Preparing For The Affordable Care Act

1. Preparing For The Affordable Care Act

3. How Will ACA Impact Refugees? • AHCCCS Expansion • Changes to Health Insurance • Focusing on Preventive Care • Improving Quality of Care • Promoting Community Health

4. ACA Timeline

5. Preparing for the Affordable Care Act AHCCCS Expansion

6. AHCCCS Expansion • All U.S. citizens and legal residents (e.g. Refugees) with income below 138% FPL will be eligible for Medicaid • Includes adults without dependent children • Enrollment period begins October 1st, 2013. • New enrollees that were previously ineligible will receive AHCCCS benefits starting January 1st, 2014.

7. Changes to AHCCCS Plans • Improvements to Medicaid • Better plans (Essential Health Benefits covered) • Streamlined enrollment & renewal processes • Online enrollment is faster • Renewal is automated by pulling data from IRS • Consolidated enrollment with other services • Enrollment combined with Heath Insurance Marketplace • Same goes for KidsCare

8. Many Programs are Accessed Through Health-e-Arizona Plus Start Here Health-e-Arizona Plus FFM Referral to FFM Link to FFM Apply for SNAP = Supplemental Nutrition Assistance Program (Nutrition Assistance) TANF = Temporary Assistance for Needy Families (Cash Assistance) Clinic SFS = Clinic-based Sliding Fee Scale programs County CAP = County-based Community Assistance Programs (CAP)(Pima and Santa Cruz Counties) PTC = Premium Tax Credit Program CSR= Cost Sharing Reduction Program SHOP = Small Business Health Opportunities Program 8

9. Applications Started at the FFM Start Here Health-e-Arizona Plus FFM No Access Assessment Apply for SNAP = Supplemental Nutrition Assistance Program (Nutrition Assistance) TANF = Temporary Assistance for Needy Families (Cash Assistance) Clinic SFS = Clinic-based Sliding Fee Scale programs County CAP = County-based Community Assistance Programs (CAP)(Pima and Santa Cruz Counties) PTC = Premium Tax Credit Program CSR= Cost Sharing Reduction Program SHOP = Small Business Health Opportunities Program 9

10. Preparing for the Affordable Care Act Health Insurance Marketplace

11. 3 Things to Know about the Marketplace 1. It’s an easier way to shop for health insurance • Simplifies the search for health insurance • All options in one place • All online • One application, one time, and an individual or family can explore every qualified insurance plan in your area 2. Most people will be able to get a break on cost • Tax Cuts and Cost Sharing programs are available based on income 3. Clear options with apples-to-apples comparisons • All health insurance plans in the Marketplace present their price and benefit information in plain language

12. The Health Insurance Marketplace • 1 million uninsured Arizonan’s will now have access to health insurance • Working families can now afford to have insurance by applying through the Marketplace • Young adults under 26 can stay on their parent’s plan • No more barriers to coverage based on preexisting conditions • Enrollment starts October 1, 2013 • Coverage begins January 2014

13. All Health Plans Will Cover These Essential Health Benefits • Ambulatory patient services • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance use disorder services, including behavioral health treatment • Prescription drugs • Rehabilitative and habilitative services and devices • Laboratory services • Preventive and wellness services and chronic disease management • Pediatric services, including oral and vision care

14. Eligibility and Enrollment • Marketplace initial open enrollment period starts October 1, 2013 and ends March 31, 2014 • Open enrollment period 2014 onward: October 15 to December 7 • Same as Medicare Advantage enrollment period • Must enroll during the open enrollment period • Unless: • You have recently become a lawfully present alien • You have a pay cut that makes you eligible for new tax credits • You have a pay raise that forces you out of AHCCCS into the Marketplace • All refugees are eligible from day one

15. Health Insurance Affordability Income <138% FPL Medicaid Income <250% FPL Tax credits to help with insurance premiums and subsidies to offset cost sharing Qualified Health Plans purchased through the Marketplace Tax credits to help with insurance premiums Income <400% FPL No financial assistance Income >400% FPL

16. Marketplace “Metal Tiers” • All Qualified Health Plans (QHPs) in the Marketplace will be reviewed and certified by the Marketplace • QHPs will be standardized into 4 tiers, based on the their coverage

17. Making Health Insurance Affordable • The Marketplace Premium Tax Credit is meant to keep your premium payments to an affordable level. • This chart shows how the Tax Credits will be calculated: • The difference between cost of premium and allowable cost percentage of income will be covered by Tax Credits

18. How Much Will It Cost Me? • All individuals with income between 100-400% FPL will receive the Premium Tax Credits. • Can accept tax credit as a tax refund, or apply to monthly premiums (called: Advanced Premium Tax Credit) • < 250% FPL will also allow you access to special Silver Plans • Subsidized monthly premiums • Reduced cost sharing (co-pays) • http://kff.org/interactive/subsidy-calculator/

19. Individual Mandate • Health Insurance is now MANDATORY! • Beginning in 2014, all U.S. citizens and legal residents are required to have health insurance • Whether Medicaid, Medicare, Tricare, Employer Insurance or Private Insurance (Marketplace) • Those without health coverage must pay a yearly tax!

20. Individual Mandate YES or NO People will need to demonstrate that they have minimum essential coverage or meet an exception.

21. Enrollment Assisters • Navigators • Must be able to assist anyone to enroll in health insurance – “no wrong door” • Must provide public education and outreach • Must provide language support • Call in advance to arrange interpretation • Arizona’s Navigator Organizations • Arizona Association of Community Health Centers • Including all Federally Qualified Health Centers (FQHCs) • University of Arizona, Center for Rural Health • Greater Phoenix Urban League • Campesinos Sin Fronteras

22. Enrollment Assisters • Certified Application Counselors (CACs) • Staff at community health centers, hospitals, or consumer-based nonprofits • Certified through Marketplace.cms.gov • No funding will be received from the marketplace • Call Center • Toll-free call center - 24/7 Federal Call Center is up and running and the number is: 1-800-318-2596.   • 150 languages available

23. Preparing for the Affordable Care Act Improving Preventive Care 23

24. Focus On Prevention • Recognition that preventing diseases from developing in the first place is the best way to keep people healthy • 7 out of 10 deaths in the US are caused by preventable diseases • Included in the EHBs of every insurance plan are FREE (no co-pay) disease prevention services • Encouraging yearly visits to your PCP • Encouraging early and regular screening for common diseases • Providing consultation for common preventable conditions • Full List: healthcare.gov/what-are-my-preventive-care-benefits/

25. Free Services For All Plans • Annual checkup • Help quitting Alcohol & Smoking • STD screening & counseling • Blood pressure, cholesterol & diabetes screening • Depression screening • Diet counseling • Vaccinations • Colonoscopy • Aspirin for heart disease

26. Women’s Preventive Services • Well-woman visits • Support for breastfeeding • Domestic violence screening and counseling • Mammograms and cancer screenings • UTI Screening • Folic Acid supplements

27. Children’s Preventive Services • Screening infants for common disorders • Behavioral Health assessments • Developmental disorders screening • Oral Health assessments and fluoride treatment • Hearing & Vision screenings • Immunizations • Lead screening

28. Preparing for the Affordable Care Act Improving Quality Of Care 28

29. New Models of Healthcare • Focusing care around the PCP and integrating services into “Patient Centered Medical Homes” – a one stop-shop for all of your health needs • Integrating primary care with behavioral health care • A focus on improving health literacy while providing health care • Measuring care quality by successful outcomes and providing financial incentives to doctors for keeping patients healthy, based on standardized criteria

30. Electronic Health Records • EHR are envisioned as key to coordinating care and cost reduction • ACA imposes penalties on medical providers for not showing “meaningful use” toward the implementation of electronic health records beginning in 2015 • Standardized EHR record file types and transfer protocols so that all the different systems can talk to each other

31. Culturally and Linguistically Appropriate Services (CLAS) • Enhanced CLAS guidelines from HHS for healthcare providers @thinkculturalhealth.hhs.gov • Navigators, patient grievance and appeals processes and summary of insurance plan must be provided in requested languages • Funding made available for Area Health Education Centers that target underserved populations • Mandatory monitoring of workplace diversity by healthcare providers

32. Preparing for the Affordable Care Act Building Healthy Communities 32

33. Meeting Community Needs • ACA Provides Guidance and Mandates Funding for Community Health Programs • Community Health Teams to facilitate prevention initiatives, patient education and connection to care • Inter-organizational Collaboration to improve care coordination and resource sharing • Encouraging Community Health Needs Assessments which lead to Community Health Improvement Plans and the focusing of local services to address local needs • Strengthening the role of Peer Support (Community Health Workers) in our health system • Healthy Community Design such as safety and green spaces to address local social determinants of health

34. Preparing for the Affordable Care Act Tips For Refugee Care Coordinators 34

35. Refugee Medical Assistance (RMAP) Starting January 1st, 2014 RMAP will no longer cover any health services except the post-arrival Preventive Health Screening • No more 8 months of RMAP coverage • No more Vision and Dental services through RMAP • If you have questions about this call RMAP: 602-542-6644 *RMAP will remain unchanged for Unaccompanied Refugee Minors (URM)

36. AHCCCS • All new arrivals will need to be enrolled in AHCCCS immediately upon arrival to begin coverage as soon as possible for all arrivals • Once an AHCCCS application is approved, it will provide retroactive coverage back to the 1st of the month, in the month that the application was submitted • Example: If Ahmed arrives on May 15 and has to visit his doctor on the May 21, as long as his AHCCCS application submitted before the end of May, his doctors visit will be covered by AHCCCS once his application is approved. • Example: If Tenzin arrives on May 31 and immediately is hospitalized, and her AHCCCS application is submitted on June 1, when her AHCCCS application is approved the expenses from June 1 onward will be covered, but not the expenses from May 31.

37. AHCCCS Changes • Pros • Childless adults will now be able to enroll in AHCCCS • AHCCCS will now cover incomes up to 138% the FPL • Adult immunizations will now be covered by AHCCCS • AHCCCS will now provide annual checkups and certain preventive health services with no co-pay • Annual renewal for AHCCCS will now be automatic (Medicaid  IRS) • Health-e-Arizona Plus will streamline enrollment in multiple services and connect you to the Marketplace if necessary • Cons • Neither AHCCCS nor RMAP will be covering Vision or Dental services for adults • AHCCCS and KidsCare will still cover Vision and Dental services for children • Refugee advocates will need to build partnerships with charity vision and dental service providers in their area

38. Improve Your Knowledge • Make sure your organization applies to become a Certified Application Counselor organization • This allows all members of your organization to take an online training course and certification quiz for enrolling clients in the Marketplace • marketplace.cms.gov/help-us/cac.html • Partner with your local Navigator organizations for enrollment support and trainings • Contact the National Hotline for Marketplace questions: • 1-800-318-2596.   • 150 languages available • Contact the Client Advocate for AHCCCS questions: • 1-602-417-4230

39. Improve Your Knowledge • www.healthcare.gov • www.cms.gov • www.kff.org • www.coveraz.org • www.enrollamerica.org • www.refugeehealthta.org • Contact your State Refugee Health Coordinator with questions or for training requests • 1-602-364-3592

40. Spread The Word • Make sure your organization’s case managers and care coordinators understand the changes that are coming • Provide outreach and enrollment for newly arrived refugees as well as those who have been in Arizona for more than a couple years • Collaborate with partner organizations such as Ethnic Community Based Organizations (ECBOs) and Faith Based Organizations (FBOs) • Contact the Refugee Health Coordinator for a list • Encourage partner organizations to become Certified Application Counselors and to connect with Navigator organizations

41. Spread The Word • Translate and disseminate informative pamphlets • Incorporate relevant ACA info into cultural orientations • Seek new funding opportunities and share with partners • Provide direct enrollment assistance

42. Remember: ACA Timeline

43. Thank You!Questions?