NIHOE ACA PPT_Health Directors Series III

7/31/2019 NIHOE ACA PPT_Health Directors Series III

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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/


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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/


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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

[email protected]
mailto:[email protected]:[email protected]

Documents

NIHOE ACA PPT_Health Directors Series III