Transcript Slides for MRHT Presentation on Mental Health

HEALTH CARE REFORM AND THE IMPACT
ON VULNERABLE POPULATIONS IN
ILLINOIS
Stephanie Altman, Programs & Policy Director
[email protected]
John Bouman, President, Shriver National Center on Poverty Law,
[email protected]
Nelson Soltman, Supervisory Attorney, LAFMC,
[email protected]
KEY COMPONENTS OF AFFORDABLE CARE
ACT
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Individual Responsibility (the “individual mandate”)
Employer Responsibility (the “employer mandate”)
 Employers with 50 or more employees are required to offer
coverage or pay a “free rider” penalty if one of their employees
is eligible for and receives a subsidy to purchase insurance
through the exchange.
Create state-based “Exchanges” through which individuals and
small businesses (# of employees to be determined by state) can
purchase coverage.
 Premium and cost-sharing credits available to
individuals/families with income between 100-400% FPL.
 “Qualified health plans“ will be sold through the exchanges
Large Expansion of Medicaid to Childless Adults up to 138% FPL.
Significant Private Insurance Market Reforms including
elimination of underwriting based on health status and ban on
pre-existing condition exclusions.
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ESSENTIAL BENEFITS PACKAGE
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The minimum contents of the
essential health benefits
package, which will be detailed
in regulations to be issued in
2012, comprise the following
categories mandated in the
Affordable Care Act (all health
plans sold through the health
care exchange must cover the
essential benefits package at a
minimum):
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Ambulatory patient services;
Emergency services;
Hospitalization;
Maternity and newborn care;
Mental health and substance
use disorder services;
Prescription drugs;
Rehabilitative and habilitative
services and devices;
Laboratory services;
Preventive and wellness
services including chronic
disease management;
Pediatric services including
oral and vision care.
STATUS OF ACA LITIGATION
Circuit Court Decisions and the “Individual
Mandate”
 Can the ACA survive without the individual
mandate?
 Supreme Court Cert in Virginia and Florida Case
 Political Considerations in Congress of the
“threat” to repeal and replace.
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MEDICAID IN ILLINOIS NOW
 Medicaid
Categorical Eligibility (All Kids;
Family Care; Moms and Babies; AABD;
GA/TA)
 The Disability Determination: SSI and
SSDI
 Medicaid Medically Needy (Spend down)
 Medicaid Buy-In for Workers with
Disabilities
 Medicaid Home and Community Based
Waivers
ILLINOIS MEDICAID 2010- 2014
 Same
mandatory and optional
categories.
 Maintenance of Effort Provision
(exceptions: All Kids; Family Care;
Illinois Cares Rx; Provider
Reimbursement.)
 Option to cover individuals in “newly
eligible” below the 138% FPL
category prior to 2014.
MEDICAID EXPANSION IN 2014
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In 2014, anyone up to 133% FPL is eligible for Medicaid, called
“newly eligible” Medicaid.
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Must be under 65, not entitled to or enrolled in Medicare A or enrolled in
Part B.
Modified gross income test and no asset test, which is different from
current Medicaid and SCHIP Programs.
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Federal government pays for much greater percentage of this
expansion.
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Potential to alleviate challenge of the Medicare waiting period –
dependent upon coverage package.
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Most applications will be filed electronically through a Health
Insurance Exchange. Others will be filed through more traditional
methods.
ENROLLMENT AND ELIGIBILITY ISSUES IN
2014
Enrollment Procedures for Medicaid and Health
Care Exchange applications online, by mail and
in person
 Eligibility Determinations
 Due Process Issues
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GOING BACKWARD BEFORE WE GO
FORWARD
Medicaid Reform Legislation passed in Illinois in
December 2010 and signed by Governor
 Caps All Kids at 300% FPL for new enrollees
after 7/1/2011.
 Grandfathers in current All Kids enrollees over
300% FPL until 7/1/2012.
 Imposed new verification and eligibility barriers
for Medicaid which have been disallowed by
CMS.
 Imposes moratorium on Medicaid expansions
until 2013.
 Requires 50% of Medicaid enrollees to be in risk
based coordinated care by 2015.
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INTEGRATED CARE PILOT
Pilot project for enrollment of 40,000 AABD
recipients (non-dual eligibles) into managed care.
 Cook and Collar Counties with exception of City
of Chicago.
 Enrollment through Illinois Health Connect and
managed care through Aetna and Illinicare.
 Network issues and exception policies.
 Single Care Agreements and Continuity of Care.
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HEALTH CARE REFORM IMPLEMENTATION IN
ILLINOIS: ILLINOISHEALTHMATTERS.ORG
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Governor Quinn signed an executive order on July 30, 2010 to
create the Illinois Health Care Reform Implementation Council to
help implement ACA.
The council issued recommendations to:
 establish a health insurance exchange and other consumer
protection reforms;
 reform Medicaid;
 assure high quality care;
 identify federal grants and other non-governmental funding
sources; and
 foster the widespread adoption of electronic medical records.
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ACA PROVISIONS ALREADY IN PLACE
IPXP: Illinois Preexisting Insurance Program at
http://insurance.illinois.gov/ipxp/
 Dependent Coverage up to age 26.
 No pre-existing condition exclusions or denial of
coverage based on health status for children.
 Small Business Tax Credits available.
 Insurance Rescissions are only allowed in cases
of intentional fraud or intentional
misrepresentation.
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HEALTH CARE EXCHANGE LEGISLATION
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SB 1555 (now Public Act 097-0142) was signed into
law in August 2011 by the Governor.
Creates a Legislative Task Force to Recommend
Implementation and Design of the Illinois Health
Care Exchange.
Governance and Financial Sustainability are the
major issues.
Recommendations are due by Veto Session 2011 in
order to continue to receive federal funding for the
implementation planning process.
State must continue to progress toward an
implementation design and then get approval for final
implementation by January 1, 2013 to continue to get
federal funding.
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Illinois Health Matters, a website, Facebook page and Twitter
feed, on health care reform in Illinois, is producing multimedia
snapshots on how the Affordable Care Act is affecting or will affect
the residents in the South and West Sides of Chicago. See our
Neighborhood Stories site here:
http://www.illinoishealthmatters.org/neighborhood-stories.aspx
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