Transcript Paths to Coverage - GWU Center for Rehabilitation

The New Economy:
Rethink, Realign, Reinvent
How will the ACA Impact People with
Disabilities?
2012 National Employment
Conference
Barbara Otto, CEO,
Health & Disability Advocates
[email protected]
1
Objectives
1. Impart critical information on how ACA will impact
workers with disabilities
2. Share information on how decisions states will be
making about the ACA will impact Vocational
Rehabilitation
3. Update on how Think Beyond the Label is
facilitating realignment and creating new
opportunities for businesses to find resources and
connect to qualified job candidates with disabilities.
2
What the“ACA” is really about…
Infrastructure
Incentives
Information
Path to
access to
health
coverage
3
Re-Design of Health Delivery System is an
Opportunity
Socio-Economic
Physical
Environment
Individual
Characteristics
•Human Services
delivery system vs.
“health care” or
“employment services”
delivery system
•Employment is a social
determinant of health
and should be tracked
and monitored
Specific Provisions of ACA &
People with Disabilities: Paths to Coverage
•
•
•
•
Pre-existing Conditions in Insurance Plans Eliminated
Individuals who previously went bankrupt over health
care costs may now find affordable coverage
Extension of dependent care coverage to 26
Massive change to mental health populations where
onset ranges from 16-26
Early intervention is key to long-term health
Elimination of caps on coverage
Beneficial for individuals with health insurance
experiencing traumatic injuries or long-term
medical conditions
Closing the doughnut hole for Medicare part D
5
ACA & People with Disabilities: Paths to Coverage
Medicaid
Exchange
• People
between 100%
- 138% of FPL
will now have
access to
Medicaid –
even if they
don’t have a
disability
determination
• People who
have earnings
between 138%
- 400% of FPL
can get a
subsidy to pay
for coverage
Employer-based
Coverage
• People can
purchase
through the
Exchange if
their
employer’s
coverage is
inadequate or
is unaffordable
6
Post 2014: Insurance Affordability Programs
Single State,
Streamlined
Application for
Health Coverage
Insurance
Products
available
Household
Income
Below 400%
of FPL
“Regular”
Medicaid or
Medicaid Optional
Program
If no disability,
households can
get a subsidy for
the Exchange
Deeper
“dive” for
eligibility for
Medicaid
Programs
7
Eligibility Screening for Insurance Affordability
Programs: Modified Adjustable Gross Income
 Modified Adjusted Gross Income is a tax
methodology and will be determined by IRS based
on tax returns.
• Calculated for the “household” and based on
earnings listed in W-2.
• Does not consider assets
• MAGI may be applied to all applicants at the time
of enrollment because of the simplified one entry
point system.
8
Intersection of Employment & Access to Health
Coverage
1. How will the states and the federal government identify
people with disabilities in the single state application
process?
2. Once identified, what will a “deeper dive” on eligibility for
Medicaid and Medicaid optional programs like the
Medicaid Buy-in look like?
3. During initial eligibility determinations and redetermination,
will low wage earners with disabilities be placed into the
Medicaid “Adult” group or the Exchange when the state’s
Medicaid Buy-in would be more appropriate?
9
How will All of this work for American
Indians & Alaska Natives?
 ACA makes the Indian Health Care
Improvement Act Reauthorization
permanent and authorizes new programs
within IHS
• Expanded IHS services including mental and
behavioral health
• Increasing clinician recruitment and retention in
Tribally Operated Health Programs
• Access to Federal Employees Health Benefits
program
10
How will this Impact Access to Health Care
for Non Citizens & Migrant Workers?
 Naturalized citizens will have the same
access and requirements as U.S. born
citizens
 Lawfully Present Immigrants:
• Eligible to Purchase Insurance from the State Health
Insurance Exchange
• Eligible for premium tax credits
• Must be (or is reasonably expected) to be lawfully present
during entire period of enrollment
• Will be subject to individual mandate.
11
How will the ACA Impact Migrant Workers?
 Migrant Health Centers will continue to be an
important safety net
• ACA provides $11 billion in dedicated funding for
community health centers – the National
Association of Health Centers believes this will
allow migrant health centers to almost double
their capacity
12
ACA & People with Disabilities:
Infrastructure / Delivery System
 Essential Health Benefits creates a “foundation” for
services packages available to all Americans:
• No federal standard and no federal definitions
• States can choose between different options –
Alternative Benefits Plans on which to base their EHB
plans (more detail in next slide)
• States must cover all the categories outlined in ACA -even if not covered in the insurance products they
select for the Exchange
13
ACA Infrastructure & Essential Health
Benefits
•Insurance policies must cover
these benefits to be certified and
offered in Exchanges, and all
Medicaid plans must cover these
services by 2014.

•Coverage must be equivalent (in
actuarial value) to one of
alternative benefits plans:

Federal Employee Health
Benefits Plan,
State Employee Plan,
Small Business Commercial
HMO Product, or
Secretary-approved coverage.







Outpatient and lab services;
Emergency services;
Hospitalization;
Maternity and newborn care;
Pediatric services, including oral and
vision care;
Mental health and substance abuse,
including behavior health treatment,
with parity to physical health
services;
Prescription drugs;
Rehabilitative and habilitative
services and devices;
Preventive and wellness services
and chronic disease management.
14
Consideration: Essential Health Benefits
• Specific EHB services under the Medicaid
expansion & Exchange are unknown at this time –
CMS is seeking comments, but won’t provide
“final” guidance until 2016
• States may include services that are not required, but
services may not be more generous than what is
already available in the existing state plan.
15
ACA & Intersection with Employment
VR &
Comparable
Benefits: will
ACA alleviate
fiscal
pressure?
?
American
Indians & Alaska
Natives: Will
ACA mean
better health
care?
VR Processes:
will the ACA
change how
we counsel
customers?
16
Important Role for VR In ACA Infrastructure
Development & Implementation
 Program & services in Medicaid & Exchange:
• Is the state creating a new Medicaid Adult Group?
• Is the state operating its own Exchange?
• How will eligibility for the Insurance Affordability Groups
work?
• What services are included in the Essential Health Benefits?
Will it alleviate pressure on VR?
• How will IHS and community health centers be impacted by
ACA?
• Have you been in any sessions at the state level where
they’re talking about HCBS modifications or improvements
(State plan options, waiver development, grant programs)?
Even in states that don’t opt for Medicaid expansion, there may be
savings for VR in comparable benefits…
17
ACA Incentives Create More Opportunities for
Employment Focused Programs
• ACA has several avenues to integrate employment
related health services and Medicaid funded
employment services in the evolving health delivery
system
• Examples:
• Health Home Models for individuals with
chronic conditions
• Medicaid State Plan Options like 1915 (i)
• Money Follows the Person
• States are looking at how to integrate expectation of
employment – a social determinant of health – into
their new systems of coordinated care
• Example: Oregon
Roles in Health Delivery System: VR
Counselors
LINK
Facilitate consumers to enroll in the best option for
them – helping navigate between Exchange and
Medicaid Optional program like the Medicaid Buy-in
EDUCATE
guide consumers AND employers on the best paths
to coverage for workers with disabilities etc.
PARTNER
Exchange & Medicaid agencies on ensuring
workers with disabilities are in the right health care
programs to sustain employment
19
How does Think Beyond the Label Help?
Rethinking business engagement
strategies: online tools, resources &
access to job candidates in one place
Reinventing employment services
marketing: connecting businesses &
people with disabilities directly
Realigning communication strategies &
providing thought leadership: blogs,
success stories & earned media
20
Targeted Business Tools & Marketing
“The folks
behind a new
online tool
called Hire
Gauge …
help
employers
calculate the
potential cost
benefits of
hiring
someone with
a disability.”
Rita Pyrillis,
Workforce
Management
21
New Strategies for Businesses to Connect Directly
to Job Candidates with Disabilities
“Seventy
percent of
disabled
Americans say
they want to
work full-time,
but only about
21 percent do.
Think Beyond
the Label, …
hopes to
change that.”
Karen E. Klein,
BusinessWeek
Online
22
New Strategies for Businesses to Connect Directly
to Local Resources like VR
“Think Beyond
the Label [helps]
employers of all
sizes throughout
the nation find
local resources
for recruiting
disabled
workers.” Sarah
E. Needleman,
The Wall Street
Journal
23
Business Communication that Redefines the
Pool of Job Candidates with Disabilities
TBTL job seekers:
•
Live in all 50 states
•
Have experience in
more than 26
different industries
•
25% have 5+
years experience
•
20% have 10+
years experience
•
30% have
professional
certifications,
college degrees &
beyond
24
Health & Disability Advocates works across public,
private and social sectors to create smarter systems of
health, disability and employment.
Barbara A. Otto
[email protected]
312.265.9090
Follow: @BarbAOtto, @hdadvocates,
Visit: www.thinkbeyondthelabel.com