Affordable Care Act - Kern County Superintendent of Schools

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Transcript Affordable Care Act - Kern County Superintendent of Schools

The Affordable Care Act & California
August 27, 2013
The Affordable Care Act
Section I
Carmen Burgos
“ The YouToons Get Ready for Obamacare:
Health Insurance Changes Coming Your
Way Under the Affordable Care Act"
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
 TRICARE (for service members, retirees and their
 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
Ambulatory patient services
Emergency services
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
Covered California/Market Place
Kern County-Health Plans
Region 14
Blue Shield-PPO
Health Net-PPO
Comparing Insurance Plans
% of expenses
paid by health
% of expenses
paid by
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
No cost
One person making
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
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
Immigrant Eligibility
The Affordable Care Act
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
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
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.
Buy health insurance in the state exchanges
Apply for tax credits for premiums and copayments
Eligible for Pre Existing Condition Insurance Plans
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
Eligible for Emergency Medicaid (Restricted MediCal)
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
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 nonemergency 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
Medi-Cal Expansion
Current Provisions (LIHP)
Section II
Yvonne Hernandez
Federal Program
Purpose – provide “medically necessary” treatments,
services, medicines and devices to certain groups of low –
income people
Pregnant women
Physically and mentally disabled individuals
Those suffering with chronic diseases
Determines who qualifies for Medi-Cal
For U.S. Citizens and LPR’s except CA
State Version
Medi-Cal is California's Medicaid Program
Administered by the state Department of
Health Care Services (DHCS)
You can learn more about Medi-Cal at
Medi-Cal Expansion
MAGI Medical
Age 19 -65
January 1, 2014,
eligibility will
expand to those
who are:
Foster youth will
be covered until
age 26
133 % FPL, with a 5
% income disregard,
resulting in eligibility
for individuals in
households up to
138 % FPL
Key changes for the expansion
Definition of
household size
of income
of the asset
Modified 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
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
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 Care
Child Support Received
Retirement Savings
Alimony Received
Some Health Premium Costs
Workers’ Compensation
Scholarships, grants, awards used for education
Most Social Security Benefits
Gifts and Inheritances
Paid Alimony
Lump Sums
American Indian / Alaskan Native Income
Non - MAGI
Will remain unchanged for the following populations
Long Term Care
Medically Needy
Individuals deemed
eligible for Medi-Cal as a
result of other programs
such as CalWORKs,
Adoption Assistance
Program, or Foster Care
They will remain subject to the current income and asset test
Undocumented will remain eligible for restricted-scope Medi-Cal
Current Provision (LIHP)
Low Income Health Plan (LIHP)
Kern Medical Center Health Plan (KMCHP)
General Eligibility
• Age 19 -64
• NOT enrolled or eligible for other
State health plans
• Has income at or below the 133 %
FPL ( 1 Single Adult - $ 1,273.50 )
• Resident of Kern County for 30 days
• U.S Citizen or LPR for 5 yrs
Supporting Documentation
• Proof of Kern County Residency
• Valid Picture Identification
• Proof of U.S. Citizenship or Legal
• Social Security card for all applicants
• Verification of all income in household
• Record of application/ denial for state
benefits / health plan
Small Businesses
The Affordable Care Act
Section III
Ruben Cortez
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
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
Health Insurance Marketplace 1-800-318-2596 (24 hours a day, 7
days a week ) [email protected]
Low Income Health Plan
Kern Medical Center Health Plan
Small Business Health Insurance Options Program (SHOP) Monday
through Friday hours 9am-5pm Eastern time-1-800-706-7893
Contact information:
Kern Health Consumer Center
a Unit of Greater Bakersfield Legal Assistance, Inc.
615 California Avenue Bakersfield, CA 93304
Office: (661)321-3982
Fax: (661)325-4482
Section I
Section II
Section III
Carmen Burgos/Project Manager
[email protected]
Yvonne Hernandez/Case Manager
[email protected]
Ruben Cortez/Case Manager
[email protected]