1 CHOICE Regional Health Network In-Person Assister Program Helping individuals learn about and apply for health coverage through the new Washington Healthplanfinder

1CHOICE Regional Health Network

In-Person Assister ProgramHelping individuals learn about and apply for health coverage through the new Washington Healthplanfinder


Topics Covered• Who is CHOICE?• Affordable Care Act (ACA) overview• Implementation of the ACA in Washington State• Health Benefit Exchange & In-Person Assistance

Program overview• In-Person Assisters and how they can help


CHOICE Regional Health NetworkNon-profit, collaborative organization, established in 1995. Dedicated to improving

health in Central Western Washington through collective planning and action of

health care leaders.


• Emergency room visit reduction program• Donated care programs for uninsured• Dental access programs• Collaborative health system improvements

(focused on transitions of care, cardiac response)

Headquarters in Olympiawww.crhn.org

http://www.crhn.org/


Affordable Care Act (ACA) in Washington State• WASHINGTON HEALTH BENEFIT EXCHANGE:

The “Exchange” created in 2011

• MEDICAID EXPANSION: Included in 2013-2015 Biennial Budget signed by Governor Inslee on June 30, 2013


Consumer can't afford doctor

Consumer delays care, goes to ER

Consumer can't pay

Providers shift cost to Insurers

Insurers shift cost to consumer

Consumer drops policy due to high price and is

now uninsured

After 100+ years, why now?


Goals of ACA

• Slows the rising health care costs on the Gross Domestic Product

• Expands health care coverage to 32 million uninsured Americans– Expands Medicaid– Offers affordable Qualified Health Plans

In our region, the number of uninsured is estimated at 80,000 individuals.


Impact of the ACA

• Kids can’t be denied coverage if they are sick• Young adults can stay on parents policies until

age 26• Eliminates “pre-existing conditions” exclusions• Prohibits lifetime limits• Closes Medicare prescription doughnut hole• Expands coverage by expanding Medicaid and

by offering Qualified Health Plans


Ten Essential Health Benefits

Ten essential Health benefits

1. Ambulatory services 6. Prescription drugs

2. Emergency services 7. Rehabilitative and habilitative services and devices

3. Hospitalization 8. Laboratory services

4. Maternity and newborn care 9. Preventive and wellness services and chronic disease management

5. Mental health and substance use disorder services, including behavioral health treatment

10. Pediatric services, including oral and vision care

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Individual Mandate

• Require all citizens and legal residents (there are some exceptions) to have health coverage by January 1, 2014.

• There are a number of ways to meet the mandate.

• There are also exceptions.• People will not go to jail if they do not meet the

mandate!

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Satisfying the Mandate

You are insured through a combination of any of the following sources:• Medicare• TRICARE or veteran’s health program• An employer-provided plan• Medicaid/Apple Health• Insurance you buy that is at least at the Bronze level• A grandfathered health plan in existence before the

health reform law was enacted

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No Penalty


Mandate Exemptions

• Religious objections• Undocumented immigrant• Incarcerated• American Indians and Alaskan Natives• Income below the tax filing threshold• The lowest cost plan option exceeds 8 percent of an

individual’s income

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No penalty for being without health

insurance.


Penalties

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2014

$95 per adult $47.50 per child (max. $285/family)

or 1% of income

whichever is greater

2015

$325 per adult $162.50 per child (max. $975/family)

or 2%of income


2016

$695 per adult $347.50 per child (max. $2,085/family)

or 2.5% of income



Uninsured in WA

1998 2000 2002 2004 2006 2008 2010 2012 20140

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

1,000,000

Tota

l Pop

ulati

on

Estimated impact of ACA in Washington

Data Source: Office of Financial Management, State Population Survey; compiled by CHOICE


*Urban Institute

15

82,000 11%

222,00031%

73,000 10%

253,000 35%

96,500

13%

QHP/Non-Subsidy

Tax Credits

Medicaid Eligible (Welcome Mat)

Medicaid Expansion

Not eligible

Washington’s Uninsured

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Medicaid Expansion (WA Apple Health)• Medicaid: now expanded to cover individuals

19 – 65 with incomes up to 138% FPL, meet citizenship requirements, are not incarcerated, are not entitled to Medicare.

Presumptive SSI (aka DL-X)

Medical Care Services Program

Basic Health ProgramADATSA

BCCT

Take Charge Family Planning

Family Planning ExtensionCHIP

Medicaid Standard

Medicaid Alternative Benefit Plan

CHIP

Medicaid Standard

Exchange with Subsidy

Exchange without Subsidy

2014 Coverage Continuum through Insurance Affordability Programs (IAPs)

2013-1

5 B

ud

gets

P

rop

ose

Vari

ou

s

Elim

inati

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s


• SSI• SSI-related (Aged, Blind,

Disabled)• Medicare Savings Program• Healthcare for Workers with

Disabilities• Nursing Homes• Waiver Services• Medical Care Services (+65

or immigration status)

• MCS • ADATSA • Aged, Blind, Disabled cash

program (the old GA-X/DL-X Program).

Classic Medicaid

Auto-Converted


Current Medicaid who need to Reapply through WA Healthplanfinder

• Apple Health for Kids (Children’s Medicaid)• Pregnancy Medical


Medicare

• The new insurance marketplace does not effect those on Medicare. – There are also no Medicare supplemental plans for

purchase in new marketplace.


Washington Health Benefit Exchange • The ACA establishes an Exchange in each state, to

organize the new insurance marketplace.• HBE responsible for: – Online enrollment tool development.– Contracting with organizations for customer support.– Determining eligibility and tax credits.– Aggregate premiums and send monthly payment to carriers.– Review and certify qualified health plans.

To learn more: www.wahbexchange.org

http://www.wahbexchange.org/


Qualified Health Plan

• Qualified Health Plan (QHP): an insurance plan certified by the OIC/Exchange that provides 10 essential health benefits, follows rules on cost-sharing, and meets other requirements, like…– Network adequacy– Marketing– Include certain providers that serve low-income,

underserved communities


Qualified Health Plan - Metal Tiers

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Bronze Level Silver Level Gold Level Platinum Level

Bronze plan benefit coverage is equivalent to:

60%

Silver plan benefit coverage is equivalent to:

70%

Gold plan benefit coverage is equivalent to:

80%

Platinum plan benefit coverage is equivalent to:

90%

Actuarial Value: The amount (%) of the bill that the insurer pays


Approved Companies Offering Plans through WAHealthplanfinder.org• Bridgespan • Community Health Plan of Washington • Coordinated Care• Group Health Cooperative • Lifewise• Molina Healthcare• Premera Blue Cross• Kaiser Foundation Health Plan of the Northwest • Pediatric Dental: Dental Dental of WA, Kaiser Foundation, Lifewise,

Premera


Health Insurance Premium Tax Credits (HIPTC)

• Designed to make premiums affordable for individuals and families with lower incomes

• Only available to individuals and families with income up to 400% Federal Poverty Level (FPL)– Can be used to reduce monthly premiums– Can be claimed as a credit on annual tax return

• Must apply through Washington Healthplanfinder

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Health Insurance Premium Tax Credit andCost Sharing Reductions

Income Level Premium as Percent of Income

Up to 133% FPL

2% of income

133-150% FPL 3-4% of income

150-200% FPL 4-6.3% of income

200-250% FPL 6.3-8.05% of income

250-300% FPL 8.05-9.5% of income

300-400% FPL 9.5% of income

Income Level Reduction in Out-of-Pocket Liability

100-150% FPL

94% of the actuarial value*

150-200% FPL

87% of the actuarial value

200-250% FPL

73% of the actuarial value

Premium Tax Credits: Cost Sharing Reductions:

*Of the second lowest cost Silver plan

26CHOICE Regional Health Network26 26

New Continuum of Affordable Options

*

Medicaid (Adult Coverage)

Medicaid (Pregnancy Coverage)

Apple Health for Kids (Medicaid/CHIP)

Premium Tax Credits & Cost-Sharing Reductions for Exchange Health Plans

Exchange Health Plans

*138% 185% 300% 400%

0% 100% 200% 300% 400%

% Federal Poverty Level

* The ACA’s “133% of the FPL” is effectively 138% of the FPL because of a 5% across-the-board income disregard

Health Care Coverage in 2014


w w w . W A H e a l t h p l a n fi n d e r . o r g

How will people get coverage?

Website


WAHealthplanfinder.org Details• Single point of entry for individual, families and

small businesses to apply for coverage. • Tool provides on-the-spot eligibility results:– Interfaces with federal and state systems to verify

info

What if a user doesn’t have a computer or has questions about insurance coverage?


In-Person Assister Program• Established to help consumers learn about, apply for and enroll

in appropriate health insurance coverage.– Focused on reaching most vulnerable uninsured people who require

assistance to enroll into the expanded health care options– Community awareness, outreach, and enrollment are program

components.• HBE contracting with “Lead Organizations” to develop a

network of In-Person Assisters and referral partners to carry out this program.

• CHOICE was awarded contract in June.


CHOICE’s Seven County Region

• Clallam• Grays Harbor• Jefferson• Lewis• Mason• Pacific• Thurston


Lead Organization Responsibilities• Build local network of community-based

organizations• Lead outreach and education activities for

service area• Train Assisters within the service area• Financial agent for network partners• Performance monitoring• Reporting As defined by HBE


In-Person Assisters (IPAs)Clallam Grays Harbor Jefferson Lewis Mason Pacific Thurston

Forks Community Hospital

Grays Harbor Public Health

Jefferson County Public Health

Lewis Mason Thurston Area Agency on Aging


Cowlitz Family Health Center


Olympic Area Agency on Aging


Jefferson Healthcare

Providence Centralia Hospital

Mason General Hospital


Family Support Center

Olympic Medical Center

Sea Mar Community Health Centers


Planned Parenthood

Planned Parenthood

Valley View Health Center

Planned Parenthood

Planned Parenthood

Valley View Health Center

Providence St. Peter Hospital

VIMO Sea Mar Community Health Centers

Thurston County Food Bank


In-Person Assisters Responsibilities• Community awareness & outreach• Help answer questions about the new law and

insurance• Provide application-enrollment assistance

– Using trained and certified staff– Impartial, objective information– Cannot offer QHPs outside of open enrollment

• Assist individuals to understand their benefits• Provide effective follow-up services


Important Things to Remember

• If you are already insured, you don’t have to make any changes.• If you are uninsured, you need to apply for coverage for 2014

or face a penalty.• If you are uninsured and enroll, make sure to report your

information accurately – you could qualify for different coverage depending on your reported income. If you enroll, and your income changes through the year, report it!

• If you need help enrolling, there are organizations in your community who are available to help!


Questions?


Click icon to add picture

Libby WeisdeppProgram Manager

CHOICE Regional Health [email protected] | (360) 539-7576 x120

mailto:[email protected]

Documents

1 CHOICE Regional Health Network In-Person Assister Program Helping individuals learn about and apply for health coverage through the new Washington Healthplanfinder