Affordable Care Act Community Forum September 2013

1. Affordable Care Act Community Forum September 2013

2. Welcome David EvansChief Executive Officer

3. Affordable Care Act (ACA) Marketplace 101

4. Agenda • Introduction to the ACA and the Health Insurance Marketplace • Eligibility • Application Process • Coverage • Affordability • Responsibility for Coverage • Key Points to Remember • Local Resources www.CentralHealth.net

5. What is the ACA? • The Patient Protection and Affordable Care Act, • More commonly known as: • The Affordable Care Act (ACA) is the national health reform law passed by Congress and signed by the President in March 2010. www.CentralHealth.net

6. What is the goal of the ACA? • Increase the rate of healthcare coverage for Americans while addressing overall healthcare costs. • Establishing consumer rights and protections • Increasing insurance options • Providing assistance for healthcare costs www.CentralHealth.net

7. What is the Health InsuranceMarketplace? • Also known as the “Exchange”, the Health Insurance Marketplace is a new way to purchase health insurance. • The “Marketplace” will provide a way for consumers to: • Look for and compare health plan options • Complete one application for multiple plans • Determine eligibility for tax credits & cost sharing subsidies • Enroll in health insurance plan www.CentralHealth.net

8. Who Manages the Marketplace? • Each State can choose to: • Create and manage their own marketplace • Partner with the federal government to manage their marketplace jointly • Have the federal government manage the marketplace for their State www.CentralHealth.net

9. Who is Eligible to Participate? • Individuals and Small Businesses with up to 100 employees can purchase health insurance through the Marketplace. • Eligibility requirements: • Must live in the U.S.; within service area • Must be a U.S. citizen or national, or • Be lawfully present in U.S. • Cannot be currently incarcerated www.CentralHealth.net

10. Application Process • One streamlined process to determine potential eligibility for: • Medicaid • Children's Health Insurance Program (CHIP) • Private health insurance offered by Qualified Health Plans (possible tax credits and cost sharing subsidies) Can apply: • On-line • Phone • Mail • In person -receive personal assistance www.CentralHealth.net

11. Qualified Health Plans • Private insurance companies certified by the Marketplace in each respective State, who: • Have adequate provider networks • Provide Essential Health Benefits • Offer at least one plan at the “Silver” level and one plan at the “Gold” level • Agree to charge the same premium rates whether offered through the Marketplace or outside of the Marketplace www.CentralHealth.net

12. Coverage: Essential Health Benefits • Qualified Health Plans participating in the Marketplace will be required to offer benefits that meet a minimum set of standards called Essential Health Benefits. • Ambulatory services • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance use disorder services, including behavioral health treatment • Prescription drugs • Rehabilitative and habilitative services and devices • Laboratory services • Preventive and wellness services and chronic disease management • Pediatric services, including oral and vision care www.CentralHealth.net

13. Coverage: Plan Levels • *Based on average cost of an individual under the plan – may not be the same for every enrolled person. www.CentralHealth.net

14. Coverage: Catastrophic Plans • Who is Eligible? • Young adults under age 30 • Those who cannot afford coverage and obtain a hardship waiver from the Marketplace • What is Catastrophic Coverage? • Plans with high deductibles and low premiums • Includes coverage of 3 primary care visits and preventive services at no cost • Protects consumers from high out-of-pocket costs www.CentralHealth.net

15. Coverage: Enrollment • Initial Enrollment Period (1st year only): October 1, 2013 – March 31, 2014 • Beginning October 2014 - Annual Enrollment Period October 15th – December 7th www.CentralHealth.net

16. Coverage: Qualifying Events • Certain qualifying events will allow individuals to enroll during the year www.CentralHealth.net

17. Affordability: Advanced Premium Tax Credits • Advanced Premium Tax Credit is a new kind of tax credit that can be used to lower monthly health plan premiums • Through the Marketplace individuals can apply for advance payment of this tax credit • Advance payments will be sent directly to the insurance company and applied towards monthly premiums www.CentralHealth.net

18. Affordability: Advanced Premium Tax Credits • Monthly amounts owed by individuals can be reduced • Example: • Monthly premium: $300 • Advance payment: $240 a month • Monthly amount owed by individual: $60 www.CentralHealth.net

19. Affordability: Advanced Premium Tax Credits • The Marketplace will estimate the amount of advance payments based on projected income • Report income changes immediately to avoid overpayments • Advance payments will be reconciled at tax time against the actual Premium Tax Credit amount individuals are eligible for based upon actual income www.CentralHealth.net

20. Affordability: Advanced Premium Tax Credits • Option to pay total monthly premiums and claim tax credit on income tax return • Example: • Monthly premium: $300 • Projected advance payment: $240 month • Individual can choose to pay: $300 monthly and receive $2,880 refund ($240 x 12); instead of advance payments www.CentralHealth.net

21. Affordability: Advanced Premium Tax Credits • Who is Eligible? • Individuals/Families with household incomes between 100-400% of Federal Poverty Level (FPL) who do not have access to public health benefits or affordable employer coverage.  • Affordable employer coverage exists as long as the lowest cost "individual" plan offered by an employer does not exceed 9.5 % of the employee's household income www.CentralHealth.net

22. Affordability: Cost-Sharing Subsidies • Cost Sharing Subsidies • A provision of the ACA requires that individuals with lower income levels have their cost sharing amounts reduced • Health plans will be responsible to pay a greater share of the covered benefits for qualifying individuals • Who is Eligible? • Individuals/Families with household incomes between 100 - 250% of FPL • Who enroll in a Silver-Level plan www.CentralHealth.net

23. Affordability: Cost-Sharing Subsidies • Qualifying subsidies will be automatically reflected in individual cost sharing amounts • Example: • (Silver Plan) • Co-pays for households at 250% FPL may be $10 for Dr. Visit, $7 for prescriptions • Co-pays for households at 100% FPL may be $5 for Dr. Visit, $3 for prescriptions www.CentralHealth.net

24. Responsibility for Coverage • A provision of the ACA requires that all individuals have health insurance beginning in 2014.  • Exceptions may be given for: • Financial hardships • Religious objections • Qualifying Indian tribes • Those for whom the lowest cost health plan exceeds 8% of their household income • Those whose income is below the tax filing threshold • Those who do not qualify for an exception and do not have qualifying coverage will be required to pay an annual financial penalty.  www.CentralHealth.net

25. Responsibility for Coverage: Penalties • Penalty amounts will be phased in and will gradually increase from 2014 to 2016 www.CentralHealth.net

26. Key Points to Remember • There will be multiple options for health care coverage – • Public Programs – Medicare, Medicaid, CHIP • Health insurance plans offered thru Employers • Health insurance plans offered outside of the Marketplace • Health insurance plans offered by Qualified Health Plans through the Marketplace • Tax Credits and Cost-Sharing Subsidies available through the Marketplace www.CentralHealth.net

27. 2013 Federal Poverty Guidelines • For family units of more than 8 members, add $4,020 for each additional member • Sources: medicaid.gov and FamiliesUSA www.CentralHealth.net

28. Application Assistance Available to General Public Travis County • CommUnityCare – 512.978.9015 ▪ LoneStar Circle of Care – 1.877.800.5722 ▪ Foundation Communities – 2-1-1 www.CentralHealth.net

29. Application Assistance to Existing Client Base • Central Health Eligibility Services • Seton Community Clinics • Austin Travis County Integral Care (ATCIC) • People’s Community Clinic www.CentralHealth.net

30. Education and Referrals for Existing Client Base • Child Inc./HeadStart Program • Easter Seals • Project Access • WIC Program • SIMS & HAAM Foundations www.CentralHealth.net

31. Additional Services • Central Health has committed to fund additional outreach & education efforts • These efforts will: • Compliment services provided by Enroll America • Coordinated culturally competent, community based approach • Data driven activities, directed at targeted populations and underserved areas of county • Allow for assistance in non-traditional settings such as schools, community events or even personal residents www.CentralHealth.net

32. Additional Services • Central resource for local information & referrals • United Way for Greater Austin • Manages the local 2-1-1 Center • 10 County Central Texas region • Central Health Healthcare Navigation Center www.CentralHealth.net

33. United Way 2-1-1 Center • Available to provide: • General information and referrals to Health Insurance Marketplace Call Center • Information and warm transfers to: • Each of the local Marketplace resources • Central Health Healthcare Navigation Center • Prescreen individuals for potentially eligibility of: • Medical Access Program (MAP) • Medicaid • CHIP/CHIP Perinatal • Health Insurance Marketplace www.CentralHealth.net

34. Summary • Coordinated, systematic approach • Prevent confusion & avoid duplication of efforts • Maximize use of existing resources • Locally: • Enhanced outreach & education efforts • In person application assistance – general population • Application assistance for existing clients of multiple organizations • Education & referrals from numerous organizations • Central resource for local information - United Way 2-1-1 Center www.CentralHealth.net

35. Questions?

36. Enrollment and Outreach for Integral Care

37. ACA and Integral Care • Champion for Coverage and Certified Application Counselor Organization • Training staff and volunteers to assist with enrollment • Consumer Benefits Office will enroll eligible people using Integral Care services • Additional Open Enrollment for the public • 1631 East 2nd Street • 1702 South Lamar, Large Training Rm • 5225 North Lamar Professional Building • Dove Springs

38. Enrollment Information for People Currently Using Services • Approximately 1,200 People are Eligible • Provide Technical Assistance • Begin October 1st – March 31st • Currently Recruiting Volunteers for Enrollment Assistance for the Public (Limited Space) • Offering Extended Hours

39. Additional Outreach Efforts • Working with partner organizations for referrals to enrollment sites • Traditional marketing and social media activities • Online information and resources • Participation in fairs and community events: • Binational Health Week fair • Community Connections Health Fairs

40. Mental Health & Substance Use Parity • Parity means insurance companies can not discriminate against mental health and substance use treatment in coverage decisions • ACA designates mental health coverage as an essential health benefit • All plans offered in the Marketplace must offer coverage and you cannot be denied due to a preexisting condition

41. Prevention, Wellness & Chronic Disease Management • Essential Health Benefit • Profound disparity in life expectancy for persons with serious mental illness: • Persons with a serious mental illness are more than twice as likely to smoke cigarettes • People with major depressive disorder are at higher risk for cardiovascular disease and stroke • Includes smoking cessation and other programs to help people get and stay healthy

42. Questions?

43. Q & A Session

44. Closing Remarks David EvansChief Executive Officer