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The Affordable Care Act & California August 27, 2013. The Affordable Care Act. Section I Presented by Carmen Burgos. Introduction. “ The YouToons Get Ready for Obamacare: Health Insurance Changes Coming Your Way Under the Affordable Care Act" http://www.kff.org/video-download/ - PowerPoint PPT Presentation
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Introduction
“ The YouToons Get Ready for Obamacare:
Health Insurance Changes Coming Your Way Under the Affordable Care Act"
http://www.kff.org/video-download/
Authorization to present granted by Kaiser on 8/1/2013
The Affordable Care Act
Does not apply to you if you have: Medicare Medi-Cal or the Children’s Health Insurance Program
(CHIP) TRICARE (for service members, retirees and their
families) The Veteran’s Health Plan Program An employer plan Insurance you bought that is at least at the Bronze level A grandfathered health plan
The Affordable Care Act
On March 23, 2010, Congress passed and the President signed The Affordable Care Act into law.
Requires most U.S. Citizens and Legal Permanent Residents to have health insurance or pay a penalty (exceptions apply)
Creates a “State Based” Exchange where individuals can buy affordable coverage when not covered by employer or eligible for public programs
Requires employers with 50 or more full-time employees to offer coverage
Medi-Cal Expansion to new groups
The Affordable Care Act
Tax credits and cost sharing subsidies to individuals Basic Health Plan Option for States*
(In California for incomes between 138% -200% FPL) Plans offered through the Exchange will be required to meet
a minimum set of standards. Insurers will offer four levels Platinum, Gold, Silver, Bronze
plus a catastrophic coverage plan for individuals under 30 years of age .
Gives individuals the opportunity to comparison shop for coverage from a variety of plans through the Exchange/Covered California.
The Affordable Care Act con’t
All new plans must offer certain free preventive services
Prohibits insurance companies from rescinding coverage
Insurance companies are prohibited from imposing lifetime dollar limits on essential benefits
Individuals with incomes between 138 - 400% of the FPL who do not have access to affordable insurance through an employer or government program can buy insurance through the Exchange
A cap on out-of-pocket expenses (co-pays, deductibles)-$5,950 for an individual and $11,900 for a family
Insurances cannot charge you more due to your health condition
Essential Health Benefits/Minimum Standards
Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance abuse disorders Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services Pediatric services including oral and vision
Comparing Insurance Plans
Category % of expenses paid by health Plan
% of expenses paid by Individual
Platinum 90% 10%
Gold 80% 20%
Silver 70% 30%
Bronze 60% 40%
Tax credits and cost sharing *Based on 2013 income levels
You are You qualify for Your estimated cost to buy health insurance
One person making less than $15,856
Medi-Cal No cost
One person making$20,000
A tax credit of $2,304 that you can use to pay for your premium and subsidies
Your premium cost is $1060 per year or $89 per month
Family of 4 making less than $31,810
Medi-Cal No cost
Family of 4 making $40,000 A tax credit of $4,140 that you can use to pay for premiums and subsidies
Your premium cost is $2,028 per year or $169 per month
Family of 4 making $80,000 A tax credit of $4,740 that you can use to pay for premiums
Your premium cost is $7,596 per year or $633 per month
Health Reform Exclusions
Health Care reform does not change current eligibility rules or scope of benefits for individuals without immigration status
People who would have to pay more than 8 % of their income for health insurance
People with incomes below the threshold required for filing taxes (in 2013, $10,000 for a single person)
People who qualify for religious objections American Indians Those without coverage for less than three months Incarcerated individuals
Naturalized Citizens No difference between U.S. born citizens Must buy health insurance or pay tax penalty Verification of citizenship status in the exchange: Can first be verified via Social Security Administration
(SSA) records If unable to verify via SSA, will go to Department of
Homeland Security’s (DHS) records to verify citizenship
Will have opportunity to provide other proof or correct records if unable to be verified electronically
Legal Immigrants
“Lawfully present” Broader group of legal immigrants Includes green card holders, refugees, asylees, as well as T
and U visa holders, and others in process of adjusting their status
No waiting periods for exchanges or tax credits Federal Medicaid still restricted to narrower group of legal
immigrants (“qualified” immigrants) with 5 year waiting period and other barriers
CA provides state funded Medi-Cal to these immigrants and should continue to do so after 2014
Legal Immigrants
Immigrants who are “lawfully present” in the U.S. can:
Buy health insurance in the state exchanges Apply for tax credits for premiums and co-
payments Eligible for Pre Existing Condition Insurance Plans
(PCIP) Eligible for Basic Health Program (BHP) Are subject to the individual mandate
Children of Undocumented Immigrants
U.S. citizen or legal immigrant children of undocumented parents should have the same access to health insurance and health services as other children
Eligible for Medi-Cal Eligible to buy health insurance and get tax credits
in the exchange via “child only plans” Can seek health care services anywhere, including
community health centers or school based clinics
Undocumented Immigrants
Under the ACA
Cannot buy health insurance in the State Based Exchange
Cannot apply for tax credits for premiums or co-payments Exception: Eligible family members of mixed-status family should be eligible for tax credits
Explicitly excluded from individual mandate to have insurance and related tax penalty
Remain ineligible for:
Federal Medicaid, Children’s Health Insurance Program (CHIP) or Medicare
Undocumented Immigrants
Exceptions: Eligible for Emergency Medicaid (Restricted Medi-
Cal) Eligible family members of undocumented family
can apply for these federal health programs States like CA can still choose to cover a broader
group of immigrants in their state-funded health programs
Undocumented Immigrants Remain eligible for health programs that are available regardless
of immigration status (e.g., public health)
Hospitals must still provide emergency care regardless of insurance or immigration status (EMTALA)
Community health centers can continue to provide non-emergency health care regardless of immigration status
Eligible to be covered in group health insurance as dependent
Insurance companies may offer insurance outside the state exchange that are available to undocumented, but may or may not be affordable or comprehensive
Important dates to remember October 1, 2013 open enrollment begins for plans offered through
Covered California
January 1, 2014 healthcare coverage begins for plans purchased through Covered California
March 31, 2014 open enrollment closes for plans purchased through Covered California except for life changing events i.e. loss of a job, death of a spouse, birth of a child,
*Remember, you must buy your insurance through Covered California to be
eligible for premium assistance/tax credits
MedicaidMedi-CalMedi-Cal ExpansionCurrent Provisions (LIHP)
Section II
Presented by
Yvonne Hernandez
Medicaid Federal Program
Purpose – provide “medically necessary” treatments, services, medicines and devices to certain groups of low – income people
Generally FamiliesPregnant womenPhysically and mentally disabled individualsThose suffering with chronic diseasesSeniors
Determines who qualifies for Medi-Cal For U.S. Citizens and LPR’s except CA
Medi-Cal State Version
Medi-Cal is California's Medicaid ProgramAdministered by the state Department of
Health Care Services (DHCS)
You can learn more about Medi-Cal at www.dhcs.ca.gov
MAGIModified Gross Adjusted Income
Household income will be calculated using MAGI, based on tax filing units (including anyone claimed as a dependent) using standard IRS guidelines for defining income and household in addition to foreign income and tax exempt income
Undocumented individuals are excluded from the count of household members
All MAGI household income is counted, whether or not the individual is applying for coverage
Differences MAGI Income and current Medi-Cal income
The federal income tax code excludes some types of income currently used in calculating Medi-Cal income, therefore the following will not count as income for MAGI households
Veterans Benefits
Child Support Received
Alimony Received
Workers’ Compensation
Most Social Security Benefits
Gifts and Inheritances
Paid Alimony
Child Care
Retirement Savings
Some Health Premium Costs
Scholarships, grants, awards used for education purposes
Lump Sums
American Indian / Alaskan Native Income
Non - MAGI Will remain unchanged for the following populations
They will remain subject to the current income and asset test
Undocumented will remain eligible for restricted-scope Medi-Cal
AgedBlindDisabledLong Term CareMedically Needy
Individuals deemed eligible for Medi-Cal as a result of other programs such as CalWORKs, Adoption Assistance Program, or Foster Care
Current Provision (LIHP)
StateLow Income Health Plan (LIHP)
CountyKern Medical Center Health Plan (KMCHP)
Medi-Cal
Small Business
7.2 Million Small Businesses
½ of the private workforce
Most are very small
80% have less than 10 workers
2 in 5 do not have health coverage
Advantages of offering Coverage
Compete
Retain quality workers
18% more than larger business
Double by 2018 to $243 Billion in CA
Small business employer & tax credits
Half did not know about the credit
More likely to offer coverage
Purchase insurance through exchange
Most small firms lack HR departments
Save employers’ valuable time
Shared Responsibility
Businesses with fewer than 50 workers
(There will be no penalty)
96% of all businesses are exempt from any requirement to offer insurance.
Covered California/The Exchange
Individual responsibility requirement
Small employers still eligible for Tax Credit up to 35%
Up to 50% next year through Small Business Health Option Program (SHOP)
Helpful links Affordable Health Insurance / Covered California (AKA The
Exchange): 1-888-975-1142 http://www.coveredca.com/ Health Insurance Marketplace 1-800-318-2596 (24 hours a day, 7
days a week ) [email protected] Low Income Health Plan
http://www.dhcs.ca.gov/provgovpart/Pages/lihp.aspx Kern Medical Center Health Plan
http://www.kernmedicalcenter.com/ Businesses
www.healthlawguideforbusiness.org Small Business Health Insurance Options Program (SHOP) Monday
through Friday hours 9am-5pm Eastern time-1-800-706-7893
Contact information:
Kern Health Consumer Centera Unit of Greater Bakersfield Legal Assistance, Inc.615 California Avenue Bakersfield, CA 93304Office: (661)321-3982 Fax: (661)325-4482
Section I Carmen Burgos/Project [email protected] (661)321-3980
Section II Yvonne Hernandez/Case [email protected] (661)326-4785
Section III Ruben Cortez/Case [email protected](661)321-3982