The Patient Protection and Affordable Care Act Young Adult Outreach and Education.
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Transcript of The Patient Protection and Affordable Care Act Young Adult Outreach and Education.
Who Doesn’t Have Insurance?
19.7% of residents in California lack insurance
32.3% of 18-34 year olds in California lack insurance
15.7% of residents in the U.S. lack insurance
26.9% of 18-34 year olds in the US lack insurance
What’s already in placeWhat’s comingHealth care and
undocumented immigrants
Young adult outreach
Overview
Dependent Coverage Free Preventive Care No denial for pre-existing condition for
under 19 Student Health Plans Women’s Health Domestic Violence Support Contraception Community Health Centers
What’s Already in Effect
Under 26 can stay on parent’s plan
Under 19 – no denial for pre-existing conditions
Free Preventive Care – no co-pays on screenings and check-ups
Dependent Coverage and Preventive Care
Previously limited regulations
Now subject to standardized ACA requirements Must include preventive
care benefits 80/20 Ratio
Student Health Plans
Women’s Health Benefits
Well-women visits
Support for breastfeeding
Domestic violence screening and counseling
Mammograms and cancer screenings
Domestic Violence Provisions in the ACA
Aug. 2012: New plans must cover screenings and counseling for domestic violence with no cost-sharing
Jan. 2014: No denial of coverage for victims of domestic or sexual assault
Law provides $1.5 billion over 5 years for home visitation models
Funds for youth and teen programs on violence prevention and healthy relationship training
Contraception
As of Aug 2012, new health insurance plans must cover contraception with no co-pay
Religious institutions exempt
Religiously-affiliated institutions get 1 year delay After Aug. 2013, employees
and students get coverage directly from insurance companies
Currently 8,000 CHCs provide care to 20 million individuals
In June 2012 grants went to 219 CHCs around the country Increased number of patients
served by 1.25 million
Growth of Community Health Centers (CHCs)
California and Medi-Cal
Currently may be eligible:Enrollees of SSI/SSP, CalWorks (AFDC), Refugee Assistance, Foster Care or Adoption Assistance ProgramCertain individuals under 21, 65 or olderBlind or disabled individualsPregnant womenEligible in 2014:
EVERYONE at or below 133% of FPL
Changes for Americans with Disabilities
Expands and supports the Money Follows the Person program through 2016
Helps states create home and community-based services through improved Medicaid
Improves data collection on health disparities and improved training and culture competency for health care providers
In 2014, no annual limits, no denying coverage for pre-existing conditions
Those making 133-400 % of the federal poverty level (FPL) will qualify for subsidies (tax credits) to buy insurance on the exchange
133% of FPL for 1 person is $14,900
400% of FPL for 1 person is $44,000
Subsidies/Tax Credits
How Much of a Subsidy?
FPL IncomePremiu
mTax
CreditActual Cost
133% $1,275 $283 $244 $39
250% $2,397 $283 $90 $193
• Four tiers of plans – Bronze, Silver, Gold, and Platinum
• Subsidies are calculated based on Silver plan• Individuals can use subsidy for any plan
Shop for insurance
Each state is different, some will have federally-facilitated exchanges (FFEs)
Subsidies applied directly
Ex-cha-cha-cha-Changes
Catastrophic plans Young adults (under 30)
and those with financial hardship eligible
No Annual Limits in 2014 (already phasing out)
Tax Credit for employers (already started)
Other important parts of the ACA
Picture Source: http://wymancenter.org/the-importance-of-bulking-up-the-muscle-of-perseverance/
Created in 2010 Five-member board unaffiliated with other interest
groups Minimum requirements for insurance providers to
join the exchange Must offer at least one choice at each of the four
levels Carriers that do not participate in the exchange
may not sell catastrophic-only plans.
California Health Benefit Exchange
Individuals must have qualifying health insurance
If not, penalties $95 the first year Rises in 2016, ex.
$695Exemptions
Individual Mandate and Penalties
Picture Source: http://thepinkleague.com/2012/08/30/so-whats-the-lowdown-the-basics-of-football-part-2/
Jessica, 23 years old
Part-time student, part-time job
$10,000/year before taxes ~ 87% of poverty
Qualifies for Medi-Cal
Jeff, 22 years old
Part-time student, full-time construction worker
Earns $23,000/year Takes home: $1,438/month Total health premium:
$283/month With tax credits he pays:
$121/month
Young adults have high rates of uninsurance Many provisions in the ACA that help young adults
Dependent Coverage Student Health Plans Contraception and Women’s Health
Changes to come Expanded Medicaid Subsidies Exchanges Individual Mandate
Summary: ACA and Young Adults
Medi-Cal for Undocumented Immigrants
Undocumented immigrants who are not eligible for full scope Medi-Cal can qualify for Emergency Medi-Cal as long as they meet requirements
Services include: Breast and cervical cancer treatment Kidney dialysis Family Planning, access, care and treatment Child health and disability prevention Access for infants and mothers
The ACA does not cover undocumented immigrants
Medi-Cal could expand by 30% in the next few years
The state expects to enroll 1.5 million or more adults in Medi-Cal as 2014 reforms occur
There are concerns over cuts in the reimbursement rates for providers
ACA Expansion and Medi-Cal
Traditional Outreach Tabling Group
presentations Hosting events
New Outreach Strategies
Health Care Outreach
Your Healthcare Finder Find doctors in the area For Android and iPhone
Mobile Website Text Message Services QR Codes
Can be scanned and direct users to your website
Mobile Outreach
Find doctors and Community Health Centers in your area Search by location with
GPS or zip code Search by name or
category Shows user ratings of
doctors in the area
Find a Doctor
Explains how to find health insurance for different people (students, chronic conditions, buying your own plan)
Explains the health care law
Defines common health insurance terms
Healthcare FAQ
Facebook Create events Send news updates
Twitter Connect with new
people Coordinate plans Retweet Be fun!
Using Social Media
Picture Source: Wikimedia Commons
It’s expensive ACA offers new options
I’m young and healthy Injuries can happen to anyone Make it personal
Why do I need health insurance? Uninsured drives up health
care costs Individual mandate requires
insurance
Challenges
State exchanges – formal “Navigator” program Funded through State’s
Exchange Aids with outreach and
enrollment States with federal
exchanges – Assisters will provide help on outreach
Navigators & Assisters
California’s Assisters Program
Certified Enrollment Assisters (Navigators)
Compensated by the Exchange
Non-profit organizations, community clinics, County Social Services offices employing Eligibility Workers, and labor unions.
Direct Benefit Assistors
Not be paid by the Exchange
Health insurance agents, hospitals, and providers.
Recommendations:
Present – end of 2012: Educate young adults about ACA Ensure eligible young adults are on
dependent coverage Jan 2013 – Oct 2013:
Educate young adults about the upcoming Exchanges.
Oct 1st, 2013 – March 31st, 2014 Open enrollment for exchanges Ensure young adults are getting
subsidies and Medicaid, if possible
Timeline: What to Look For