Transcript Patient Protection and Affordable Care Act

The Affordable Care Act
and West Virginians
Libraries
West Virginia Library Commission Conference
October 10, 2013
Today’s Presentation

Review the four major provisions of
the Affordable Care Act (ACA)

Review the new enrollment process
and who will be involved in
enrollment

Discuss how libraries can be involved
in the enrollment process
2
ACA Has Four Main Goals
 New
regulations of the insurance
industry
 Renewed
emphasis on prevention
 Cost
containment, particularly for
Medicare
 Expands
health insurance to
virtually all Americans
3
Health Insurance Coverage Is
Expanded In Two Ways
 Medicaid
is expanded to cover
everyone under 138% of the
federal poverty level who is
under age 65.
 New
Health Insurance
Marketplaces are created where
subsidized, private insurance
products are sold.
4
New Coverage Options
5
Expanding Health Insurance
 The
Medicaid expansion is
projected to cover an estimated
133,500 low-income West
Virginians.
 Federal
government pays
almost all of the costs.
6
Medicaid Expansion: Income
Eligibility for a Family of Three
$30,000
$26,951
$25,000
$20,000
$15,000
$10,000
$5,000
$3,036
$0
Current Eligibility
Expansion Eligibility
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Medicaid Eligibility
◦ Income
◦ Household size
<138% of FPL
◦ US citizenship
◦ State Residency
◦ Under age 65
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Income Eligibility for
Medicaid
Family Size
138% of FPL
155% of FPL
1
$15,856
$17,810
2
$21,404
$24,040
3
$26,951
$30,272
4
$32,499
$36,502
138% applies to children over age one and adults. 155%
applies to pregnant women and children under age one.
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Changes in CHIP

With the increase in Medicaid
eligibility, many children currently
enrolled in CHIP will become
Medicaid eligible and cannot remain
on CHIP:

10,800 CHIP kids transfer to
Medicaid

2,800 kids gain CHIP coverage under
the new income eligibility rules
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Health Insurance
Marketplace
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Health Insurance Marketplace
A
marketplace allows
consumers to compare and
choose private health insurance
policies that best suits their
needs. Policies offered through a
web site, 1-800 number, by mail
or with personal assistance.
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Health Insurance Marketplace
 The
marketplace is open to
individuals who do not have
employer sponsored health
insurance and small businesses.
 Significant
tax credits for individuals
between 100% and 400% of the FPL.
 An
estimated 99,000 West Virginians
will qualify for premium tax credits
in the exchange.
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Policy Cost = $789
Family Pays = $282
Govt. Subsidy = $507 (64%)
Additional assist with
deductibles and
copayments plus out-ofpocket maximum
protection
Subsidy for
family of 4
earning
$50,000
14
FPL for Cost Sharing Subsidies
and Premium Subsidies
Family Size
250% of the FPL
400% of the FPL
1
2
3
4
$28,725
$38,775
$48,825
$58,875
$45,960
$62,040
$78,120
$94,200
250% of the FPL level is the eligibility threshold
for cost sharing reductions and 400% of the
FPL is the threshold for premium assistance
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Health Insurance Marketplace
 Highmark
Blue Cross Blue Shield
the only carrier to participate in
2014
 They
are offering 11 different plans:
4 gold plans; 3 silver and 3 bronze
plans; and one catastrophic plan.
 Two
additional ones from BCBS
nationally, but appear to be
identical to state offered plans.
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Three Levels of Plan Options
in West Virginia
 Gold
plan
◦ Insurance company pays 80% of
claims and consumers on average
pay 20% of the claims.
 Silver
= 70/30
 Bronze = 60/40
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Premiums in the Various
Metal Levels
 Premiums
in a gold plan would
be higher, while deductibles and
copayments would be lower
 Conversely, the
premiums in a
bronze plan will be lower, while
the cost sharing would be higher
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The Marketplace and
Small Businesses
 Eligibility
for the SHOP
marketplace is 50 or fewer
employees, about 42,000 West
Virginia businesses employing
280,000 people.
 Highmark
is offering 4 plans in
the SHOP Marketplace in 2014
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How Will the Enrollment
Process Work?
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The Enrollment Process
 Simplified
enrollment for
Medicare, CHIP and premium
tax credits in the health
insurance marketplace
◦ One enrollment form
◦ No face-to-face interviews
◦ No paper documentation
◦ No asset test
21
Timelines

Enrollment begins October 1, 2013

If someone enrolls by the 15th of the
month, then coverage for Medicaid
and qualified health plans begins the
first day of the following month. Get
people enrolled by December 15th.

If after the 16th on the month,
coverage begins on the first day two
months later.
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How Do We Enroll All These
People?

HHS will maintain a web site:
www.healthcare.gov
And a call center: 800-318-2596

Can also enroll through the mail

A number of entities will provide
personal assistance
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Personal Assistance

Insurance agents and brokers

Navigators
 Advanced Patient Advocacy/Hospitals
 WVU Healthy Starts
 TSG Consulting

In-person assisters – 270
 Maximus
 Placed in DHHR and SHIP offices so far.

Community health center employees

Certified Application Counselors

DHHR Employees
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How to Find Personal
Assistance

bewv.wvinsurance.gov: Click on
Where Can I Find Local Help? Gives
county level data

The national web site has ZIP code
level data, but doesn’t filter
information well. See
localhelp.healthcare.gov
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Community Assisters

Enroll uncomplicated cases, arrange
for public education sessions, and
connect the uninsured to navigators,
in-person assisters, community health
centers, etc.

WVAHC is providing mini grants,
training and on-going technical
support to develop community
assisters.
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Community Assisters Are
Throughout the State
 Eastern
Panhandle
◦ EPFC
◦ Berkley County Health
Department
◦ Morgan County Starting Points
◦ Mineral County FRN
◦ Future Generations
27
Community Assisters Are
Throughout the State
 North
Central West Virginia
◦ Tucker County FRN
◦ Taylor County FRN
◦ Milan Puskar Health Right
◦ Lewis County FRN
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Community Assisters Are
Throughout the State
 Northern
Panhandle
◦ AIDS Task Force of the Upper
Ohio Valley
◦ Brooke County Health
Department
◦ Hancock County Health
Department
◦ Wheeling Health Right
29
Community Assisters Are
Throughout the State
 Mid-Ohio Valley
◦ Boys and Girls Club of Parkersburg
◦ Catholic Charities
◦ Good Samaritan Clinic
◦ Mid-Ohio Valley Regional
Corrections
30
Community Assisters Are
Throughout the State
 Kanawha/Cabell
◦ Covenant House
◦ West Virginia Health Right
◦ Marshall University (students)
◦ Partnership of African American
Churches
◦ WV FREE
◦ WV Healthy Kids and Family
Coalition
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Community Assisters Are
Throughout the State
 Southern West Virginia
◦
◦
◦
◦
◦
◦
◦
Beckley Health Right
Big Creek People in Action (McDowell)
Christian Help of Mingo County
Community Connections
Greenbrier County Health Department
Nicholas County Starting Points
Raleigh County Community Action
Program
◦ SALS
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Community Application
Counselors

Library employees can be certified
application counselors. Guidance on
CAC is available at
http://www.cms.gov/CCIIO/Resource
s/Regulations-andGuidance/Downloads/CACguidance-7-12-2013.pdf
33
Certified Application
Counselors

Disadvantage: There is no federal or
state funding for CAC.

Advantages: Eligibility is a web based
training for 5 hours and pass a test.

Listed on HHS and OIC web sites
as being certified.
34
How Can Libraries Be
Involved
 Connect
uninsured patrons to
navigators, in-person assisters,
community health centers, etc.
so they can get covered.
 Host
enrollment sessions at
your library.
35
How Can Libraries Be
Involved
 Post
the names and contact
information of navigators, in
person assisters, community
health centers, CAC, and
community assisters in the
library
36
How Can Libraries Be
Involved
 Display
material that
objectively explains the
Affordable Care Act and the
new enrollment process
 Other
suggestions?
37
Opportunity
 We
have a once-in-a-lifetime
opportunity to improve the lives
of thousands of our friends and
neighbors. I hope you will join
WVAHC in this journey
 We
need…
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Contact Information
Perry Bryant
[email protected]
304-344-1673 (Office and Home)
304-533-7941 (Cell)
www.wvahc.org
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Web Sites
www.wvahc.org
bewv.wvinsurance.gov
localhelp.healthcare.gov
www.healthcare.gov
www.marketplace.cms.gov
www.kff.org
www.enrollamerica.org
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