October 9, 2012 – StateWide’s Annual Conference

1A nonprofit service and advocacy organization © 2012 National Council on Aging

October 9, 2012 – StateWide’s Annual Conference

Health Care Reform: Past, Present,

and the Road Ahead

Nora Dowd EisenhowerDirector, National Center for Benefits

Access at NCOA


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.


What we’ll cover

Recap the health reform law changes Review June 2012 Supreme Court decision Discuss what’s to come with 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


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


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


Highlights of ACA that impact your clients with Medicare and/or Medicaid

Tests new models for better care, better coordination of services (www.innovations.cms.gov)

Give states more flexibility to offer Home and Community Based Services (HCBS)


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)…


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


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


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


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 ACAo 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


Medicaid Expansion – What are states considering?

Factors affecting states’ decision:

o Pressure from stakeholders within the state

o Spending cuts, deficit reduction efforts

o Incentive to expand Medicaid (i.e., 100% federal funding from 2014 through 2016)

o November 2012 electionso No deadline to decide


Now, let’s talk about…


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”)


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


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)


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


Where are states at re: deciding on an Exchange?


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

o 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 Grantso Grant used to design and implement the information

technology (IT) infrastructure needed to operate the Exchanges.

• $59.2 million in Exchange Establishment Grantso Grant helps to implement key provisions of the Affordable

Care Act.


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


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


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


What might an Exchange website look like?

Example, Colorado’s Exchange website at: www.getcoveredco.org


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 $663More than 1.1 million people with original Medicare received at least one preventive service at no cost to themMore than 120,00 people received the Annual Wellness Visit


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


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


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: [email protected]

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October 9, 2012 – StateWide’s Annual Conference

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