Affordable Care Act (ACA) Webinar Series September 12, 2013

Purpose We will be sharing the latest information on the health care insurance exchange, exchange navigators, and efforts to expand Medicaid coverage. We strive to provide objective updates of useful information as the ACA moves into a key phase of its implementation over the coming months. Today’s Objectives 1. Provide an update on ACA Healthcare Insurance Exchanges 2. Provide an update on ACA Healthcare Insurance Navigators and

Certified Application Counselors in Ohio. 3. Provide an update on Medicaid expansion and changes in Ohio.

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Today’s agenda

1:00 Welcome & Introduction -Jeff Biehl, Access HealthColumbus

1:05 Update on Healthcare Insurance Exchanges -Doug Anderson, Bailey Cavalieri LLC

1:25 Update on Navigators and Certified Application Counselors (CAC) -Isi Ikharebha, Physicians CareConnection

1:45 Update on Medicaid Expansion

-Jeff Biehl

1:50 Q&A

By 2020… not 1/1/2014

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0%

100%

200%

300%

400%

500%

Children 0-18without coverage

Parents Childless Adults Disabled Workers Other Aged, Blindand Disabled

Fed

eral

Po

vert

y Le

vel (

FPL)

Medicaid

Private Insurance $92,200*

(family of 4)

Disabled Ohioans in this income range “spend down” their income to qualify for Medicaid

$31,809* (family of 4)

Health Benefit Exchange

Optional ACA Medicaid Expansion to 138%

* The 2012 poverty threshold is $11,170 for an individual and $23,050 for a family of four.

Current Ohio Medicaid Eligibility Federal Exchange Eligibility Not Covered by Ohio Medicaid or Federal Exchange

2014 Federal Health Coverage Expansion

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Healthcare Insurance Exchanges

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Healthcare Insurance Exchanges

• SHOP Exchange

• Individual Exchange

• www.healthcare.gov

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Healthcare Insurance Exchanges

October 1st: Exchanges open for business; people can shop for and enroll in coverage.

January 1st: Coverage bought before Dec. 15 becomes effective

March 31st : Open enrollment for 2014 ends; after March 31st, coverage is not available until the next open enrollment period except for “special enrollments” (eg., loss of a employment and coverage)

October. 15, 2014: Open enrollment for 2015 begins

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Companies in the Ohio Exchange

SHOP Exchange

– Anthem

– Assurant

– AultCare

– HealthSpan

– Kaiser

– Medical Mutual

– SummaCare

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Individual Exchange – Anthem – Assurant – AultCare – Buckeye Community – CareSource – Coventry – HealthSpan – Humana – Kaiser – Medical Mutual – Molina – Paramount – SummaCare

Provider Networks

Medicaid plans entering commercial insurance exchanges

– Buckeye

– CareSource

– Molina

Plans may be some of the most affordable

Nearly half of exchange plans in the 13 states

with early fillings have narrow networks Modern Healthcare 8/19/13

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Delayed Rules

Employer mandate and employer reporting requirements

Employee choice of plans in the SHOP Exchange

Coordinated out-of-pocket spending limits

for medical and dental plans sold by

separate companies

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90 Day Grace Period

CMS rule gives consumers a 90-day grace period if they do not

pay their premium before their insurer can drop coverage

1-30 days insurance companies financially responsible

31-90 days providers financially responsible

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Navigators and Certified Application Counselors (CAC)

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Navigators and Certified Application Counselors

Source: Ohio Hospital Association, August 2013

Federal Awards

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Navigator Organizations in Ohio

– Ohio Association of Foodbanks - $1,958,961 (Statewide)

www.ohiofoodbanks.org/

– Children’s Hospital Medical Center - $124,419 (Cincinnati)

– Clermont Recovery Center, Inc. - $44,938 (Clermont County/Cincinnati)

– Helping Hands Community Outreach Center - $230,920 (Dayton)

– Neighborhood Health Association - $684,630 (NE Ohio)

FQHC Certified Application Counselor (CAC) in Columbus/Franklin County

– Columbus Neighborhood Health Center, Inc. – $230,369

– Heart of Ohio Family Health Centers – $79,548

– Lower Lights Christian Health Center – $105,189

– Southeast, Inc. - $73,630

Enrollment Collaboratives

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ONCE (Ohio Network for Health Coverage and Enrollment)

– Collaborative coordinated by HPIO focused on coordinating enrollment

efforts across the state

– To learn more: OhioONCE@gmail.com

Enroll America

– Ohio chapter is working to coordinate enrollment efforts across the

state

– To learn more: www.enrollamerica.org

FQHC Counselor Collaborative

– Collaborative coordinated by Access HealthColumbus focused on

Medicaid enrollment with local FQHCs

Medicaid Expansion

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0%

100%

200%

300%

400%

500%

Children 0-18without coverage

Parents Childless Adults Disabled Workers Other Aged, Blindand Disabled

Fed

eral

Po

vert

y Le

vel (

FPL)

Medicaid

Private Insurance $92,200*

(family of 4)

Disabled Ohioans in this income range “spend down” their income to qualify for Medicaid

$31,809* (family of 4)

Health Benefit Exchange

Optional ACA Medicaid Expansion to 138%

* The 2012 poverty threshold is $11,170 for an individual and $23,050 for a family of four.

Current Ohio Medicaid Eligibility Federal Exchange Eligibility Not Covered by Ohio Medicaid or Federal Exchange

2014 Federal Health Coverage Expansion

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Source: Kaiser Family Foundation

2014 Medicaid Expansion as of September

Debate Ongoing

24 21 1 4

Source: The Washington Post

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11 8

1 0

5

10

15

20

25

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1965 1966 1967 1970 1982

States

History of Medicaid Participation by States

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Medicaid Expansion Scenarios and Implications to business, government, health care, and the social sectors of Franklin County

No Medicaid Expansion • Welcome mat = ~28,000 in Franklin County currently eligible • Loss of $13 billion in additional federal dollars to the state over six years • $59 to $88 million yearly penalties statewide for employers with low-income workers • Loss of significant DSH/HCAP funding for hospitals that serve low-income people • Loss of $1.8-1.9 billion in new net savings and revenue for state budget • Loss of economic impact between $8.6-19.8 billion • Loss of sales tax revenues for counties ~$375 million

Partial Medicaid Expansion after Jan 2014 • Insured: welcome mat + some new eligibles • Ohio House and Senate sub-committees looking at “reform” versus “expansion” • Potential HHS waiver similar to Arkansas

ACA/Full Medicaid Expansion • Welcome mat= ~28,000 + New eligible = ~41,000 in Franklin County • Strong revenue and economic benefit for Ohio and counties • Post January 1, 2014 scenario = partial loss of 100% federal funding • Ballot scenario = target of Fall 2014, partial loss of 100% federal funding

More Will Qualify for Medicaid Without Expansion

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CMS adopts Modified Adjusted Gross Income (MAGI) Income Guidelines

5% Income Disregard

– Children / Pregnant Women up to 205% FPL

– Parents up to 95% FPL

New Income Exemptions

– Child Support / Social Security Income

New Household Formation Rules

– Stepparents and their income included

Where does Medicaid expansion stand?

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House and Senate focused on reform not expansion

Ohio House Speaker predicting 12 bills to be introduced by early October

A coalition (Healthy Ohioans Work) of health-care providers, unions, businesses,

religious organizations and other advocates for the uninsured announced the launch

of a campaign for a November 2014 statewide ballot (1)

Speculation is mounting that any concrete action by the General Assembly won't

occur until after the primary election filing deadline on Feb. 5 so as to protect

incumbents from challenges on the right. (2)

Speculation that Governor could seek expanded appropriation authority through the

Controlling Board (2)

Source: (1) The Columbus Dispatch, 9/4/13, (2) Gongwer Statehouse News Service, 9/2/13

Where does expansion stand?

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Current Medicaid Bills in House

– HB 125 (Carney, J., Antonio, N.)

– HB 176 (Sears, B.)

– HB 208 (Amstutz, R., Sykes, V.)

Current Medicaid Bills in Senate:

– SB 117 (Smith, S.)

– SB 145 (Burke, D.)

– SB 166 (Cafaro, C.)

Q&A

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Future ACA Learning Sessions

• Monthly webinar to provide objective information about ACA

implementation.

• Sessions held the second Thursday of the month from 1:00-2:00PM

• 2013-2014 Webinars

• October 10

• November 14

• December 12

• January 9

• February 13

• March 13

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