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Preparing For The Affordable Care Act

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How Will ACA Impact Refugees?

AHCCCS ExpansionChanges to Health InsuranceFocusing on Preventive CareImproving Quality of CarePromoting Community Health

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ACA Timeline

09/01/13Consumer

Support Line

10/01/13Health-e-Arizona Plus and

Health Insurance Marketplace go live

Open enrollment begins

01/01/14Coverage Begins

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AHCCCS Expansion

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Preparing for the Affordable Care Act

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AHCCCS Expansion

All U.S. citizens and legal residents (e.g. Refugees) with income below 138% FPL will be eligible for Medicaid Includes adults without dependent children

Enrollment period begins October 1st, 2013.

New enrollees that were previously ineligible will receive AHCCCS benefits starting January 1st, 2014.

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Changes to AHCCCS Plans

Improvements to Medicaid Better plans (Essential Health Benefits covered) Streamlined enrollment & renewal processes

Online enrollment is faster Renewal is automated by pulling data from IRS

Consolidated enrollment with other services Enrollment combined with Heath Insurance Marketplace

Same goes for KidsCare

SNAP TANF Clinic SFS County CAP

AHCCCS & KidsCare PTC CSR

Private Insurance

(No Subsidy)

SHOP

Many Programs are Accessed Through Health-e-Arizona Plus

FFMHealth-e-Arizona Plus

SNAP = Supplemental Nutrition Assistance Program (Nutrition Assistance)TANF = Temporary Assistance for Needy Families (Cash Assistance)Clinic SFS = Clinic-based Sliding Fee Scale programsCounty CAP = County-based Community Assistance Programs (CAP)(Pima and Santa Cruz Counties)PTC = Premium Tax Credit ProgramCSR= Cost Sharing Reduction ProgramSHOP = Small Business Health Opportunities Program

Link to FFM

Start Here

Apply for Referral to FFM

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SNAP TANF Clinic SFS County CAP

AHCCCS & KidsCare PTC CSR

Private Insurance

(No Subsidy)

SHOP

Applications Started at the FFM

FFMHealth-e-Arizona Plus

SNAP = Supplemental Nutrition Assistance Program (Nutrition Assistance)TANF = Temporary Assistance for Needy Families (Cash Assistance)Clinic SFS = Clinic-based Sliding Fee Scale programsCounty CAP = County-based Community Assistance Programs (CAP)(Pima and Santa Cruz Counties)PTC = Premium Tax Credit ProgramCSR= Cost Sharing Reduction ProgramSHOP = Small Business Health Opportunities Program

Start Here

No Access Apply forAssessment

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Health Insurance Marketplace

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Preparing for the Affordable Care Act

1. It’s an easier way to shop for health insurance Simplifies the search for health insurance All options in one place All online One application, one time, and an individual or family can explore

every qualified insurance plan in your area

2. Most people will be able to get a break on cost Tax Cuts and Cost Sharing programs are available based on income

3. Clear options with apples-to-apples comparisons All health insurance plans in the Marketplace present their price and

benefit information in plain language

3 Things to Know about the Marketplace

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The Health Insurance Marketplace

1 million uninsured Arizonan’s will now have access to health insurance

Working families can now afford to have insurance by applying through the Marketplace

Young adults under 26 can stay on their parent’s plan No more barriers to coverage based on preexisting conditions

Enrollment starts October 1, 2013 Coverage begins January 2014

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All Health Plans Will Cover These Essential Health Benefits

6. Prescription drugs

7. Rehabilitative and habilitative services and devices

8. Laboratory services

9. Preventive and wellness services and chronic disease management

10. Pediatric services, including oral and vision care

1. Ambulatory patient services

2. Emergency services

3. Hospitalization

4. Maternity and newborn care

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

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Eligibility and Enrollment Marketplace initial open enrollment period starts October 1, 2013

and ends March 31, 2014

Open enrollment period 2014 onward: October 15 to December 7 Same as Medicare Advantage enrollment period Must enroll during the open enrollment period Unless:

You have recently become a lawfully present alien You have a pay cut that makes you eligible for new tax credits You have a pay raise that forces you out of AHCCCS into the Marketplace

All refugees are eligible from day one

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Health Insurance Affordability

Income <400% FPL

Income <250% FPL

Income <138% FPL

No financial assistanceIncome >400% FPL

Tax credits to help with insurance premiums

Tax credits to help with insurance premiums and subsidies to offset cost sharing

Medicaid

Qualified Health Plans purchased through the Marketplace

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Marketplace “Metal Tiers”

All Qualified Health Plans (QHPs) in the Marketplace will be reviewed and certified by the Marketplace

QHPs will be standardized into 4 tiers, based on the their coverage

Plan type Plan coversMember's

responsibility(premium)

Bronze 60% 40%

Silver 70% 30%

Gold 80% 20%

Platinum 90% 10%

Making Health Insurance Affordable

The Marketplace Premium Tax Credit is meant to keep your premium payments to an affordable level.

This chart shows how the Tax Credits will be calculated:

The difference between cost of premium and allowable cost percentage of income will be covered by Tax Credits

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Income Level Premium as a allowable % of IncomeUp to 133% FPL 2% of income133-150% FPL 3 – 4% of income150-200% FPL 4 – 6.3% of income200-250% FPL 6.3 – 8.05% of income250-300% FPL 8.05 – 9.5% of income300-400% FPL 9.5% of income

How Much Will It Cost Me? All individuals with income between 100-400% FPL will

receive the Premium Tax Credits. Can accept tax credit as a tax refund, or apply to monthly

premiums (called: Advanced Premium Tax Credit) < 250% FPL will also allow you access to special Silver Plans

Subsidized monthly premiums Reduced cost sharing (co-pays)

http://kff.org/interactive/subsidy-calculator/ 18

Family Size FPL Income Premium Tax Credit Actual Cost1 139% $1,333 $252 $207 $451 250% $2,427 $252 $56 $1954 139% $2,625 $862 $731 $914 250% $4,908 $862 $467 $395

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Individual Mandate

Health Insurance is now MANDATORY!

Beginning in 2014, all U.S. citizens and legal residents are required to have health insurance

Whether Medicaid, Medicare, Tricare, Employer Insurance or Private Insurance (Marketplace)

Those without health coverage must pay a yearly tax!

Individual Mandate

Are you:• Part of a religious group with an exception• Incarcerated• Undocumented resident• American Indian• Pay more than 8% of take-home pay for

employer coverage• So low-income you don’t pay federal income

taxes• Someone who doesn’t qualify for Medicaid,

but still can’t afford health insurance in the FFM

• Some other hardship exemption

Do you have:• Coverage through a job• Coverage through an

exchange/at least bronze individual coverage

• Medicaid, Medicare, CHIP• Tricare or VA Care• Student Health Plan• Grandfathered plan

No Penalty

Penalty• 2014—Greater of 1% family income or $95

adult/$285 family maximum• 2015—Greater of 2% family income or $325

adult/$975 family maximum• 2016—Greater of 2.4% family income or $695

adult/$2085 family maximum

or

YES

NO

P e o p l e w i l l n e e d t o d e m o n s t r a t e t h a t t h e y h a v e m i n i m u m e s s e n ti a l

c o v e r a g e o r m e e t a n e x c e p ti o n .

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Enrollment Assisters

Navigators Must be able to assist anyone to enroll in health insurance – “no

wrong door”Must provide public education and outreachMust provide language support

Call in advance to arrange interpretation

Arizona’s Navigator OrganizationsArizona Association of Community Health Centers

Including all Federally Qualified Health Centers (FQHCs)University of Arizona, Center for Rural HealthGreater Phoenix Urban LeagueCampesinos Sin Fronteras

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Enrollment Assisters

Certified Application Counselors (CACs)Staff at community health centers, hospitals, or

consumer-based nonprofitsCertified through Marketplace.cms.gov No funding will be received from the marketplace

Call CenterToll-free call center - 24/7 Federal Call Center is up and

running and the number is: 1-800-318-2596. 150 languages available

Improving Preventive Care

Preparing for the Affordable Care Act

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Focus On Prevention

Recognition that preventing diseases from developing in the first place is the best way to keep people healthy

7 out of 10 deaths in the US are caused by preventable diseases

Included in the EHBs of every insurance plan are FREE (no co-pay) disease prevention services Encouraging yearly visits to your PCP Encouraging early and regular screening for common diseases Providing consultation for common preventable conditions

Full List: healthcare.gov/what-are-my-preventive-care-benefits/

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Free Services For All Plans

Annual checkup

Help quitting Alcohol & Smoking

STD screening & counseling

Blood pressure, cholesterol & diabetes screening

Depression screening

Diet counseling

Vaccinations

Colonoscopy

Aspirin for heart disease

Women’s Preventive Services

Well-woman visits

Support for breastfeeding

Domestic violence screening and counseling

Mammograms and cancer screenings

UTI Screening

Folic Acid supplements

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Children’s Preventive Services

Screening infants for common disorders

Behavioral Health assessments

Developmental disorders screening

Oral Health assessments and fluoride treatment

Hearing & Vision screenings

Immunizations

Lead screening

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ImprovingQuality Of Care

Preparing for the Affordable Care Act

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New Models of Healthcare

Focusing care around the PCP and integrating services into “Patient Centered Medical Homes” – a one stop-shop for all of your health needs

Integrating primary care with behavioral health care

A focus on improving health literacy while providing health care

Measuring care quality by successful outcomes and providing financial incentives to doctors for keeping patients healthy, based on standardized criteria

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Electronic Health Records

EHR are envisioned as key to coordinating care and cost reduction

ACA imposes penalties on medical providers for not showing “meaningful use” toward the implementation of electronic health records beginning in 2015

Standardized EHR record file types and transfer protocols so that all the different systems can talk to each other

Culturally and Linguistically Appropriate Services (CLAS)

Enhanced CLAS guidelines from HHS for healthcare providers @thinkculturalhealth.hhs.gov

Navigators, patient grievance and appeals processes and summary of insurance plan must be provided in requested languages

Funding made available for Area Health Education Centers that target underserved populations

Mandatory monitoring of workplace diversity by healthcare providers

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Building Healthy Communities

Preparing for the Affordable Care Act

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Meeting Community Needs

ACA Provides Guidance and Mandates Funding for Community Health Programs Community Health Teams to facilitate prevention initiatives,

patient education and connection to care Inter-organizational Collaboration to improve care

coordination and resource sharing Encouraging Community Health Needs Assessments which

lead to Community Health Improvement Plans and the focusing of local services to address local needs

Strengthening the role of Peer Support (Community Health Workers) in our health system

Healthy Community Design such as safety and green spaces to address local social determinants of health

Tips For Refugee Care Coordinators

Preparing for the Affordable Care Act

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Refugee Medical Assistance (RMAP)

Starting January 1st, 2014 RMAP will no longer cover any health services except the post-arrival Preventive Health Screening

No more 8 months of RMAP coverage No more Vision and Dental services through RMAP

If you have questions about this call RMAP: 602-542-6644

*RMAP will remain unchanged for Unaccompanied Refugee Minors (URM)

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AHCCCS All new arrivals will need to be enrolled in AHCCCS

immediately upon arrival to begin coverage as soon as possible for all arrivals

Once an AHCCCS application is approved, it will provide retroactive coverage back to the 1st of the month, in the month that the application was submitted

Example: If Ahmed arrives on May 15 and has to visit his doctor on the May 21, as long as his AHCCCS application submitted before the end of May, his doctors visit will be covered by AHCCCS once his application is approved.

Example: If Tenzin arrives on May 31 and immediately is hospitalized, and her AHCCCS application is submitted on June 1, when her AHCCCS application is approved the expenses from June 1 onward will be covered, but not the expenses from May 31. 36

AHCCCS Changes Pros

Childless adults will now be able to enroll in AHCCCS AHCCCS will now cover incomes up to 138% the FPL Adult immunizations will now be covered by AHCCCS AHCCCS will now provide annual checkups and certain preventive health

services with no co-pay Annual renewal for AHCCCS will now be automatic (Medicaid IRS) Health-e-Arizona Plus will streamline enrollment in multiple services and

connect you to the Marketplace if necessary

Cons Neither AHCCCS nor RMAP will be covering Vision or Dental services for adults

AHCCCS and KidsCare will still cover Vision and Dental services for children

Refugee advocates will need to build partnerships with charity vision and dental service providers in their area

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Improve Your Knowledge

Make sure your organization applies to become a Certified Application Counselor organization This allows all members of your organization to take an online training

course and certification quiz for enrolling clients in the Marketplace marketplace.cms.gov/help-us/cac.html

Partner with your local Navigator organizations for enrollment support and trainings

Contact the National Hotline for Marketplace questions: 1-800-318-2596. 150 languages available

Contact the Client Advocate for AHCCCS questions: 1-602-417-4230

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Improve Your Knowledge

www.healthcare.gov

www.cms.gov

www.kff.org

www.coveraz.org

www.enrollamerica.org

www.refugeehealthta.org

Contact your State Refugee Health Coordinator with questions or for training requests 1-602-364-3592

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Spread The Word Make sure your organization’s case managers and care coordinators

understand the changes that are coming

Provide outreach and enrollment for newly arrived refugees as well as those who have been in Arizona for more than a couple years

Collaborate with partner organizations such as Ethnic Community Based Organizations (ECBOs) and Faith Based Organizations (FBOs)

Contact the Refugee Health Coordinator for a list

Encourage partner organizations to become Certified Application Counselors and to connect with Navigator organizations

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Spread The Word

Translate and disseminate informative pamphlets

Incorporate relevant ACA info into cultural orientations

Seek new funding opportunities and share with partners

Provide direct enrollment assistance

Remember: ACA Timeline

09/01/13Consumer Support Line

01/01/14Coverage Begins

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Thank You!

Questions?