program (CHIP) • TRICARE (for service members, retirees and their families) • The Veteran’s Health Plan Program • An employer plan • Insurance you bought that is at least at the Bronze level • A grandfathered health plan

  5. The Affordable Care Act • On March 23, 2010, Congress passed and the President signed The Affordable Care Act into law. • Requires most U.S. Citizens and Legal Permanent Residents to have health insurance or pay a penalty (exceptions apply) • Creates a “State Based” Exchange where individuals can buy affordable coverage when not covered by employer or eligible for public programs • Requires employers with 50 or more full-time employees to offer coverage • Medi-Cal Expansion to new groups

  6. The Affordable Care Act • Tax credits and cost sharing subsidies to individuals • Basic Health Plan Option for States*(In California for incomes between 138% -200% FPL) • Plans offered through the Exchange will be required to meet a minimum set of standards. • Insurers will offer four levels Platinum, Gold, Silver, Bronze plus a catastrophic coverage plan for individuals under 30 years of age . • Gives individuals the opportunity to comparison shop for coverage from a variety of plans through the Exchange/Covered California.

  7. The Affordable Care Act con’t • All new plans must offer certain free preventive services • Prohibits insurance companies from rescinding coverage  • Insurance companies are prohibited from imposing lifetime dollar limits on essential benefits • Individuals with incomes between 138 - 400% of the FPL who do not have access to affordable insurance through an employer or government program can buy insurance through the Exchange • A cap on out-of-pocket expenses (co-pays, deductibles)-$5,950 for an individual and $11,900 for a family • Insurances cannot charge you more due to your health condition

  8. Essential Health Benefits/Minimum Standards • Ambulatory patient services • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance abuse disorders • Prescription drugs • Rehabilitative and habilitative services and devices • Laboratory services • Preventive and wellness services • Pediatric services including oral and vision

  9. Covered California/Market Place

  10. Kern County-Health Plans Region 14 • Anthem-PPO • Blue Shield-PPO • Health Net-PPO • Kaiser-HMO

  11. Comparing Insurance Plans

  12. Taxcredits and cost sharing *Based on 2013 income levels

  13. Health Reform Exclusions • Health Care reform does not change current eligibility rules or scope of benefits for individuals without immigration status • People who would have to pay more than 8 % of their income for health insurance • People with incomes below the threshold required for filing taxes (in 2013, $10,000 for a single person) • People who qualify for religious objections • American Indians • Those without coverage for less than three months • Incarcerated individuals

  14. Immigrant Eligibility & The Affordable Care Act

  15. Naturalized Citizens • No difference between U.S. born citizens • Must buy health insurance or pay tax penalty • Verification of citizenship status in the exchange: • Can first be verified via Social Security Administration (SSA) records • If unable to verify via SSA, will go to Department of Homeland Security’s (DHS) records to verify citizenship • Will have opportunity to provide other proof or correct records if unable to be verified electronically

  16. Legal Immigrants • “Lawfully present” • Broader group of legal immigrants • Includes green card holders, refugees, asylees, as well as T and U visa holders, and others in process of adjusting their status • No waiting periods for exchanges or tax credits • Federal Medicaid still restricted to narrower group of legal immigrants (“qualified” immigrants) with 5 year waiting period and other barriers • CA provides state funded Medi-Cal to these immigrants and should continue to do so after 2014

  17. Legal Immigrants • Immigrants who are “lawfully present” in the U.S. can: • Buy health insurance in the state exchanges • Apply for tax credits for premiums and co-payments • Eligible for Pre Existing Condition Insurance Plans (PCIP) • Eligible for Basic Health Program (BHP) • Are subject to the individual mandate

  18. Children of Undocumented Immigrants • U.S. citizen or legal immigrant children of undocumented parents should have the same access to health insurance and health services as other children • Eligible for Medi-Cal • Eligible to buy health insurance and get tax credits in the exchange via “child only plans” • Can seek health care services anywhere, including community health centers or school based clinics

  19. Undocumented Immigrants Under the ACA • Cannot buy health insurance in the State Based Exchange • Cannot apply for tax credits for premiums or co-payments Exception: Eligible family members of mixed-status family should be eligible for tax credits • Explicitly excluded from individual mandate to have insurance and related tax penalty Remain ineligible for: • Federal Medicaid, Children’s Health Insurance Program (CHIP) or Medicare

  20. Undocumented Immigrants Exceptions: • Eligible for Emergency Medicaid (Restricted Medi-Cal) • Eligible family members of undocumented family can apply for these federal health programs • States like CA can still choose to cover a broader group of immigrants in their state-funded health programs

  21. Undocumented Immigrants • Remain eligible for health programs that are available regardless of immigration status (e.g., public health) • Hospitals must still provide emergency care regardless of insurance or immigration status (EMTALA) • Community health centers can continue to provide non-emergency health care regardless of immigration status • Eligible to be covered in group health insurance as dependent • Insurance companies may offer insurance outside the state exchange that are available to undocumented, but may or may not be affordable or comprehensive

  22. Important dates to remember • October 1, 2013 open enrollment begins for plans offered through Covered California • January 1, 2014 healthcare coverage begins for plans purchased through Covered California • March 31, 2014 open enrollment closes for plans purchased through Covered California except for life changing events i.e. loss of a job, death of a spouse, birth of a child, *Remember, you must buy your insurance through Covered California to be eligible for premium assistance/tax credits

  23. MedicaidMedi-CalMedi-Cal ExpansionCurrent Provisions (LIHP) Section II Presented by Yvonne Hernandez

  24. Medicaid • Federal Program • Purpose – provide “medically necessary” treatments, services, medicines and devices to certain groups of low – income people Generally • Families • Pregnant women • Physically and mentally disabled individuals • Those suffering with chronic diseases • Seniors • Determines who qualifies for Medi-Cal • For U.S. Citizens and LPR’s except CA

  25. Medi-Cal • State Version • Medi-Cal is California's Medicaid Program • Administered by the state Department of Health Care Services (DHCS) • You can learn more about Medi-Cal at

  26. Medi-Cal ExpansionMAGI Medical

  27. Key changes for the expansion population

  28. MAGIModified Gross Adjusted Income • Household income will be calculated using MAGI, based on tax filing units (including anyone claimed as a dependent) using standard IRS guidelines for defining income and household in addition to foreign income and tax exempt income • Undocumented individuals are excluded from the count of household members • All MAGI household income is counted, whether or not the individual is applying for coverage

  29. Differences MAGI Income and current Medi-Cal income • The federal income tax code excludes some types of income currently used in calculating Medi-Cal income, therefore the following will not count as income for MAGI households

  30. Non - MAGI • Will remain unchanged for the following populations • They will remain subject to the current income and asset test • Undocumented will remain eligible for restricted-scope Medi-Cal

  31. Current Provision (LIHP) • State • Low Income Health Plan (LIHP) • County • Kern Medical Center Health Plan (KMCHP) Medi-Cal

  32. Small Businesses & The Affordable Care Act Section IIIPresented by Ruben Cortez

  33. Small Business • 7.2 Million Small Businesses • ½ of the private workforce • Most are very small • 80% have less than 10 workers • 2 in 5 do not have health coverage

  34. Advantages of offering Coverage • Compete • Retain quality workers • 18% more than larger business • Double by 2018 to $243 Billion in CA

  35. Small business employer & tax credits • Half did not know about the credit • More likely to offer coverage • Purchase insurance through exchange • Most small firms lack HR departments • Save employers’ valuable time

  36. Shared Responsibility • Businesses with fewer than 50 workers (There will be no penalty) • 96% of all businesses are exempt from any requirement to offer insurance.

  37. Covered California/The Exchange • Individual responsibility requirement • Small employers still eligible for Tax Credit up to 35% • Up to 50% next year through Small Business Health Option Program (SHOP)

  38. Helpful links • AffordableHealthInsurance / Covered California (AKA The Exchange): 1-888-975-1142 • • HealthInsuranceMarketplace1-800-318-2596 (24 hours a day, 7 days a week ) • LowIncomeHealth Plan • Kern Medical Center Health Plan • Businesses • Small Business Health Insurance Options Program (SHOP) Monday through Friday hours 9am-5pm Eastern time-1-800-706-7893

  39. Contact information: Kern Health Consumer Center a Unit of Greater Bakersfield Legal Assistance, Inc. 615 California Avenue Bakersfield, CA 93304 Office: (661)321-3982 Fax:   (661)325-4482 Section I Carmen Burgos/Project Manager (661)321-3980 Section II Yvonne Hernandez/Case Manager (661)326-4785 Section III Ruben Cortez/Case Manager (661)321-3982