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Health Reform and Health Coverage: Changes Ahead for Kids and Families

Health Reform and Health Coverage: Changes Ahead for Kids and Families. Kim VanPelt St. Luke’s Health Initiatives September 16, 2013. Coverage Expansion . Employer-based coverage. Medicaid. The “Exchange”. Medicaid Expansion . Over 300,000 Arizonans will benefit

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Health Reform and Health Coverage: Changes Ahead for Kids and Families

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  1. Health Reform and Health Coverage: Changes Ahead for Kids and Families Kim VanPelt St. Luke’s Health Initiatives September 16, 2013

  2. Coverage Expansion Employer-based coverage Medicaid The “Exchange”

  3. Medicaid Expansion • Over 300,000 Arizonans will benefit • Provides coverage up to 138% of the federal poverty level (approximately $32,500 for a family of four) • Supported by the Governor, passed by the Legislature • Restores the will of the voters • Approximately 60 percent of voters support restoration or expansion • Eligibility screening begins in October, coverage begins on January 1, 2014

  4. Improvements to Coverage • Prevents discrimination in pricing based on pre-existing conditions • Essential benefits chosen by Arizona allows for coverage of many services • Those who have self-insured or grandfathered plans will not benefit from essential benefits, elimination of cost-sharing

  5. Essential Benefits • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance use disorder services • Prescription drugs; • Rehabilitative and habilitative services and devices • Laboratory services • Preventive and wellness services • Chronic disease management • Pediatric services, including oral and vision care

  6. Essential Benefits • Arizona picked state employee plan, administered by United Health Care, as benchmark • www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/arizona-ehb-benchmark-plan.pdf

  7. The Marketplace • Exchange now called the Marketplace • Arizona deferring to the federal government to run • Online site for individuals and small businesses to compare and purchase health coverage • Intended to simplify and structure health insurance choices for individuals, families and small businesses • Exclusive mechanism for receiving federal subsidies and plans with cost-sharing limits

  8. The Marketplace • Open enrollment begins October 1 • Open enrollment will occur through the end of March • 1.3 million Arizonans predicted to eventually receive coverage through the marketplace

  9. The Marketplace Expected Enrollment by Type • Individual Exchange: 496,000 • AHCCCS (assuming Medicaid expansion): 343,000

  10. Plan Levels of Coverage

  11. Catastrophic Plans • Eligible to adults under 30 years of age • Also available to those who obtain a hardship waiver from the marketplace • Includes plans with high deductibles, lower premiums • Includes coverage or three primary care visits and preventive services

  12. Premium Subsidies • Tax credit is advanceable or refundable • Eligibility is based on • Projected household income and family size • 100 – 400% FPL ($23,550 -$94,200 for a family of four in 2013) • Obtaining qualified coverage through the marketplace • Ineligible for government-sponsored coverage, affordable-sponsored insurance, or certain other minimum essential coverage • Tax credits available to immigrants who are lawfully present

  13. Cost Sharing Reduction • Eligibility for reduced cost sharing is based on • Incomes at or below 250% of FPL ($58,875 annually for a family of four in 2013) • Receiving the new premium tax credit • Enrolling in a marketplace silver-level plan • No cost sharing for members of Tribes

  14. Individual Mandate • Beginning in 2014, most people must have health coverage or pay a fee when you file your tax return • Some people may qualify for an exemption

  15. Cover Arizona • Builds off of the successful outreach efforts for the Pre-Existing Conditions Insurance Pool • More than 300 members • Two goals: • Maximize enrollment of individuals and families in the new insurance marketplace and Medicaid • Identify and assess outreach efforts so that we can build on our successes

  16. Local Action Needed to Ensure Success • Awareness • Outreach • Enrollment Assistance

  17. Enrollment Assistance • Navigators • Certified Application Counselors • Toll Free Hotline • Brokers

  18. Special Issues for Kids and Families • Members of the same family may qualify for different programs • KidsCare II disappears in 2014 • Businesses may begin dropping family coverage

  19. Two Doors • Health E Arizona Plus • Marketplace

  20. Timeline • August – Navigator grants awarded • August – September – Navigators and certified enrollment assisters trained • October – Determination of which plans will participate in the exchange • October - Open enrollment in the exchange begins • October - Media campaign begins, driving people to Healthcare.gov • January 1, 2014 – Coverage purchased through exchanges takes effect

  21. Need more information • www.healthcare.gov • Marketplace Call Center (Consumers) - 24/7 English and Spanish and 150 Languages 1-800-318-2596, 1-855-889-4325 (TTY) • www.marketplace.cms.gov • www.coveraz.org

  22. www.slhi.org

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