2012 National Employment Conference

Barbara Otto, CEO,

Health & Disability Advocates

botto@hdadvocates.org

The New Economy: Rethink, Realign, Reinvent

How will the ACA Impact People with Disabilities?

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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.

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Objectives

What the“ACA” is really about…

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Re-Design of Health Delivery System is an Opportunity

•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

Socio-Economic

Physical Environment Individual

Characteristics

• Pre-existing Conditions in Insurance Plans EliminatedIndividuals 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

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Specific Provisions of ACA & People with Disabilities: Paths to Coverage

ACA & People with Disabilities: Paths to Coverage

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Post 2014: Insurance Affordability Programs

Single State, Streamlined Application for Health Coverage

If no disability, households can get a subsidy for the Exchange

“Regular” Medicaid or Medicaid Optional Program

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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.

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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?

Intersection of Employment & Access to Health Coverage

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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

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How will All of this work for American Indians & Alaska Natives?

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.

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How will this Impact Access to Health Care for Non Citizens & 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

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How will the ACA Impact Migrant Workers?

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

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ACA & People with Disabilities: Infrastructure / Delivery System

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.

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• 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.

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Consideration: Essential Health Benefits

ACA & Intersection with Employment

VR & Comparable Benefits: will ACA alleviate fiscal pressure?

VR Processes: will the ACA change how we counsel customers?

American Indians & Alaska Natives: Will ACA mean better health care?

?

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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…

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Important Role for VR In ACA Infrastructure Development & Implementation

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

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Rethinking Rethinking business engagement strategies: online tools, resources & access to job candidates in one place

ReinventingReinventing employment services marketing: connecting businesses & people with disabilities directly

RealigningRealigning communication strategies & providing thought leadership: blogs, success stories & earned media

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How does Think Beyond the Label Help?

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

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“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

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New Strategies for Businesses to Connect Directly to Job Candidates with Disabilities

“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

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New Strategies for Businesses to Connect Directly to Local Resources like VR

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

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Business Communication that Redefines the Pool of Job Candidates with Disabilities

Health & Disability Advocates works across public, private and social sectors to create smarter systems of health, disability and employment.

Barbara A. Ottobotto@hdadvocates.org312.265.9090

Follow: @BarbAOtto, @hdadvocates, Visit: www.thinkbeyondthelabel.com