The Affordable Care Act, Undocumented Workers and the Future of Health Insurance. Lisa A. Ball, Esq.

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Chrystal Carr
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1 The Affordable Care Act, Undocumented Workers and the Future of Health Insurance. Lisa A. Ball, Esq.

2 The Affordable Care Act Expanding access to health insurance for Millions of uninsured persons. The ACA requires that employers and insurers offer dependent coverage that includes Adult Children to Age 26. In 2011 this kept 6.6 million young adults insured. The ACA offers Federal monies to incentivize states to Expand Medicaid starting January 1, 2014 Individuals earning up to $14,856, and families of Four with incomes up to $30,657 will be eligible for Medicaid.

3 The Affordable Care Act The ACA requires subsidies be available for individuals and families making 400% or below the Federal Poverty Level. In real numbers: An individual earning up to $44,680, and a family of four with income up to $92,200 are eligible for subsidies. The ACA eliminates the pre-existing condition exclusion for all individuals. The ACA standardizes coverage across insurance plans, and provides certain preventative coverage cost free to consumers.

4 The Affordable Care Act and New Yorkers There are currently 2.7 million New Yorkers who are un-insured. In 2014, the New York Health Exchange Marketplace hopes to enroll 1.68 million New Yorkers. New York State estimates that 85% of Immigrants in NY are eligible for coverage on the exchange 72% of those eligible are Non-White, including 41% Hispanics.

5 Medicaid Expansion The ACA expands Medicaid eligibility to 133% of the Federal Poverty Level. Pregnant women and infants under 1 will be covered for full Medicaid (instead of prenatal care only) up to 200% of the FPL. Household is counted as Mother plus number of Expected children. E.G.; Mom plus twins = HH of 3.

6 Medicaid Expansion Medicaid Budgeting rules change starting January 1, Applicants fall into two categories. MAGI- Eligibility based on Modified Adjusted Gross Income. Gross income test with 5% income disregard. This makes the eligibility effectively 138% of FPL. Non- MAGI- Those whose eligibility is based on their status as aged, blind or disabled (Formerly DAB.)

7 The ACA Coverage Mandate Starting in January of 2014, the individual mandate states that everyone must have insurance, or face a tax penalty. Plans must meet the minimum standard of quality Medicare; Medicaid or CHIP; TRICARE; Veteran s health program; Employer sponsored; Individual Market plans; Grandfathered Plans There are exemptions based on financial hardship (contribution exceeds 8% of income, earn too little to file taxes), undocumented immigrants, religious exemptions, incarceration, and being a member of an Indian Tribe

8 The ACA Coverage Mandate If you are uninsured for more than 3 months you must pay a tax penalty. 2014: greater of $95 or 1% of family income per adult/max $285 family. 2015: greater of $325 or 2% of family income per adult/max $975 family. 2016: greater of $695 or 2.5% family income per adult/max $2,085 family. No criminal penalties, liens or levies allowed for nonpayment of the penalty.

9 The ACA and Consumer Protections Medicare Benefits: Over 2 million New Yorkers with Medicare have no copayments and annual deductibles for preventive services. The Medicare donut hole will close by By 2014, Medicare Advantage plans will be required to spend at least 85 of every $1 on health care for seniors. Preventative Care at No Cost: No Co-Payments or deductibles for in-network preventive services. Women s preventive services: This went into effect as of August 1, There are 22 additional preventative services covered for women and pregnant women.

10 The ACA and Consumer Protections No more lifetime limits; New appeal rights for commercial coverage- including a mandatory independent review for self insured plans. Essential Health Benefits: Must cover 10 categories of benefits.

11 New York State Health Insurance Exchange New York State of Health There is a website and a hotline where New Yorkers can go to shop for and enroll in qualified health plans. There are tiers of plans- Bronze, Silver, Gold, and Platinum, and a Catastrophic plan (individuals under 30 only). All plans will cover Essential Health Benefits Package. The Exchange reviews all household demographic and income information and provides the consumer with their level of premium subsidies and cost sharing reductions if applicable.

12 New York State Health Insurance Exchange The Exchange screens for Medicaid and Child Health Plus eligibility. Premium payments are made directly to the Health Insurance plan.

13 The ACA and Coverage for Immigrants in 2014 Lawfully present immigrants may purchase health insurance on the exchange and are eligible for subsidies if they meet income requirements. PRUCOL Immigrants in NY who don t qualify for the exchange up to 150% of the FPL will get Medicaid coverage. Only two groups of Immigrants are NOT eligible for Medicaid in NYS Undocumented persons; Non- Immigrants (short term visa holders students/tourists). Immigrants with qualified alien status are eligible under the exchange.

14 The ACA and Undocumented Workers Undocumented immigrants may not purchase health insurance of the Exchange, but may be able to pre-qualify for Emergency Medicaid through the Exchange in the future. Undocumented Children are still eligible for Child Health Plus. Pregnant Women do not need to provide immigration information. Information provided on the Exchange is not to be reported to USCIS. New York State has a long standing policy that these applications are confidential- However, issues may arise if there is an active deportation order.

15 The ACA and Undocumented Workers Undocumented workers will still be able to access clinics and hospitals that were able to provide them care before the ACA

16 Navigators and the NYS Insurance Exchange Navigators are certified by New York State to help individuals and small business owners and their employees enroll on the New York State of Health Marketplace. Navigators were chosen by the New York State Department of Health in July after RFP s were submitted. Navigators are un-biased and are funded through grants by New York State. There are hundreds of individuals (and counting) who are already certified Navigators. Navigators will never charge for services.

17 Navigators and the NYS Insurance Exchange Navigators have the ability to track an application from beginning to end, and help individuals and families provide the necessary information to choose the best plan available. Navigators cannot make the decision for the individual, but they can help the individual with the decision making process. All services are confidential.

18 Questions?

The Affordable Care Act and American Indian and Alaska Natives. Frequently Asked Questions

The Affordable Care Act and American Indian and Alaska Natives Frequently Asked Questions 1. Is IHS coverage going away under the Affordable Care Act? No. The IHS, Tribal and urban Indian health programs