The Affordable Care Act. Improving Grandfamily Health

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1 The Affordable Care Act Improving Grandfamily Health

2 Background: The Affordable Care Act Enacted March 2010 Implemented Gradually Goal: Affordable Coverage for All Paving the Way for the 2014 Exchanges

3 How Does The ACA Affect Grandfamilies?

4 Benefits for Children in Grandfamilies

5 How The ACA Benefits Children Expansion of Medicaid Fully Funds CHIP Home Visiting Young Adults Until Age 26 Child-Only Policies

6 Expansion of Medicaid Extends Medicaid To individuals and families at or below 133% FPL In 2014, Medicaid also expands coverage to: Former foster youth up to age 26 similar to the private insurance option which became effective in 2010 Authorizes the Federal Government to provide states with 100% FMAP For newly eligible enrollees

7 Children s Health Insurance Program Fully funds CHIP through 2015 Originally set to expire in 2013 Continues authority for the program through 2019 Requires MOE through 2014 It also extends and increases funding provided in CHIPRA For Medicaid and CHIP enrollment and renewal activities through 2015

8 Home Visiting Grants Creates a dedicated federal funding stream to support home visitation programs Authorizes $1.5 billion over five years Requires states choosing to apply to conduct a needs assessment Would identify at-risk communities, and Describe the quality and capacity of existing programs or initiatives in the states Requires eligible programs to meet certain outcomerelated benchmarks Gives funding priority to evidenced-based models

9 Adoption Tax Credit Expands the adoption assistance program and adoption tax credit Increases the adoption tax credit and adoption assistance program by $1,000 This brings the amount to $13,170 each Makes the tax credit refundable for all types of adoptions Extends the tax credit through December 31, 2011

10 Ability to Purchase Child-Only Policies 2014 Exchanges Grandfamilies Other relatives raising children Parents whose employers do not provide coverage for dependents

11 Benefits for Older Adults in Grandfamilies

12 How The ACA Benefits Older Adults Early Retiree Reinsurance Program Medicare Part D Prescription Drug Costs Insurance for Long-Term Care Community First Choice Program

13 Early Retiree Reinsurance Program Number of Employers Offering Health Insurance to Retirees Has Declined Early Retirees: ERRP 55+, who are not eligible for Medicare At high risk of being uninsured Employers can now apply for ERRP Provides subsidies to keep early retirees covered

14 Medicare Part D Prescription Drug Costs What is the Donut Hole? Gap in Prescription Drug Coverage: Medicare pays for your prescriptions up to $ amount Then, you pay for all prescription drug costs out-of-pocket Until, paid enough out-of-pocket for to kick-back in ACA Closes the Donut Hole by 2020 Until then, automatic 50% off brand-name, covered drugs 7% off generic prescription drugs

15 Insurance Plan for Long-Term Care 70% Americans Will Need Long-Term Care Expenses: Home Health Aides, Home Modifications New, Voluntary Insurance Program Employer participates, automatically enrolled Age, disability, illness difficulty performing daily activities Avg. $50 cash benefit per day For info, visit the Administration on Aging:

16 Community First Choice Program New Medicaid Plan Expands Eligibility More Home & Community-Based Care Alternative to Institutional Care

17 Health Care Benefits For All Ages

18 How The ACA Benefits All Generations Pre-Existing Conditions Free Preventive Care Services Coverage When You re Sick Appeals & External Review Lifetime & Annual Limits Tax Credits to Lowers Monthly Premiums Help Choosing & Managing Policy

19 Coverage: Pre-Existing Conditions Coverage under the New Exchanges 2014 Insurance Company Cannot: Charge You Higher Premiums Limit Your Benefits Deny You Coverage Altogether Coverage until the New Exchanges Pre-Existing Condition Insurance Plans (PCIPs) Cannot discriminate against children

20 Free Preventive Care Services Free Preventative Care Services For: Children Youth Adults Those Covered By Medicare

21 Coverage When You re Sick Application Mistakes/Technical Errors Insurance Company Cannot: Rescind Your Coverage Deny Payment for Claims Participation in a Clinical Trial Insurance Company Cannot: Drop You Limit Your Coverage

22 Appeals & External Review Right to Appeal First, Ask Insurer to Reconsider Right to External Review If Turned Down, Seek an Independent Review Appeal Quickly After Denial Time Limits

23 Lifetime & Annual Limits ACA Bans Lifetime Limits Insurance Company Cannot: Place a Dollar Limit on Amount It Will Spend Cumulatively Over Your Lifetime Essential Health Care Services ACA Bans Annual Limits in 2014 Insurance Company Cannot: Place Absurdly Low Annual Limit Now Place Any Dollar Limit Yearly Starting in 2014

24 Tax Credits to Lower Monthly Premiums Available in 2014 For: Individuals making up to about $43,000 Families making up to about $88,000 Don t Have to Wait UntiI Tax Time! Can use credits to lower premiums each month

25 Help Choosing & Managing a Policy Health Insurance Finder Assist You With: Finding, Selecting, Enrolling in Insurance Plan Consumer Assistance Offices Assist You With: Enrolling in a Health Insurance Plan Filing a Complaint or Appeal Answer Questions

26 Where to Go For More Information Generations United s ACA Fact Sheet CWLA s Website Generations United s Website Alliance for Health Reform: Allhealth.org

27 Questions?

28 Contact Information For Presenters YaMinco Varner Policy Associate, Health Care Child Welfare League of America Allison Alt Public Policy Coordinator Generations United

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