The Affordable Care Act and West Virginians LibrariesWest Virginia Library Commission Conference October 10, 2013

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Today’s PresentationReview the four major

provisions of the Affordable Care Act (ACA)

Review the new enrollment process and who will be involved in enrollment

Discuss how libraries can be involved in the enrollment process

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ACA Has Four Main GoalsNew regulations of the insurance industry

Renewed emphasis on prevention

Cost containment, particularly for Medicare

Expands health insurance to virtually all Americans

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Health Insurance Coverage Is Expanded In Two Ways

Medicaid is expanded to cover everyone under 138% of the federal poverty level who is under age 65.

New Health Insurance Marketplaces are created where subsidized, private insurance products are sold.

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New Coverage Options

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Expanding Health InsuranceThe Medicaid expansion is projected to cover an estimated 133,500 low-income West Virginians.

Federal government pays almost all of the costs.

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Medicaid Expansion: Income Eligibility for a Family of Three

Current Eligibility Expansion Eligibility$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$3,036

$26,951

Medicaid Eligibility

◦Income◦Household size

◦US citizenship

◦State Residency

◦Under age 65

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<138% of FPL

Income Eligibility for Medicaid

Family Size 138% of FPL 155% of FPL

1 $15,856 $17,8102 $21,404 $24,0403 $26,951 $30,2724 $32,499 $36,502

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138% applies to children over age one and adults. 155% applies to pregnant women and children under age one.

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Changes in CHIPWith the increase in Medicaid

eligibility, many children currently enrolled in CHIP will become Medicaid eligible and cannot remain on CHIP:

10,800 CHIP kids transfer to Medicaid

2,800 kids gain CHIP coverage under the new income eligibility rules

Health Insurance Marketplace

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Health Insurance MarketplaceA marketplace allows consumers to compare and choose private health insurance policies that best suits their needs. Policies offered through a web site, 1-800 number, by mail or with personal assistance.

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Health Insurance MarketplaceThe marketplace is open to individuals who do not have employer sponsored health insurance and small businesses.

Significant tax credits for individuals between 100% and 400% of the FPL.

An estimated 99,000 West Virginians will qualify for premium tax credits in the exchange.

Subsidy for family of 4 earning $50,000

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Policy Cost = $789Family Pays = $282Govt. Subsidy = $507 (64%)

Additional assist with deductibles and copayments plus out-of-pocket maximum protection

FPL for Cost Sharing Subsidies and Premium Subsidies

Family Size 250% of the FPL 400% of the FPL

1 $28,725 $45,9602 $38,775 $62,0403 $48,825 $78,1204 $58,875 $94,200

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250% of the FPL level is the eligibility threshold for cost sharing reductions and 400% of the FPL is the threshold for premium assistance

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Health Insurance MarketplaceHighmark Blue Cross Blue Shield the only carrier to participate in 2014

They are offering 11 different plans: 4 gold plans; 3 silver and 3 bronze plans; and one catastrophic plan.

Two additional ones from BCBS nationally, but appear to be identical to state offered plans.

Three Levels of Plan Options in West VirginiaGold plan

◦Insurance company pays 80% of claims and consumers on average pay 20% of the claims.

Silver = 70/30 Bronze = 60/40

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Premiums in the Various Metal LevelsPremiums in a gold plan would be higher, while deductibles and copayments would be lower

Conversely, the premiums in a bronze plan will be lower, while the cost sharing would be higher

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The Marketplace and Small Businesses

Eligibility for the SHOP marketplace is 50 or fewer employees, about 42,000 West Virginia businesses employing 280,000 people.

Highmark is offering 4 plans in the SHOP Marketplace in 2014

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How Will the Enrollment Process Work?

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The Enrollment ProcessSimplified enrollment for Medicare, CHIP and premium tax credits in the health insurance marketplace◦One enrollment form◦No face-to-face interviews◦No paper documentation◦No asset test

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TimelinesEnrollment begins October 1, 2013If someone enrolls by the 15th of the

month, then coverage for Medicaid and qualified health plans begins the first day of the following month. Get people enrolled by December 15th.

If after the 16th on the month, coverage begins on the first day two months later.

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How Do We Enroll All These People?HHS will maintain a web site:

And a call center: 800-318-2596

Can also enroll through the mail

A number of entities will provide personal assistance

www.healthcare.gov

Personal AssistanceInsurance agents and brokersNavigators

Advanced Patient Advocacy/Hospitals WVU Healthy Starts TSG Consulting

In-person assisters – 270 Maximus Placed in DHHR and SHIP offices so far.

Community health center employeesCertified Application CounselorsDHHR Employees

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How to Find Personal Assistancebewv.wvinsurance.gov: Click

on Where Can I Find Local Help? Gives county level data

The national web site has ZIP code level data, but doesn’t filter information well. Seelocalhelp.healthcare.gov

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Community AssistersEnroll uncomplicated cases,

arrange for public education sessions, and connect the uninsured to navigators, in-person assisters, community health centers, etc.

WVAHC is providing mini grants, training and on-going technical support to develop community assisters.

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Community Assisters Are Throughout the StateEastern Panhandle

◦EPFC◦Berkley County Health Department

◦Morgan County Starting Points

◦Mineral County FRN◦Future Generations

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Community Assisters Are Throughout the StateNorth Central West Virginia◦Tucker County FRN◦Taylor County FRN◦Milan Puskar Health Right◦Lewis County FRN

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Community Assisters Are Throughout the StateNorthern Panhandle

◦AIDS Task Force of the Upper Ohio Valley

◦Brooke County Health Department

◦Hancock County Health Department

◦Wheeling Health Right

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Community Assisters Are Throughout the StateMid-Ohio Valley

◦Boys and Girls Club of Parkersburg

◦Catholic Charities◦Good Samaritan Clinic◦Mid-Ohio Valley Regional Corrections

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Community Assisters Are Throughout the StateKanawha/Cabell

◦Covenant House◦West Virginia Health Right◦Marshall University (students)◦Partnership of African American Churches

◦WV FREE◦WV Healthy Kids and Family Coalition

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Community Assisters Are Throughout the StateSouthern West Virginia

◦Beckley Health Right◦Big Creek People in Action (McDowell)◦Christian Help of Mingo County◦Community Connections◦Greenbrier County Health Department

◦Nicholas County Starting Points◦Raleigh County Community Action Program

◦SALS

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Community Application CounselorsLibrary employees can be

certified application counselors. Guidance on CAC is available at http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/CAC-guidance-7-12-2013.pdf

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Certified Application CounselorsDisadvantage: There is no

federal or state funding for CAC.

Advantages: Eligibility is a web based training for 5 hours and pass a test.

Listed on HHS and OIC web sites as being certified.

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How Can Libraries Be InvolvedConnect uninsured patrons to navigators, in-person assisters, community health centers, etc. so they can get covered.

Host enrollment sessions at your library.

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How Can Libraries Be InvolvedPost the names and contact information of navigators, in person assisters, community health centers, CAC, and community assisters in the library

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How Can Libraries Be InvolvedDisplay material that objectively explains the Affordable Care Act and the new enrollment process

Other suggestions?

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OpportunityWe have a once-in-a-lifetime opportunity to improve the lives of thousands of our friends and neighbors. I hope you will join WVAHC in this journey

We need…

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Contact InformationPerry Bryantperrybryant@sudddenlink.net

304-344-1673 (Office and Home)

304-533-7941 (Cell)

www.wvahc.org

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Web Siteswww.wvahc.orgbewv.wvinsurance.govlocalhelp.healthcare.govwww.healthcare.govwww.marketplace.cms.govwww.kff.orgwww.enrollamerica.org