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Making Health Reform Work for California:

Making Health Reform Work for California:. What to Expect and How to be Prepared A presentation for CHIs, members and partners. Why Do We Need it to Work?. So that California children and families have access to health care and other services necessary for their health and well-being.

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Making Health Reform Work for California:

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  1. Making Health Reform Work for California: What to Expect and How to be Prepared A presentation for CHIs, members and partners

  2. Why Do We Need it to Work? • So that California children and families have access to health care and other services necessary for their health and well-being

  3. Goals of the Presentation • ACA Policy Changes • Role of CHIs and Partners • Preparing for Implementation

  4. The Affordable Care Act

  5. Intent of the ACA • Expand access to health care • End health insurance abuses • Improve health care affordability • Enhance the quality of health care

  6. California’s Coverage Landscape

  7. COUNTY’S Coverage Landscape

  8. Individual Mandate • Takes effect January 2014 • Penalty enforced on income tax filings • Ensures a healthy insurance pool

  9. How the ACA Impacts Our Work • Medi-Cal expansion • Eligibility and enrollment processes and systems • Covered California

  10. The Medi-Cal Expansion • All individuals up to 133% FPL • Children ages 6-18 between 100% and 133% FPL

  11. Eligibility and Enrollment • New MAGI formula • “No wrong door”

  12. Covered California • A new health insurance marketplace • CalHEERS • Qualified Health Plans

  13. New Features of the Exchange • Tax credit and cost-sharing subsidies • Guaranteed issue • Community rating • Purchasing pool

  14. http://www.coveredca.com/media/4648/Covered_California_Getting_Covered_fact_sheet_English.pdfhttp://www.coveredca.com/media/4648/Covered_California_Getting_Covered_fact_sheet_English.pdf

  15. Education and Outreach • Extensive education and outreach campaign • 20,000 to 30,000 assistors and navigators

  16. Role of CCHI Members and Partners

  17. Navigators and In-Person Assistors • Responsibilities include: • Distribute fair and impartial information • Facilitate enrollment • Provide referrals to Consumer Assistance Programs • Provide culturally, linguistically appropriate information • Navigators also conduct public education

  18. Certified Application Counselors • Role defined by CMS • Exchange will certify staff and volunteers

  19. A Cautionary Note • Reimbursement for enrollment in QHP, not Medi-Cal • The California Endowment payment partnerships: • $13M in FY 2013-14 for assistor fees • $6.5M in FY 2014-15 for retention assistor payments

  20. Preparing for Implementation

  21. How to Get Ready for 2014 • Pursue partnerships • Collect data • Organize trainings • Understand eligibility • Track funding

  22. Pursuing Partnerships • Re-educate traditional CHI base • Seek out new partners • Connect with Health and Human Services Agency • Connect with health plans • Advocate for those left out of coverage

  23. Collecting Data • Learn about the newly eligible • Who are they/where are they? • How can you reach them? • Share successes with stakeholders

  24. Categories of Uninsured Workers in California • Adult students (18+) 761,000 • Construction 563,000 • Restaurants/food service 517,000 • Crop production 167,000 • Landscaping services 141,000 • Private households 111,000 Source: American Community Survey, U.S. Census Bureau, 2010

  25. Organizing Trainings • Assess where workforce is, where it needs to be • Personalize this presentation • Prepare staff for new roles • Network with your peers

  26. Understanding Eligibility • Educate staff on new changes • Identify how changes impact procedures • Identify what data matching is planned • Plan new outreach efforts

  27. Tracking Funding • Current sources • Community partners • Foundations • Health plans • New sources • Assister Reimbursement Program • Navigator Grants • Community Outreach Grants

  28. Final Thoughts

  29. It’s Happening Now! • Know how you fit into the solution, explain your role • Prepare CAAs for new roles • Get up to speed on social media • Link back to CCHI • Do your homework!

  30. There Will Be Bumps in the Road • Getting enrollment and retention right • Preparing for the residually uninsured • Building a strong health workforce, ensuring access • Getting enough uptake in Covered California

  31. For More Information: • Contact name, organizationContact information

  32. Additional Resources • CCHI: www.cchi4families.org • Kaiser Family Foundation: www.healthreform.kff.org • Healthcare and You: www.healthcareandyou.org • Federal Health Reform: www.healthcare.gov • California HealthCare Foundation: www.chcf.org • The Exchange: www.healthexchange.ca.gov and www.coveredca.org • The Health Consumer Alliance: www.healthconsumer.org • State Refor(u)m: www.statereforum.org • Enroll America: www.enrollamerica.org

  33. Parting Advice… “It is not the strongest of the species that survives nor the most intelligent, but rather the one most adaptable to change.” Charles Darwin

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