Transcript ACA: A Native American Perspective

ACA: NATIVE AMERICAN PERSPECTIVE
SEPTEMBER 22, 2014
OVERVIEW
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HEALTH CARE REFORM & THE FEDERAL
TRUST RESPONSIBILITY
2014 ACA IMPLEMENTATION
MODIFIED ADJUSTED GROSS INCOME
(MAGI)
RECOMMENDED DOCUMENTATION
2015 ACA IMPLEMENTATION
EXEMPTION APPLICATION
AI/AN PROTECTIONS
Health Care Reform & the
Federal Trust Responsibility
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The ACA recognizes the
federal trust relationship &
strengthens tribal
sovereignty through:
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Protection & enhancement of
the IHS health care system with
the passing of the Indian Health
Care Improvement Act
Greater access to quality health
care with new sources of
insurance coverage and grants
Expansion of tribal government
consultation in health care
policy decision-making
ACA Implementation…2014
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All individuals below 100% FPL and
others, including American Indians,
Alaska Natives and I/T/U users are not
required to get insurance & are exempt
from the shared responsibility tax
payment that has to be paid beginning in
2015
Plus, there’s no cost-sharing for AI/AN’s
at or below 300% FPL for any Health
Insurance Marketplace plan at any level
(bronze, silver, gold or platinum)
MAGI does not include…
SSI, TANF, Veterans’ disability, Workers’
Compensation, child support, federal tax credits &
cash assistance
 Foster care, guardianship or adoption assistance
payments, scholarships & education grants not
used for living expenses
 Distributions from Alaska Native Corporations &
Settlement Trusts; from property held in trust by
the Secretary of the Interior; from real property
ownership interests related to natural resources &
improvements & BIA student financial assistance
(Note: An amount received as a lump sum shall only
be counted as income only in the month received)
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Recommended Tribal Documentation
for Enrollment (AI/AN & I/T/U Users)
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Electronic data verification w/IHS RPMS
Tribal enrollment card
Certificate of degree of Indian blood
Shareholder certificate for Alaska Native Regional or Village
Corporation
Tribal enrollment certificate
Tribal Census Document
Birth certificate linking child to parent
Adoption certificate linking child to parent
Foster care documentation linking child to AI/AN foster
parent
Disability determination linking child to AI/AN parent
IHS/Tribal Form or Letter verifying eligibility for IHS Services
Marriage Certificate with Tribal Spouse
ACA Implementation…2015
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For the general population, open enrollment in the
Marketplace begins on November 15, 2014 and
ends on February 15, 2015
American Indians/Alaska Natives have special
monthly enrollment periods anytime of the year in
Marketplace plans
The ACA does not change your eligibility to get
health care services at an Indian Health care
provider. AI/AN’s who enroll in a Marketplace
health plan, Medicaid or CHIP may continue to
receive these services
ACA Implementation…2015
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IHS is not insurance. IHS provides medical and
public health services. Insurance affords greater
access to services at IHS, Tribal and Urban Indian
program providers by increasing their revenue
In some cases referrals to private providers is
necessary through Contract Health Service (CHS)
referrals. This is when having health insurance
will help American Indians. This program was
recently renamed as Purchased/Referred Care
(PRC)
American Indian people will benefit from
increased revenue to the Indian health care
system and greater access to care
ACA Implementation…2015
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IRS Reporting – Individual Shared Responsibility
Payment –Statutory Exemptions
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You’re uninsured for less than 3 months of the year
You’re a member of a federally recognized tribe
You’re incarcerated (either detained or jailed), and not
being held pending disposition of charges
You’re not lawfully present in the U.S.
IRS Reporting - Individual Shared Responsibility
Payment – Regulatory Hardship Exemptions
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Eligible for services through an Indian Health Service
provider
American Indian Exemption
Application
Who can use this
form?
 Members of federally
recognized Tribes
 Individuals eligible to
receive services at
Indian health care
providers:
- IHS
- Tribal
- Urban
How do I prove that I am exempt?
An application for exemption must be completed on the specific
form for:
 American Indian/Alaska Natives
 Other individuals who are eligible to receive services from an
Indian Health Care Provider
 Only one application required per tax household
 Only have to submit application once
Need the following:
 Federally Recognized Tribes:
 Tribal membership (CDIB, enrollment card, etc.)
 Social Security Number
 Information about people in tax household
Tribal member NOT enrolled in Federally Recognized Tribe:
 Eligible for services from IHS, tribal (638) or urban Indian
health care provider. A letter from IHS Patients Benefits
Coordinator can be requested.
Exemption Letter
Family Names
Exemption Certification Number
Affordable Care Act
American Indian/Alaska
Native
Specific Protection
AI/AN Protections
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AI/AN are exempt from the mandate that requires
individuals to purchase health insurance or pay a
tax penalty (submit exemption application)
Special monthly enrollment periods for AI/AN to
facilitate and overcome barriers to enrollment will
be established
AIAN at or below 300% FPL who are federally
recognized (or who meet the Indian hardship
exemption) are exempt from cost-sharing in the
Marketplace
There is no cost-sharing (co-pays, co-insurance,
deductibles) for Indians under any Marketplace
plan for services provided by the I/T/U or through a
CHS referral
AI/AN Protections
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Distributions and payments from AI/AN resources
listed in ARRA Section 5006 and certain income
exclusions codified in the Internal Revenue Code
shall not be used in determining Medicaid or CHIP
eligibility under the new streamlined MAGI
methodology
AI/AN income exemptions in the determination of
MAGI-based income must be calculated on the
Marketplace and Exchange calculator
Qualified Indian health care benefits, including
accident or health insurance that a Tribe buys for its
members, a spouse or dependent, cannot be
deemed as income by the IRS for tax purposes or
for provision of benefits under the ACA
AI/AN Protections
AI/AN income exemptions for Medicaid/CHIP:
 Alaska Native Corporation and Land Settlement Trusts
 Property Held in Trust Under the Supervision of the Secretary
of the Interior
 Ownership Interest From Rents, Leases, Royalties, and Usage
Rights Related to Natural Resources
 Sub-marginal Trust Lands held in Trust
 Distributions with a Unique Religious, Spiritual, Traditional, or
Cultural Significance
 Bureau of Indian Affairs Student Financial Assistance
 Judgment Fund Distributions
 Tribal Trust Per Capita – Distributions to tribal members by the
BIA or a Tribe from tribal trust income collections (i.e., lease
rentals, right-of-way payments, oil, mineral or timber harvesting
royalties)