Affordable Care Act

1. Affordable Care Act Health Care Reform Update September 14, 2013 Supervisor Dave Roberts San Diego County Board of Supervisors Third District

2. What is the Affordable Care Act (ACA)? Insurance Reform Health System Reform • What is expected to happen? • More people covered • More benefits & protections • Lower costs (consumers, govt.) • How will this be accomplished? • Medicaid expansion • Insurance exchanges & exchange subsidies • Kids under 26 covered • Preventive services coverage • Minimum coverage provision • What is expected to happen? • Improved quality and efficiency • Stronger workforce & infrastructure • Greater focus on public health & prevention • How will this be accomplished? • Prevention & Public Health Fund, including Community Transformation Grants • Accountable Care Organizations • Dual eligible's care coordination • Public health workforce development • Community health needs assessments

3. The Affordable Care Act in California • Medi-Cal being expanded to new populations • 1 in 6 San Diegans will now be on Medi-Cal (up from 1 in 8) • California’s new health insurance exchange • 1 in 9 San Diegans are projected to purchase products via exchange

4. Medicaid Eligibility Expanded to Fill Coverage Gaps for Adults Medicaid Eligibility Expanded to Fill Coverage Gaps for Adults Medicaid Eligibility Expanded to Fill Coverage Gaps for Adults Eligibility Today Limited to Specific Groups • Medi-Cal that we have today covers: • Aged (65 + years), Blind or Disabled • Long-Term Care Individuals • Medicare eligible (Part A/B) • Individuals eligible for SSI or Foster Care Eligibility in 2014 Pregnant Women Children Adults Elderly & Disabled • Medi-Cal Expansion will cover: • Children (0-18 years) • Parents or Caregiver Relatives • Pregnant Women • Adults (19-64 years) Parents *138% FPL =$15,856 for an individual and $26,951 for a family of three in 2013

5. Covered California: CA’s Health Benefits Exchange Private Insurance (400% +) Advanced Premium Tax Credit (200%-400%) FPL Traditional Medical Medi-cal Expansion (0-138%) FPL

6. Who and When? Who can use Covered California to purchase insurance starting October 1, 2013? • Legal residents • Small employers with 50 or fewer full-time equivalent When can you purchase coverage through Covered California? • Enrollment begins October 1, 2013 • First open enrollment period extends to March 31, 2014 • Second open enrollment period begins in October 2014 for coverage in 2015.

7. Covered California 10 Essential Benefits 1. Ambulatory Patient Services 6. Rehabilitative Services 2. Prescription Drugs 7. Preventive and Wellness Services 8. Laboratory Services 3. Emergency Care 4. Mental Health Services 9. Pediatric Care 10. Maternity and Newborn Care 5. Hospitalization

8. Getting Yourself and Your Family Covered Affordable Health Coverage: Tax credits • Medi-Cal assistance

9. Health Insurance Offered • Covered California Health Plans Offered in San Diego: • Anthem Blue Cross Blue Shield of California • Health Net Kaiser Permanente • Molina Healthcare Sharp Health Plan There will be four basic levels of coverage: platinum, gold, silver and bronze. Lower Monthly Premium Payment

10. Frequently Asked Questions Do I have to buy health insurance? • Starting in January 2014, most people will be required to have health insurance or pay a penalty if they don't • In 2014, the penalty will be 1% of annual income or $95; whichever is greater • By 2016, the penalty will be 2.5% of your annual income or $695 Some people do not have to pay a penalty, including: • People who would have to pay more than 8 percent of their income for health insurance • People with incomes below the threshold required for filing taxes • People who qualify for religious exemptions • Undocumented immigrants • People who are incarcerated • Members of Native American tribes

12. Covered California Impacts on San Diego County San Diego County is expected to: • Automatically transition all Low Income Health Program clients into expanded Medi-cal on January 1, 2014 • Conduct eligibility for expanded Medi-cal and mixed household Covered California health plans • Serve Family Resource Center walk-in customers and direct calls to HHSA ACCESS and MyBenefits for expanded Medi-cal and Covered California health coverage plans

13. Questions? Supervisor Dave Roberts Dave.Roberts@sdcounty.ca.gov 619-531-5533 Lindsey Masukawa Lindsey.Masukawa@sdcounty.ca.gov 619-531-5855 Covered California: http://www.coveredca.com/