Didactic Series Understanding Patient Health Care Coverage Issues Susan Farrington MPH Sierra Foothills AIDS Foundation June 13, 2013 ACCREDITATION STATEMENT: University of California, San Diego School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The University of California, San Diego School of Medicine designates this educational activity for a maximum of one credit per hour AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. 1
Learning Objectives 1) To understand the changes in health care coverage resulting from the expansion of Medicaid and the implementation of the Affordable Care Act. 2) To identify how these changes will impact Ryan White and ADAP services. 2
Medicaid Expansion Medical services through managed care provider and funded 100% by federal government, decreasing to 90% by 2020 Applications and on-going coverage processed by county human services 3
The Affordable Care Act The Exchange will: Offer a variety of Qualified Health Plans Provide side-by-side comparisons of the Plans, their benefits, and premiums. Applicants can choose the plans that fit their needs and their budget. www.coveredca.com 4
The Affordable Care Act (cont) Offers three coverage components for individuals and small businesses Called Covered California For individuals/families: Medicaid Expansion (Medi-Cal) Advanced Premium Tax Credits (tax credits and subsidies) 5
The Affordable Care Act (Cont) For small business: less than 50 employees SHOP: Small Business Health Insurance Options Program 6
Essential Health Benefits Include: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, behavioral health treatment, prescription drugs, rehabilitative and habilitation services and devices, laboratory services, preventive and wellness services chronic disease management, and pediatric services, including dental and vision care. 7
Medicaid Expansion All Medi-Cal clients must chose a managed care provider. A list of providers will be distributed by County of residence. Clients receiving SSI or Medicare may chose to opt out of managed care. Managed care is set to begin on June 1 st, 2013 8
Medicaid Expansion (cont) Medical services through managed care provider and funded 100% by federal government, decreasing to 90% by 2020 Applications and on-going coverage processed by county human services 9
Medicaid Expansion (cont) Existing LIHP recipients move to MAGI Medi-Cal on January 1, 2014 Existing Medi-Cal program continues Current Legislative Session to streamline and simplify program to align with MAGI Medi-Cal Eliminate asset test 10
Medicaid Expansion (cont) Reduce paperwork requirements Will have two programs: MAGI Medi-Cal and non-magi Medi-Cal 11
Advanced Premium Tax Credit Individuals and families: Purchase coverage through the Exchange and receive tax credit or cost sharing subsidies No age limitations Between 139-400% Federal Poverty Level; by Modified Adjusted Gross Income methodology Receive level of medical services provided by individual s choice of Insurance Carrier offered by the Exchange 12
Shop For small businesses less than 50 employees: Can offer employees a variety of Health Plans, much as large employers can Decide whether and when to participate in SHOP Choose own level of contribution toward employees coverage Lower costs by shared purchasing May be eligible for small business tax credits 13
Covered CA: How it will work For individuals: Single, simplified application Apply by phone at Covered CA call center or online at Covered CA website; option for walk in at county human services All verifications completed electronically through federal hub to IRS, SSA, INS Approvals at time of application or within short period thereafter 14
Timeline Activity Start End Purpose Outreach and Education May 1, 2013 June 30, 2013 Raise awareness Get Ready, Get Set July 1, 2013 Sept 30, 2013 Coverage is coming Enroll Oct 1, 2013 March 31, 2014 Open enrollment Reinforcement and Special Enrollment April 1, 2014 July 31, 2014 Special circumstances Get Ready, Get Set July 1, 2014 Sept 30, 2014 Open enrollment coming. Enroll! Oct 1, 2014 Dec 31, 2014 Second year open enrollment 15
Our Role in Covered CA Education and Outreach Application Assistors Enrollment Continued Enrollment 16
ACA and Ryan White Ryan White will continue to be the funder of last resort. Potential savings in ambulatory care and ADAP. Ryan White funds may be used for copays All eligible RW clients must apply for Medi- Cal or other ACA health insurance plan. 17
ACA and Ryan White Requirement for 75% RW core services 25% support services Medical or non Case Management 75/25 waivers 18
References Affordable Care Act Covered CA 19