1 / 30

Affordable Care Act Overview

Affordable Care Act Overview. Session 1 Presented by Tokie Moriel & John Tvedt. What is ACA?. The Affordable Care Act (ACA) Comprehensive reforms that: Improve access to affordable health Protect consumers. ACA Key Facts. Stronger Consumer Rights and Protections

jin
Télécharger la présentation

Affordable Care Act Overview

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Affordable Care ActOverview Session 1 Presented by Tokie Moriel & John Tvedt DHS/DFO/IMTA/2013-07-15

  2. What is ACA? • The Affordable Care Act (ACA) • Comprehensive reforms that: • Improve access to affordable health • Protect consumers DHS/DFO/IMTA/2013-07-15

  3. ACA Key Facts • Stronger Consumer Rights and Protections • More Affordable Coverage • Better Access To Care • Stronger Medicare DHS/DFO/IMTA/2013-07-15

  4. Consumer Rights & Protections • End to Pre-Existing Condition Discrimination • End to Limits on Care • End to Coverage Cancellations DHS/DFO/IMTA/2013-07-15

  5. More Affordable Coverage • Value for Your Premium Dollar • Stopping Unreasonable Rate Increases • Small Business Tax Credits DHS/DFO/IMTA/2013-07-15

  6. Better Access to Care • Free Prevention Benefits • Coverage for Young Adults • Coverage for Americans with Pre-Existing Conditions • Affordable Insurance DHS/DFO/IMTA/2013-07-15

  7. Strengthening Medicare • Lower Cost Prescription Drugs • Free Preventive Services • Fighting Fraud • Providing Choices while Lowering Costs DHS/DFO/IMTA/2013-07-15

  8. Federal Rules • The Department of Health and Human Services (HHS) and the Internal Revenue Service (IRS) issued federal rules that included changes and alignment to eligibility: • Requirements • Methods and processes DHS/DFO/IMTA/2013-07-15

  9. Eligibility Requirement Changes • Modified Adjusted Gross Income (MAGI) based income standards • Medicaid uses current monthly income • Cost Sharing Reductions (CSR) and Advanced Premium Tax Credits (APTC) use projected annual income • Redefines household composition DHS/DFO/IMTA/2013-07-15

  10. Eligibility Requirement Changes • Income Changes. • Non-recurring Lump sums • Scholarships and grants • Income of American Indians and Alaska Natives • Child Support • Worker Compensation • Veteran’s Benefits • Depreciation of business expenses DHS/DFO/IMTA/2013-07-15

  11. Eligibility Requirement Changes • Federal Poverty Level (FPL) • Determining proper coverage DHS/DFO/IMTA/2013-07-15

  12. Seamless, Streamlined System of Eligibility and Enrollment DHS/DFO/IMTA/2013-07-15

  13. A Seamless System of Coverage Qualified Health Plans without Financial Assistance Qualified Health Plan w/ Premium Tax Credits 250%-400% FPL Medicaid/CHIP Children Qualified Health Plan w/ Premium Tax Credits and Cost-sharing reductions between 100% - 250% FPL Iowa Health and Wellness Plan 101% - 133% FPL DHS/DFO/IMTA/2013-07-15

  14. FFM Plan Levels of Coverage DHS/DFO/IMTA/2013-07-15

  15. A Seamless Path to Affordable Coverage • The Affordable Care Act: • Expands access to affordable coverage • Simplifies Medicaid & CHIP • Ensures a seamless system of coverage DHS/DFO/IMTA/2013-07-15

  16. Expanding Access to Coverage • Enrollment in the new income-based category without having to first screen for other eligibility groups • Enables people with disabilities and those needing long-term care services & supports to enroll in the group that best meets their needs DHS/DFO/IMTA/2013-07-15

  17. Expanding Access to Coverage • Creates new coverage group for former foster care children • Expansion of Presumptive Medicaid increases the number of providers allowed to make presumptive determinations for more populations. DHS/DFO/IMTA/2013-07-15

  18. Simplifying Medicaid & CHIP • Switch to MAGI methodology • Modernize verification process • Federal data matches • Renewals at least every 12 months DHS/DFO/IMTA/2013-07-15

  19. Coordination: A Seamless System of Coverage • Single, streamlined application for all insurance affordability programs • Website that provides program information and facilitates enrollment in all insurance affordability programs • Coordinated verification policies across Medicaid, CHIP and the FFM • Standards and guidelines for eligibility determinations and information transfers DHS/DFO/IMTA/2013-07-15

  20. Coordination: Key Provisions of ACA • The Medicaid/CHIP agency: • Determines eligibility for individuals transferred from another insurance affordability program • Evaluates an individual for potential eligibility for other insurance affordability programs • Certifies for the FFM/other programs the criteria applied in determining Medicaid eligibility DHS/DFO/IMTA/2013-07-15

  21. Coordination: Key Provisions of ACA • Medicaid/CHIP agencies have established agreements with the FFM that clearly delineate the responsibility of each program to: • Minimize burden on individuals • Ensure compliance with the other eligibility coordination requirements of the provision (i.e., MAGI screen) • Ensure prompt determinations of eligibility and enrollment consistent with timeliness standards DHS/DFO/IMTA/2013-07-15

  22. State Responsibilities: Potential Eligibility for Other Programs • For individuals determined as not eligible for Medicaid/CHIP, the agency: • Evaluates the individual for potential eligibility for other insurance affordability programs • Transfers the individual’s electronic account to the FFM for CSR/APTC determinations for insurance plan enrollment DHS/DFO/IMTA/2013-07-15

  23. Coordinated Eligibility Determinations with FFM • The Federally Facilitated Marketplace makes initial assessment of Medicaid/CHIP eligibility; State make the final eligibility determination • Assessments made using the applicable Medicaid/CHIP income standards, citizenship and immigration status, using verification rules and procedures consistent with Medicaid and CHIP regulations • The FFM and Iowa have entered into an agreement outlining each entities responsibilities ensuring a seamless and coordinated process DHS/DFO/IMTA/2013-07-15

  24. Coordinated Eligibility Determinations with FFM • When the FFM makes an initial assessment, Iowa: • Accepts the electronic account • Does not request duplicative information/documentation • Promptly determines Medicaid/CHIP eligibility without requiring a new application • Accepts any findings made by another program, no further verification • Notifies the other program of the receipt of the electronic account and Medicaid’s final eligibility determination if the individual is receiving coverage through another program DHS/DFO/IMTA/2013-07-15

  25. Non-MAGI Populations Applying through FFM • The FFM will transfer applications to Iowa for a determination of Medicaid on a basis other than MAGI • Iowa will: • Notify the FFM of the final determination of eligibility for those individuals who are participating in an insurance affordability program DHS/DFO/IMTA/2013-07-15

  26. Non-MAGI Populations Applying through Iowa • Evaluating eligibility for other insurance affordability programs for individuals undergoing a Medicaid determination on a basis other than MAGI • Iowa: • Determines potential eligibility other insurance affordability programs • Transfers the individual’s account to the FFM • Provides timely notice to the FFM DHS/DFO/IMTA/2013-07-15

  27. Continuation of Coverage • Coverage renewal • FFM • State DHS/DFO/IMTA/2013-07-15

  28. A New Approach • Shifts verification responsibilities • Less reliance on paper • “Which coverage is right for you?” DHS/DFO/IMTA/2013-07-15

  29. Time Frames • October 1, 2013 • Open enrollment for insurance affordability programs • Must accept single streamlined applications and apply new rules • Must be able to transmit information to Marketplace • Evaluate under current rules for eligibility prior to 1/1/14 • January 1, 2014 • Coverage under insurance affordability programs can begin DHS/DFO/IMTA/2013-07-15

  30. Conclusion • Additional ACA webinars • Session review – Income Maintenance Workers ONLY DHS/DFO/IMTA/2013-07-15

More Related