The ACA & KY’s Health Exchange Options

2016

Governor-Elect Bevin has promised to dismantle kynect

At this time, in his current status, he does not have the ability to act on this promise

Currently, all health insurance and Medicaid plans are open on the kynect Exchange for application & the Office of Kentucky’s Health Benefit Exchange & the DOI state they will honor all plans offered

The Exchange is processing eligibility and continuing to assist individuals, families, and small business owners in accessing affordable care under the ACA guidelines

The future of kynect—what we know

Once the new administration takes office, they can petition the Federal Government to stop operations of the kynect marketplace. From our understanding, this request must be submitted one year in advance and, IF approved by the Federal Government, is accompanied by the required return of Federal monies KY received to set up our Exchange. This has been reported to be around 23 million dollars that the new administration would have to return.

Cont’d The future of kynect

The new administration may immediately address the Medicaid Expansion and what now qualifies individuals for Medicaid under current guidelines.

Completely pulling back on the state’s choice to expand and provide coverage to families at or below138% of the FPL is also a decision that would require the return of Federal monies; however, it would be less than dismantling our online marketplace.

Eliminating citizens from qualifying by reducing the income threshold for Medicaid or transitioning our state’s model to a more co-pay/co-insurance intensive model would be something the new administration could do quickly to reduce the state’s share of Medicaid support to low income citizens.

Cont’d The future of kynect

The take aways today are: ◦ The Governor-elect has no official ability to act on his

promises immediately.◦ Medicaid expansion and kynect, our online insurance

marketplace, are 2 different components of how KY chose to carry out the “increasing affordable access to health insurance” of the Affordable Care Act.

◦ In 2016 and 2017, those two components may or may not exist in unison as they do now, depending upon how a new administration handles them but that is yet to be seen.

◦ For now, it is business as usual for all kynector services—we are still charged with assisting the citizens of KY in enrolling for plans on the Exchange, including Medicaid.

Cont’d The future of kynect

In 2013, Kentucky chose to Expand Medicaid (make it available to more low income citizens)

Kentucky also chose to create it’s own online marketplace that: ◦ Provides cost comparison information and comparison tools

◦ Streamlines the application and enrollment process for programs offered via kynect

◦ Offers health insurance plans that have essential health benefits, offer different levels of coverage and meets new insurance market requirements

◦ Provides one-stop-shopping for a range of health coverage options, including Medicaid and KCHIP, as well as tax credits

◦ Helps individuals determine their eligibility in real time during open enrollment for Medicaid, KCHIP, tax credits, and other Insurance Affordability Programs

The ACA in Kentucky

Like all citizens of the US, Kentucky residents are not immune from the ACA’s requirement for individuals to have health insurance coverage.

This began in 2014 and will remain in effect under the Affordable Care Act, regardless of how KY proceeds with Medicaid or kynect.

The ACA in Kentucky

The requirement to have basic health insurance is sometimes called “individual responsibility” or the “individual mandate.”

The only people who are not required to obtain health insurance are those who file for and receive an “exemption.” If you don’t get health insurance or an exemption, you will have to pay a fee

This fine or fee is assessed at the time you file your federal tax return.

Understanding the Requirementto Have Health Insurance

Household Size

Medicaid Eligibility KCHIP Eligibility

1 $16,243 $25,659

2 $21,983 $34,728

3 $27,724 $43,797

4 $33,465 $52,865

5 $39,206 $61,934

6 $44,947 $71,003

7 $50,687 $80,072

8 $56,428 $89,141

2016 Income Eligibility Guidelines for Medicaid and KCHIP

Who is eligible for Medicaid?

• Unemployed unemployment proceeds are countable income

• Employed but Medicaid eligible even if job offers insurance

• Overall income eligible

What does Medicaid/KCHIP offer?

• Physician visits and Hospitalization• Dental • Vision• Hearing exams (for children)• Prescriptions• Behavioral Health• Many other programs—many now

have Special Benefit programs and incentives for prenatal and well care visits

• Services are at no or low cost

How does someone get Medicaid coverage?

• www.kynect.ky.gov• Work with a kynector• Call kynect at (855)459-6328• Department for Community

Based Services local office (DCBS)

What choices do I have with Medicaid?

Chances are your current healthcare provider accepts Medicaid. Find out who they work with and that is the one you choose.

• Anthem• Coventry Cares—

changes to Aetna in Feb 2016

• Humana Caresource• Passport• Wellcare

• You can enroll in Medicaid or KCHIP any time of year.

• There’s no limited enrollment period for either Medicaid or KCHIP.

• If you qualify, your coverage can begin immediately.

• Keep your address updated.• Report any change of income.

Keep in mind…Currently

Qualified Health Plans on kynect Anthem CareSource Just4Me Wellcare Health Plans of KY Humana United Health Care of KY Aetna Health, Inc.

Open Enrollment 2016 is NOW

• November 1, 2015: Open enrollment starts - first day you can enroll in a 2016 Marketplace plan

• January 1, 2016: First date 2016 coverage can start

• January 31, 2016: 2016 enrollment ends

What Qualifies for Special Enrollment?

Special Enrollment is available on kynect year-round to individuals/families in the following circumstances: • Marriage• Having or adopting a baby• Turning 26• If losing or lost health coverage• Divorce• Change in Income that places you in a

new income category

(859)581-6607

Boone, Kenton, Campbell, Pendleton, Grant, Gallatin, Owen

Counties

For enrollment assistance or community education