October 9, 2012 – StateWide’s Annual Conference

1. October 9, 2012 – StateWide’s Annual Conference Health Care Reform: Past, Present, and the Road Ahead Nora Dowd Eisenhower Director, National Center for Benefits Access at NCOA

2. NCOA - National Council on Aging NCOA is a nonprofit service and advocacy organization. Our mission is to improve the lives of millions of older adults, especially those who are vulnerable and disadvantaged.

3. What we’ll cover • Recap the health reform law changes • Review June 2012 Supreme Court decision • Discuss what’s to comewith health care reform: • Medicaid: How/Will my state choose to expand Medicaid? • Health Insurance Exchanges: How could my NY’s work? • Information on how to maximize the change • Resources

4. What’s the impact of health care reform? • Affordable Care Act (ACA) signed into law on March 23, 2010 • Key components of ACA are designed to: • Strengthen consumers’ health care choices and protections • Offer a wide-range of coverage options • Make health care affordable and accessible for all Americans • Many changes, varying effective dates, bigger components in place by 2014

5. Highlights of ACA that impact your Medicare clients • Closes Part D Coverage Gap, started in 2010 with $250 rebate check, followed by increasing discounts to 2020 • Starting with the 2012 plan year, moved and extended annual Part D and Medicare Advantage open enrollment period (Oct 15-Dec 7) • As of 2011, provides new and free preventive benefits under Medicare

6. Highlights of ACA that impact your clients with Medicare and/or Medicaid • Tests new models for better care, better coordinationof services (www.innovations.cms.gov) • Give states more flexibility to offer Home and Community Based Services (HCBS)

7. Highlights of ACA that impact those in need of health insurance • As of July 2010, establishes Pre-Existing Condition Insurance Plan (PCIP), helps people that could not get or afford insurance due to pre-existing conditions • Allows states option to expand Medicaid to those not traditionally covered beginning as soon as 2010 • For 2014, establishes the Health Insurance Exchanges • And more (see healthcare.gov for complete list)…

8. Supreme Court June 2012 ruling – What about it? • After health reform law was passed, 26 states filed a lawsuit against: • Individual Mandate • Medicaid Expansion • June 28, 2012, the Supreme Court: • Upheld that individual mandate is not unconstitutional • However, States cannot be “coerced” (lose current Medicaid funding) into expanding Medicaid

9. Medicaid Expansion - What changes? • Will cover many of those not previously eligible: • Ages 19-65 and • Income under 133% of federal poverty level (FPL) • No resource test • Does not cover undocumented immigrants • By 2019, Medicaid expansion estimated to cover ~16 million people who otherwise would be uninsured

10. Will states choose to expand Medicaid? As of September 12, 2012: • Participating (12 states and DC) • Leaning toward participating (2 states) • Undecided/no comment (25 states) • Leaning toward not participating (5 states) • Will not participate (6 states) Had filed ACA lawsuit

11. What is at stake if states do not expand Medicaid? • State decisions to expand Medicaid will affect approximately: • Millions of uninsured adults with incomes below 133% of FPL, who would be newly eligible under ACA • 11.5 million have income under 100% of FPL would not be eligible for tax credits/cost sharing to get insurance coverage under the ACA if their state does not expand its Medicaid program • Over 10% of the uninsured adults are between the ages of 55 and 64 Source: http://www.urban.org/UploadedPDF/412630-opting-in-medicaid.pdf

12. Medicaid Expansion – What are states considering? • Factors affecting states’ decision: • Pressure from stakeholders within the state • Spending cuts, deficit reduction efforts • Incentive to expand Medicaid (i.e., 100% federal funding from 2014 through 2016) • November 2012 elections • No deadline to decide

13. Now, let’s talk about…

14. What are benefits of the Health Insurance Exchanges? • One-stop shopping – single application for Exchange, Medicaid, and CHIP • Affordable options for people with limited income (tax credits, reduced cost-sharing) • Can’t be denied insurance even with pre-existing conditions (Guaranteed Issue) • Standard offering of health benefits (“Essential Health Benefits”)

15. Exchanges: Individual versus SHOP • Individual Exchanges - qualifications: • U.S. citizen or legal resident, • Not incarcerated, and • Do not have access to affordable employer coverage • SHOP Exchanges • Small Business Health Options Program (SHOP) Exchanges available to businesses with 100 or fewer employees • States can limit enrollment to business with fewer than 50 employees during the first year • SHOP must offer coverage to all full-time employees • In state where business is located • Businesses receive tax credits in 2014 and 2015 as an incentive to offset costs

16. How are Exchanges run? • Exchanges: • Must be a government agency or non-profit • Must serve both individual and businesses • Can form regional Exchanges, or have multiple exchanges operating in one state • States can choose from three models : • State-based exchange • State-federal partnership • Federally-facilitated exchange (FFE)

17. What are the three Exchange models? • State-based exchange • State runs its own exchange • May have an Exchange Board to settle on policy decisions (i.e., model type, benefits package, IT structure, contracts) • State-federal partnership • State works with federal government, likely help with plan management functions such as certifying qualified health plans, oversight, etc. • Federally-facilitated exchange (FFE) • Federal government ensures state has Exchange in place, will still need help from states • Default model if states do not choose a model by Jan 1, 2013

18. Where are states at re: deciding on an Exchange?

19. New York Moves Ahead to Develop a State-Based Exchange • New York has received $87.6 million in grants for research, planning, information technology development, and implementation of Affordable Insurance Exchanges. • $1 million in Planning Grants • Grant provides resources to conduct research and planning to build a better health insurance marketplace and determine how the state’s exchange will be operated and governed. • $27.4 million in Early Innovator Grants • Grant used to design and implement the information technology (IT) infrastructure needed to operate the Exchanges. • $59.2 million in Exchange Establishment Grants • Grant helps to implement key provisions of the Affordable Care Act.

20. Streamlined, Dynamic Application Process • Streamlined application can be used to apply for: • Insurance through the Individual or SHOP Exchanges • Medicaid • SCHIP • Applications can be submitted: • Online via the Exchange Website • Call Center • By Mail • In-Person • Information collected includes: • Baseline information • Income information (for Medicaid or tax credits) • Program Specific Information

21. Who will help consumers of the Exchange? • Exchanges will contract with Navigators • Similar to SHIP/HIICAP model – objective, trustworthy for uptake • States encouraged to contract with at least two agencies/organizations, with one being a community-based partner • Receive grant funding by the Exchange • Exchanges will also have Assisters • For example, brokers and agents can continue to help people with the health insurance marketplace and enroll in health plans

22. Key Enrollment Dates through the Exchanges • Initial Open Enrollment Period: • October 1, 2013-March 31, 2014 • Coverage effective no sooner than January 1, 2014 • Annual Open Enrollment Period (starting in 2015) • October 15 – December 7, coverage effective following January 1 • Also, Special Enrollment Periods (SEP) for exceptional situations *Note: Medicaid & CHIP apps can go through the Exchange or through Medicaid offices, and anytime of the year

23. What might an Exchange website look like? • Example, Colorado’s Exchange website at: www.getcoveredco.org

24. In New York… Since ACA became a law, people with Medicare saved over $322 million on prescription drugs • In 2012… • On average, people who hit the Medicare “donut hole” have saved $663 • More than 1.1 million people with original Medicare received at least one preventive service at no cost to them • More than 120,00 people received the Annual Wellness Visit

25. What does this mean for you? • Still a lot unknown, stay tuned for updates • Consider the benefits already in place, take advantage • Use online resources to stay up-to-date on changes, updates in your state

26. Resources • Medicare Rights Center: http://www.medicarerights.org/issues-actions/health-reform-and-medicare.php. • Where states stand on Medicaid expansion: http://ahlalerts.com/2012/07/03/medicaid-where-each-state-stands-on-the-medicaid-expansion/ • Health Insurance Exchanges: http://www.healthcare.gov/news/factsheets/2011/05/exchanges05232011a.html • State Exchange Profiles (KFF): http://healthreform.kff.org/State-Exchange-Profiles-Page.aspx • Center for Consumer Information and Insurance Oversight (CCIIO): http://cciio.cms.gov/ • National Association of Insurance Commissioners (NAIC): http://naic.org/index_health_reform_section.htm

27. Stay in touch Visit us on the web at: www.CenterforBenefits.org And for your clients: www.MyMedicareMatters.org www.BenefitsCheckUp.org Contact today’s presenters: Nora.Eisenhower@ncoa.org