April 2013Presented by: Ed Kiryczun

Health Care ReformHealth Care Reform

How Is Access to Health Care Changing?

• Low and Medium income families will have access to more affordable Health Care Coverage

• Medi-Cal is being expanded and simplified• Health Insurance Plans are accessible at lower

costs • And - for many low income individuals and families

the premiums can be off-set by subsidies• Moderate income individuals can access more

complete and affordable coverage also

Changes to Medi-Cal• Medi-Cal will be based on income

– Up to 138% FPL– Legal Permanent Resident– No asset test

• Applying for and staying on Medi-Cal is streamlined– Income Based on MAGI (Modified Adjusted Gross

Income)– Verified electronically when possible– Create “administrative” Renewal process

• Adds non-disabled adults without dependants as a new, mandatory coverage group

Health Care Coverage for those making above 138% FPL• HealthCare Exchange – Covered California• Offers: Advanced Premium Tax Credit (APTC) to

purchase insurance policies– Subsidize for 138-400% FPL – Uses new Modified Adjusted Gross Income

(MAGI) – Subsidize based on “Sliding scale”

• Unsubsidized coverage at affordable rates – For those making 401% FPL and higher

No wrong door• HSA

– Walk in, Mail in, Call or go-on line– Will screen and enroll in any of the coverage programs– Responsible for Medi-Cal application processing and case

maintenance• Covered California

– Apply on line or over the phone for Health Coverage programs

– CC network of assistors and navigators– Responsible for APTC and Unsubsidized applications and

case maintenance – Those found Medi-Cal eligible forwarded to County for

processing

Integrating Programs helps address family's needs comprehensively

• Nearly everyone eligible for CalFresh will be eligible for Medi-Cal

• Most newly eligible for MAGI-based Medi-Cal will be eligible for CalFresh

• Opportunities to integrate across other programs– CalWORKS– Employment and Vocational Services– Children and Family Service– Shelters, etc.

• Opens “gateway” for many to Behavioral Health Services and Substance Abuse Services

Implementation: Key Dates• April – October HSA develops policies and

procedures for new programs

• September – HSA Community Partners Health Care Reform Eligibility Forum

• October 1 – Open Enrollment for APTC and Unsubsidized program opens (ends March 31, 2014)

• January 1, 2014 – New Medi-Cal rules take effect

Thank you!