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7/31/2019 NIHOE ACA PPT_Health Directors Series III
1/23
The Affordable Care Act:
What Does It Mean for You and Your Health Clinic?August 28, 2012
Series 3 of 4
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AcronymsACA Affordable Care Act
AI/AN American Indian/Alaska Native
FPL Federal Poverty LevelIHCIA Indian Health Care Improvement Act
I/T/U Indian Health Services, Tribal and Urban
Indian organization programs/providersCHIP Childrens Health Insurance Program
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Basic Health Insurance Terms
Premium: The amount paid to an insurance company, usually ona monthly basis, for health insurance coverage.
Out-of-pocket costs: Health care costs paid by the patient. These
include copayments, coinsurance, and deductibles.
Deductible: A specific dollar amount paid by the user each yearbefore your health insurance plan starts to make payments for aclaim. Not all health insurance plans require a deductible.
Exclusions: Things not covered by the health insurance policy.Make sure to check the fine print of the health insurance policyfor which conditions are excluded.
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Basic Health Insurance Terms cont.
Benefit:Any service or supply (an office visit or a prescription drug)your health insurance plan will pay for.
Co-payment (copay): The dollar amount paid for a medical service
or supply according to your insurance plan. ($20 for sick visit)
Pre-existing condition:A health problem or diagnosis that you hadbefore applying for health insurance or before the effective date ofyour new health plan. By 2014, companies will be unable to deny
you coverage based on pre-existing conditions.
Lifetime maximum: Refers to the amount of money the healthinsurance policy will pay for the entire life plan.
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The Health Care Law
On March 23, 2010, PresidentObama signed into law the PatientProtection and Affordable Care Act(ACA)
The ACA protects the right of allAmericans, including AmericanIndians and Alaska Natives, toaccess affordable health care
More than 32 million in this countrywho would otherwise not havehealth insurance will have accessto health coverage
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Recent Supreme Court Decision On June 28, 2012 the Court
upheld minimum coveragerequirement
Precluded Medicaidexpansion requirement
Protected IHCIA and
implementation efforts todate
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The Federal Trust Responsibility
The ACA fulfills the federaltrust relationship andstrengthens tribal sovereigntythrough:
o Protection of the IHSsystem
o Providing equal accessto quality care
o
Expansion of tribalgovernments role inhealth care decisions
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ACA Benefits American Indians & Alaska Natives
o Permanent reauthorizationof the IHCIA
o Strengthens the IndianHealth Service systemauthorities
o Greater access to healthinsurance coverage
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What Does the ACA Mean for Your Clinic
New sources of fundingfor tribal facilities
Quality health care forcitizens
Stronger role for tribalgovernments
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You Can Improve Your Local Facilities
Third-party billing Offer services to
non-IHS eligiblebeneficiaries
Share facilities andservices with VA and
DOD Expand workforce
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ACA Can Help Expand Your WorkforceThe NHSC & IHS offers
Loan Repayment Programs
Scholarship ProgramsTo learn more visit: http://www.nhsc.hrsa.gov/
http://www.ihs.gov/loanrepayment/http://www.scholarship.ihs.gov
http://www.nhsc.hrsa.gov/http://www.ihs.gov/loanrepayment/http://www.scholarship.ihs.gov/http://www.scholarship.ihs.gov/http://www.ihs.gov/loanrepayment/http://www.nhsc.hrsa.gov/7/31/2019 NIHOE ACA PPT_Health Directors Series III
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You Can Compact or Contract Community Health
Aide ProgramsDental Health Aid
Therapists Dialysis Programs Long Term Care Alternative Health
Care Delivery Models Transportation for
Health Services Expanded BehavioralHealth Care Options
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Medicaid Benefits with ACA Implementation
More AI/ANs will qualifyfor Medicaid under theexpansion
No Medicaid premiumsor cost sharing whenreceiving services froman I/T/U
Medicaid Eligibility andEnrollment Streamlined
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Is Your Staff Ready for Reform
Outreach & Education
Efforts Will Help!
Focus on Eligibilityand EnrollmentCapacity
ACA Trainings
Newspaper Articles Radio PSAs
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Covering Preventative Services with
No Deductible or Co-Pay
Cancer screenings such asmammograms &colonoscopies
Vaccinations such as flu,
mumps & measles Blood pressure screening Cholesterol screening Tobacco cessation
counseling and interventions
Birth control Depression screening And more
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You Can Educate About theState Exchanges
No co-pay ordeductibles
Monthly enrollment
Tribes can choose topay premiums for
Tribal citizens
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You Can Work to Implement the Law
Policymakers need your help State-Based Insurance Exchanges State Medicaid Expansion
Federally Facilitated Exchanges
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What You Can Do1. Improve your local health care
2. Educate tribal citizens
3. Increase access to care
4. Expand your authority the compacting and contracting
5. Meet tribal needs through the state and federal
consultation process
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Learn More Athttp://www.tribalhealthcare.org http://www.HealthCare.gov
http://www.IHS.gov
http://www.tribalhealthcare.org/http://www.healthcare.gov/http://www.ihs.gov/http://www.ihs.gov/http://www.healthcare.gov/http://www.tribalhealthcare.org/7/31/2019 NIHOE ACA PPT_Health Directors Series III
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National Indian Health Outreach & Education(NIHOE) Initiative
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NIHOE National Partners
* With generous support from the Indian Health Service
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13 NIHOE Area Coordinators
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National Indian Health Board
Tyra BaerTribal Health Care Reform Project Coordinator
Tbaer@nihb.org
mailto:Tbaer@nihb.orgmailto:Tbaer@nihb.orgRecommended