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Working with States: How to Implement Health Reform While Partnering with Your State

Working with States: How to Implement Health Reform While Partnering with Your State. The Affordable Care Act Provides New Healthcare Options For Tribal Members:. State-Based Health Insurance Exchanges Federal Employee Health Benefits Plan Consumer Operated and Oriented Plans (CO-OPs)

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Working with States: How to Implement Health Reform While Partnering with Your State

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  1. Working with States: How to Implement Health Reform While Partnering with Your State

  2. The Affordable Care Act ProvidesNew Healthcare Options For Tribal Members: State-Based Health Insurance Exchanges Federal Employee Health Benefits Plan Consumer Operated and Oriented Plans (CO-OPs) Pre-Existing Condition Insurance Program Medicaid Expansion and Eligibility

  3. New Health Insurance Exchanges Starting in 2014, if you own a small business or your employer doesn’t offer insurance, you will be able to buy it directly in an Affordable Insurance Exchange Market. An Exchange is an insurance marketplace for individuals and small businesses to buy coverage. Exchange Marketplaces will offer you a choice of health plans that meet certain benefits and cost standards.  

  4. EVERYState Will Have A Health Exchange • One-Stop Shopping and Accessibility: • Will supply easy to understand, standard information • Provides credits & subsidies to purchase insurance: • Will provide credits and subsides up to 400% of the federal poverty level to help individuals and families purchase insurance. • Out of pocket limits: • Plans in the health insurance Exchanges will have a cap on what insurance companies can require in out-of-pocket expenses, such as co-pays and deductibles.

  5. EVERYState Will Have A Health Exchange [Small business tool screen grab]

  6. State Exchanges MUST Collaborate with Tribes According to section 1311(d)(6) of the Affordable Care Act, Exchanges are required to consult with certain groups of stakeholders as they establish their programs and throughout ongoing operations. Each Exchange that has one or more Federally-recognized tribes must engage in regular and meaningful consultation and collaboration with such tribes and their tribal officials on all Exchange policies that have tribal implications.

  7. Tribal Eligibility-Federal Employee Health Benefits The Federal Employees Health Benefits (FEHB) Program became effective in 1960. It is the largest employer-sponsored group health insurance program in the world. Section 409 of the Affordable Care Act entitles Indian tribes, tribal organizations, and urban Indian organizations to purchase FEHB coverage, rights, and benefits for their common law employees.

  8. Tribal FEHB Eligibility Requirements:

  9. ConsumerOperatedandOrientedPlans(CO-OPs) CO-OPs are a new type of non-profit health insurer, created by the Affordable Care Act . These insurers are run by their customers. CO-OPs are meant to offer consumer-friendly, affordable health insurance options to individuals and small businesses. The federal government is offering loans to non-profit organizations to help establish CO-OPs. CO-OPs are required to meet the same state and federal quality and financial standards as other health insurance plans. The health care law encourages CO-OP plans to offer better coordination of consumers’ medical care.

  10. What CO-Ops Mean for You By January 1, 2014, you may have the opportunity to buy health insurance coverage from a CO-OP for yourself or your family. If you’re a small business owner, you may be able to buy health coverage for your employees from a CO-OP. You and your fellow members elect the board of directors. A majority of these directors must themselves be CO-OP customers. CO-OPs must use profits to lower premiums, improve benefits, or improve the quality of members’ health care. As an individual or small business owner, you may be able to join others in creating a CO-OP and apply for a federal loan to help get it started. 

  11. Pre-Existing Condition Insurance Program • Provides affordable insurance for Americans who have been uninsured for six months due to a medical condition. • The PCIP provides a health coverage option if: • you have been uninsured for at least six months, • you have a pre-existing condition or have been denied health coverage because of your health condition, • and are a U.S. citizen or are residing here legally • www.PCIP.gov

  12. Coverage Expansions: Medicaid Expands Medicaid Program by 2014 • Available to individuals under age 65 with incomes up to 133% of the Federal Poverty Level • $14,000 for an individual • $29,000 for a family of four • States receive 100% federal funding for the first three years to support the expansion • phasing to 90 % federal funding in subsequent years

  13. Regional Director Contact Information Marguerite Salazar, Regional Director, Region VIII U.S. Department of Health and Human Services Marguerite.Salazar@hhs.gov 303-844-3372 Marjorie McColl PettyRegional Director, Region VI U.S. Department of Health and Human Services Marjorie.Petty@hhs.gov (214) 767-3301

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