The Affordable Care Act: Present and Future Opportunities for Coverage

1. The Affordable Care Act: Present and Future Opportunities for Coverage Kathy Chan, Associate Director and Director of Policy and Advocacy Illinois Maternal and Child Health Coalition Thursday, October 4, 2012 Illinois Maternal & Child Health Coalition

2. About IMCHC www.ilmaternal.org/ Healthcarereform Become a fan on Facebook! Follow us on Twitter at ILMaternal! Illinois Maternal & Child Health Coalition Our Projects and Initiatives: Campaign to Save Our Mothers and Babies Chicago Area Immunization Campaign Illinois Coalition for School Health Centers Illinois Premature Infant Health Network text4baby

3. Presentation Overview • Understand major provisions of the Affordable Care Act • Find out which policies/programs are currently in effect • Learn about changes that will occur in the near future • Be aware of pending policy decisions at the state and federal levels and opportunities for advocacy • Questions and Answers Illinois Maternal & Child Health Coalition

4. Affordable Care Act Overview • Signed into law on March 23, 2010 • Establishes a floor, not a ceiling • States are largely responsible for implementation • Phases-in changes to private health insurance coverage and expands public coverage • Enacts tax credits to help individuals and small businesses access more affordable insurance options • Reforms Medicare, protects Medicaid and CHIP • Authorization of numerous grant programs and pilot projects • Individual and employer responsibility provisions Illinois Maternal & Child Health Coalition

5. Present Opportunities for Coverage • All Kids – comprehensive health insurance coverage for kids <300% FPL • FamilyCare – coverage for parents and relative caregivers <133% FPL • Moms & Babies – coverage for pregnant women and infants up to 1 year of age <200% FPL • Illinois Healthy Women – limited family planning coverage to women <200% FPL • Illinois Breast and Cervical Cancer Program – for uninsured women 35-64 years, no income limit Visit www.health.illinois.gov for more information Illinois Maternal & Child Health Coalition

6. Present Opportunities for Access to Affordable Coverage and Care • Illinois Pre-existing Condition Plan (IPXP) - http://insurance.illinois.gov/ipxp/ • Expansion of young adult coverage to 26 years in private insurance plans • No-cost preventive care in new private health insurance plans • Women-specific preventive services went into effect on August 1, 2012 Illinois Maternal & Child Health Coalition

7. Present Opportunities for Access to Affordable Coverage and Care (cont'd) • August 2012 – No-cost women’s preventive health services for new insurance plans • Well-women visits • Gestational diabetes screenings • HPV DNA testing (separate from pap smear results) • STI counseling, HIV screening and counseling • Contraceptives (i.e. birth control) • Breastfeeding support services and supplies • Domestic violence screenings Illinois Maternal & Child Health Coalition

8. Present Opportunities for Access to Affordable Coverage and Care (cont'd) • Elimination of lifetime limits and phasing out of annual limits • Elimination of pre-existing conditions for children • Tax credits to help qualifying small businesses and nonprofits pay for private health insurance for their employees • New protections for breastfeeding women • Direct access to OB/GYNs • Grants for programs and demonstration projects, e.g. Community Transformation Grants Visit www.healthcare.gov for more information Illinois Maternal & Child Health Coalition

9. Health Insurance Landscape in 2014 • New options for coverage • Competitive health insurance marketplace, i.e. the Exchange • Tax credits – for those with incomes up to 400% FPL (~$92,000/year for a family of four) • New Medicaid limits to cover newly eligible - 138% FPL (~$20,000/year for family of two) • 1.6M Illinois residents will have access to affordable coverage • Over 1M will be eligible to use the Exchange • 600,000+ newly eligible for Medicaid Illinois Maternal & Child Health Coalition

10. Health Insurance Landscape in 2014 (cont'd) • Guaranteed issue – no more pre-existing condition exclusion or gender rating; limited age rating • Benchmark essential health benefits package Illinois Maternal & Child Health Coalition

11. What must be included in the Essential Health Benefits? Illinois Maternal & Child Health Coalition Ambulatory Patient Services Emergency Services Hospitalization Maternity and Newborn Care Mental Health and Substance Abuse Services (including Behavioral Health Treatment) Prescription Drug Coverage Rehabilitative and Habilitative Services and Devices Laboratory Services Preventive and Wellness Services Chronic Disease Management Pediatric Services, Including Oral and Vision Care

12. Pending Illinois Policy Decisions • Illinois’ Essential Health Benefits selection • Establishment of a Competitive Health Insurance Marketplace in Illinois (aka “the Exchange”) • Single-entry point, simplified screening/application process • Developing a Navigator Program • Ensure Illinois covers all of the newly eligible in Medicaid • Implementation of Medicaid reform legislation • State budget challenges - ongoing need to preserve Medicaid and related programs Illinois Maternal & Child Health Coalition

13. Pending Federal Policy Decisions • Pending rules and regulations • November election Illinois Maternal & Child Health Coalition

14. What You Can Do! • Spread the word! • Subscribe to IMCHC’s newsletter and action alert, Facebook, Twitter (@ILMaternal) • Download and share our factsheets and toolkit • Subscribe to our podcast • Invite us to present and suggest future topics • Bookmark www.illinoishealthmatters.org Illinois Maternal & Child Health Coalition

15. Questions? Kathy Chan kchan@ilmaternal.org 312-491-8161x24 www.ilmaternal.org Illinois Maternal & Child Health Coalition

16. Resources Illinois Maternal & Child Health Coalition