Albert Schweitzer Fellowship Monthly Meeting September 11, 2013
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Transcript of Albert Schweitzer Fellowship Monthly Meeting September 11, 2013
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Albert Schweitzer Fellowship Monthly Meeting
September 11, 2013
The Affordable Care Act: How it will Affect the Patients
We Serve
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Topics Covered Today
• Overview of the Affordable Care Act
• Private Health Insurance
• Public Health Insurance
• Covered Services
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Implementation of the Affordable Care Act• Quick Overview!
http://kff.org/health-reform/video/youtoons-obamacare-video/
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The Marketplace: Private Health Insurance• What is a Health Insurance Marketplace? - A virtual portal available to consumers to figure out what insurance coverage
they are eligible for, review and compare insurance plans, and enroll in health
coverage.
• How will Illinois consumers apply for health coverage?
- Consumers in Illinois will apply for health coverage through the Illinois Health Insurance Marketplace, that is a partnership between the state and federal government.
- Marketplace will be accessible through a website, phone or paper application.
- Timeframe for enrollment: October 1, 2013- May 31, 20144
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Medicaid: Public Health Insurance
• What is Medicaid?-A public health insurance option administered jointly by the states
and the federal government.
- Participation in the program is voluntary, Congress has instituted a number of eligibility and coverage requirements for states that wish to participate.
- States retain significant power in crafting coverage and eligibility provisions, which vary significantly from state to state.
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How is Medicaid Changing Under the Affordable Care Act?
Federal & Illinois Medicaid Policy- A national Medicaid minimum eligibility level of 133% of the
federal poverty level ($29,700 for a family of four in 2011/($14,484 for an individual in 2011) for nearly all Americans under age 65.
- New mandatory eligibility group consisting of non-pregnant adults between 19-65 with incomes at or below $133% FPL.
-This Medicaid eligibility expansion goes into effect on January 1, 2014 but states can choose to expand coverage with Federal support anytime before this date.
- Approximately 500, 000 to 800,000 Illinois residents will be covered under this restructured Medicaid program at little or no cost to individuals.
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New Eligibility Standards: Modified Adjusted Gross Income (MAGI)
• Federal Agency Regulation & Enforcement- Internal Revenue Service- Department of Health & Human Services- State Agency: Illinois Department of Healthcare and Family
Services
• Income Calculation- Countable Income + 5% Universal Income Deduction
- up to 138% FPL
• All other forms of income deductions formerly included will be disregarded.
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Traditional Medicaid and Medicaid Expansion Under the Affordable Care Act Traditional Medicaid Plans
- Eligibility based on individual’s aid category + State Financial Test
- Pregnant women, Children, Parents, Seniors, Individuals with Disabilities
- Medicaid beneficiaries receive wide range of benefits not covered in plans on the private market.
Alternative Benefit Plans (ABPs)- Medicaid Benchmark Equivalent Plans, must cover the Essential
Health Benefits (EHBs) specified in the ACA. - Newly Eligible Individuals will receive benefits through this plan.
Churning- Medicaid and Marketplace Eligibility standards will significantly
effect individuals with varying income levels. 8
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Individuals Affected by Medicaid Expansion Women
- Pregnant Women: more women would qualify for Medicaid after pregnancy
- Non-Pregnant Women: Entitled to 22 Preventive Care Services without cost sharing or deductibles.
Children - All children between the ages of 0-19 are eligible for Medicaid as
long as they fall at or below the 133%-138% FPL.
Families (Parents/Caretaker Relatives)- All former income deductions will be disregarded to determine
eligibility.
Homeless Youths- Eligible for traditional Medicaid or newly eligible Medicaid,
depending on age.- Lack of awareness is the main concern.
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Services Required Under the Affordable Care Act
•Autism Screening•Behavioral Assessments•Depression Screening
•Developmental Screening• Iron Supplements
•Hematocrit or Hemoglobin Screening• Immunization Vaccines
•Height, Weight & BMI Measurements•Lead Screening
•Obesity Counseling•PKU Screening
•STI Prevention Counseling•Vision & Hearing Screening
•Well Women Visits•Breast Cancer Genetic Test and Mammography
Screening•Cervical Cancer Screening
•FDA approved Contraception•Domestic Violence Counseling•HIV Screening & Counseling
•HPV DNA Test•Osteoporosis Screening
•Rh Incompatibility Screening•Sexually Transmitted Infections Counseling
•Abdominal Aortic Aneurysm one-time screening
•Alcohol Misuse Counseling•Blood Pressure Screening•Cholesterol Screening
•Colorectal Cancer Screening•Depression Screening
•Diabetes (Type 2 Screening)•HIV Screening
• Immunization Vaccines•Obesity Counseling•Syphilis Screening
•Ambulatory patient services. • Emergency services.
•Hospitalization. •Maternity and newborn care.
• Mental health and substance use disorder•Prescription drugs.
•Rehabilitative & habilitative•Laboratory services.
•Preventive and wellness •chronic disease management.
•Pediatric services
Essential Health
Benefits (EHBs)
Preventive Care
Services - Adults
Preventive Care
Services – Children
Preventive Care
Services – Women
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Illinois Programs to Facilitate Implementation Illinois CountyCare (1115 State Waiver)
- CountyCare is a federally-funded demonstration project, waiving traditional Medicaid requirements for many uninsured adults in Cook County.
- Early implementation of the Medicaid Expansion under the Affordable Care Act for select patients and providers.
- Cook County HHS estimates that at least 115,000 and as many as 250,000 residents may be eligible for CountyCare.
ABE (Application for Benefits Eligibility)- Streamline Access to Enrollment Process: The client facing portal that
individuals can use to apply to several public benefits programs: TANF, SNAP and other medical benefits.
- Question/Answer format brings the applicant to the correct page for either the Health Insurance Marketplace or Medicaid.
- Not real time eligibility, but ABE will help to assess potential eligibility and provide guidance to the correct program. 11
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Sources for Health Reform Information & Updates• United States Department of Health & Human Services
http://www.hhs.gov • Centers for Medicare & Medicaid Services
http://www.cms.gov • Medicaid.gov- Keeping America Healthy
http://www.medicaid.gov • American Public Health Association
http://www.apha.org • American College of Obstetricians & Gynecologists
http://www.acog.org/ • Illinois Department of Healthcare & Family Services http
://www2.illinois.gov/hfs
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Loyola University Chicago School of Law
Public Interest Law Reporter
Annual Law Journal Symposium
Increased Access to Healthcare: The Impact of the Affordable Care Act’s Medicaid
Expansion on Underserved Communities
November 8, 2013
9:30am- 4pm
Philip Corboy Law Center, 25 E. Pearson St., Chicago IL
Invitation!
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“In the Health Justice Project, doctors, social workers, lawyers and students of each profession are
partnering to address the social and environmental causes — like unhealthy housing conditions and
improperly denied food stamps — at the root of poor health.”
Emily A. Benfer, clinical professor of law, director of the Health Justice Project, Loyola University Chicago School of Law, Beazley Institute for Health Law & PolicyChicago Tribune, October 5, 2011
Health Justice Project
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