Transcript Document

Inter Tribal Council of Arizona
Affordable Care Act (ACA)
AI/AN Outreach & Enrollment
Arizona Enrollment Assistance Training
September 15, 2014
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Health Care Reform & the
Federal Trust Responsibility
The ACA recognizes the federal
trust relationship & strengthens
tribal sovereignty through:
• Protection & enhancement of the
IHS health care system with the
passage 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.
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ACA/IHCIA Training & Enrollment
Activity
• In 2012, IHS funded a National
Initiative to educate Tribal
Leaders & Tribal Health
Officials & to begin ACA
consumer education.
• In 2013, IHS implemented a
ACA Business Plan. Certified
Application Counselors (CAC’s)
have been added to the IHS
workforce (NAO-62, PAO-27,
TAO-8, PYT-8, Native Health-1).
Navigators are working at
TCRHCC & NAC thru AACHC.3
Training/Enrollment Activity
• Inter Tribal Council of Arizona, Inc. received its first ACA
training grant in 2012. The current grant is in place through
December 2014.
• ITCA provides training to the Tribes in the Phoenix and Tucson
IHS Areas (Arizona, but not the Navajo Nation, 3 of 8 Tribes in
Utah and all of Nevada).
• The Arizona Marketplace Workgroup grant runs through
November 2014. Tribes will recommend an outreach &
education strategy in terms of ACA implementation and
provide other policy recommendations to the Governor’s
office.
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Affordable Care Act
Implementation in
Indian Country
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ACA Implementation…2014
 Nearly all U.S. citizens/legal residents are now required to
have health insurance that meets minimum requirements
unless available coverage costs more than 8% of your
income.
 You are covered if you have job based coverage, Medicare,
Medicaid/CHIP, TRICARE/VA , a Marketplace Plan or an
individual policy outside of the Marketplace.
 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.
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ACA Implementation…2014
 The ACA provides ways to help people get health
insurance. Individuals and families with incomes at or
below 400% FPL are eligible to get tax credits for subsidies
to help pay for premiums. The Health Insurance
Marketplace can pay it monthly to the plan the individual
enrolls in.
 Plus, there’s no cost-sharing for AI/AN’s at or below 300%
FPL for any Health Insurance Marketplace plan at any
metal level (bronze, silver, gold or platinum).
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ACA Medicaid Changes…2014
• The Medicaid Expansion option
allows states to expand
eligibility & obtain increased
Federal funding.
• Governor Brewer signed the
Medicaid Restoration Plan into
law on 6/17/13. It restored
coverage to those between
100-133% of the Federal
Poverty Level, including
Childless Adults
• AHCCCS coverage for these
groups started on 1/1/14.
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ACA Medicaid Changes…2014
• State Medicaid programs are now required to use
the new Modified Adjusted Gross Income
(MAGI) methodology and streamline screening
and enrollment into four eligibility categories –
children, pregnant women, parents/caretaker
relatives and other adults.
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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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ACA Implementation…2014
• The 2013 Poverty Guidelines for Household Income of
the lower 48 States and the District of Columbia will
be used to determine eligibility for seeking financial
assistance:
100% FPL/1 person=$11,490
133% FPL/1 person=$15,282
300% FPL/1 person=$34,470
400% FPL/1 person=$45,960
100% FPL/4 Persons=$23,550
133% FPL/4 persons=$31,322
300% FPL/4 persons=$70,650
400% FPL/4 persons=$94,200
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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
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ACA Implementation…2015
 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.
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ACA Implementation…2015
• 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
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greater access to care.
ACA Implementation…2015
IRS Reporting – Individual Shared Responsibility Payment
• If you can afford health insurance, but choose not to buy it, you
must pay a fee known as the individual shared responsibility
payment when you file your federal income tax return in 2015.
The ACA requires you and each member of your family to either:
 Have minimum essential coverage, or
 Have an exemption from the responsibility to have minimum
essential coverage, or
 Make a shared responsibility payment when you file your 2014
federal income tax return in April 2015.
• People with health insurance coverage do not need to do anything
more than maintain that coverage. Tax forms will be developed to
report the information.
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ACA Implementation…2015
IRS Reporting – Individual Shared Responsibility Payment
Payment Calculations
• The fee in 2014 is 1% of your yearly income or $95 per person
for the first year, whichever is higher. The fee increases every
year. In 2015, it’s 2% of your income or $325 per person and in
2016, it's 2.5% of income or $695 per person, whichever is
higher.
• The payment for an uninsured child is ½ of the adult rate. The
individual who claims the dependent will be responsible for the
payment
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ACA Implementation…2015
IRS Reporting – Individual Shared Responsibility Payment –
Statutory Exemptions
• You’re uninsured for less than 3 months of the year
• The lowest-priced coverage available to you would cost more
than 8% of your household income
• You don’t have to file a tax return because your income is too low
• You’re a member of a federally recognized tribe.
• You’re a member of a recognized health care sharing ministry
• You’re a member of a recognized religious sect with religious
objections to insurance, including Social Security and Medicare
• You’re incarcerated (either detained or jailed), and not being held
pending disposition of charges
• You’re not lawfully present in the U.S.
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ACA Implementation…2015
IRS Reporting - Individual Shared Responsibility Payment –
Regulatory Hardship Exemptions
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Eligible for services through an Indian Health Service provider
Homeless
Evicted in the past 6 months or facing eviction or foreclosure
Shut-off notice from a utility company
Recently experienced domestic violence
Death of a close family member
Experienced a fire, flood, or other natural or human-caused
disaster that caused substantial damage to your property
• Filed for bankruptcy in the last 6 months
• Medical expenses you couldn’t pay in the last 24 months which
resulted in substantial debt
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ACA Implementation…2015
IRS Reporting - Individual Shared Responsibility Payment Hardship Exemptions (cont.)
• Another person is required by court order to give medical support
to a dependent child. In this case, you do not have to pay the
penalty for the child.
• As a result of an eligibility appeals decision, you’re eligible for
enrollment in a qualified health plan (QHP) through the
Marketplace, lower costs on your monthly premiums, or costsharing reductions when you weren’t enrolled in a Marketplace
plan.
• Your state didn’t expand eligibility for Medicaid.
• Your individual insurance plan was cancelled.
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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
American Indian Exemption Application
• Tax Household = any person you are claiming as dependents on your 2014 taxes
• Adults
• Dependents
• Do not include dependents who are not asking for the exemption
American Indian Exemption Application
Important Note:
Each person in
“Tax household” or
those claimed as
“dependents”
need to complete
Section 2.
Members of federally
recognized Tribes only
need to complete
Questions 1-7.
Leave rest of page
blank.
When should I submit the application?
 Exemption applications are now available
– Paper copy only (no electronic copies)
– Get paper copy online:
http://marketplace.cms.gov/applications-and-forms/tribalexemption.pdf
– Get a paper copy from Certified Application Counselors at IHS
facilities.
 Mail to: Health Insurance Marketplace-Exemption Processing
465 Industrial Blvd.
London, KY 40741
• 2014 Tax Season
– Submit exemption application before filing taxes
– Receive “Exemption Certification Number.”
– Use on 2014 Tax filing form
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.
Affordable Care Act
American Indian/Alaska Native
Specific Protections
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AI/AN Protections
Health Insurance Marketplace/State Exchanges:
• AI/AN are exempt from the mandate that requires
individuals to purchase health insurance or pay a tax
penalty.
• A process to identify exempt individuals must be
allowed. The law states that the HHS Secretary will set
the requirements for what information needs to be
provided by individual AI/AN’s.
• Special monthly enrollment periods for AI/AN to
facilitate and overcome barriers to enrollment will be
established.
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AI/AN Protections
• Health plan networks must include Essential Community
Providers that serve low-income and medically
underserved individuals. The regulation encourages the use
of the Model Indian Addendum to contract with I/T/U
providers.
• Stakeholders/advocates must be consulted on enrolling
hard to reach populations. Guidance requires consultation
with Tribes on policy and operational facets that affect
AI/AN.
• Indian Tribes, Tribal organizations, and Urban Indian
organizations are organizations that may be designated as
“Navigators.”
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AI/AN Protections
• 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.
• Health programs operated by I/T/U’s shall be the payers
of last resort for services provided to Indians.
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AI/AN Protections
Medicare/Medicaid/CHIP:
• Reimbursement for all Medicare Part B services by Indian
hospitals and clinics reinstated.
• All costs incurred by I/T/U’s and the AIDS Drug Assistance
Program in dispensing pharmaceuticals shall be counted as
“true out-of-pocket” costs by AIAN’s enrolled in Medicare
Part D plans.
• Medicaid State agencies are required to consult with Tribes
in the development of Waivers and Medicaid & CHIP State
Plan Amendments (SPAs) and submit documentation of
consultation to CMS. (ARRA Section 5006(e))
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AI/AN Protections
• I/T/U’s added to list of agencies that could serve as an
“Express Lane Agency” under Sect. 1902(e)(13) of the
Social Security Act and allowed to determine
presumptive eligibility for public benefit programs.
• 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.
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AI/AN Protections
• 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.
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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).
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ACA Training Project Staff
Alida Montiel, Health Systems Director
(602) 258-4822, Ext. 1543
[email protected]
Verna Johnson, Health Program Manager
(602) 258-4822, Ext. 1584
[email protected]
Cynthia Freeman, Public Benefits Program Coordinator
(602) 258-4822, Ext. 1554
[email protected]
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AI/AN Protections
• American Indian members who are active or
previous users of the IHS, Tribal health programs
operated under P.L. 93-638, or urban Indian health
programs are exempt from premiums and other cost
sharing in Medicaid/CHIP.
• AI/AN enrolled in AHCCCS Managed Care Plans can
continue to get services through an I/T/U even if the
I/T/U provider is not a provider in the individual
AI/AN’s managed care network.
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Thank you for this opportunity!
Questions?
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