Eligibility for Health Care Coverage in CPCA Ambassador Program Informational Webinar

Transcription

1 Eligibility for Health Care Coverage in 2014 CPCA Ambassador Program Informational Webinar

2 What This Webinar is NOT This webinar is NOT for training enrollment Assisters This webinar will NOT provide in-depth information about how to assess eligibility and provide enrollment assistance into health care coverage More information will be available soon!*

3 This Webinar WILL ACA Background Eligibility Enrollment The Single Streamlined Application System (CalHEERS) Health Center Considerations

4 ACA Background Signed into law March 2010 Enacts a series of reforms designed to: Establish greater protections for consumers Make health insurance more affordable Dramatically reduce number of uninsured

5 ACA Background Greater Protections for Consumers: Cannot Cancel Policies Ban on Lifetime Limits Ban on Annual Dollar Limits Free Preventive Care and Annual Checkups Premium Rebates Essential Health Benefits More Doctors

6 ACA Background Making Health Insurance More Affordable: Federal Premium Tax Credits Cost Sharing Subsidies Single Risk Pool Limited Premium Variation

7 ACA Background Dramatically Reduce the Number of Uninsured: Young Adults Can Stay On a Parent s Plan Until Age 26 No Denials or Extra Charges for Pre-Existing Conditions Medicaid Expansion for Low-Income Californians Covered California

8 ACA Background Individual Mandate Everyone* must have insurance! *You are exempt from the tax penalty if: You have insurance through your employer or purchase individual insurance on your own You have insurance through Medicare, Medicaid, CHIP, Veteran s Administration and/or Tricare, Indian Health Services, or a health care sharing ministry You would have to spend more than 8% of your household income on the cheapest qualifying health insurance plan, even after tax credits and subsidies.

9 If you re uninsured now How will you get insurance? Medi-cal Expansion Covered California

10 Medi-Cal Overview of What We Know Now

11 Eligibility: Medi-Cal Medicaid (Medi-Cal) Eligibility January 1, 2014 anyone with income up to 133% Federal Poverty Level (FPL) eligible for Medi-Cal 5% income disregard brings threshold effectively to 138% FPL The law standardizes definition of income used to determine eligibility for Medicaid and the tax credits to: Modified Adjusted Gross Income (MAGI). Aligns with IRS methodology Standardizes Medicaid eligibility with Exchange MAGI rules do not apply to some groups (65 or older, disabled, etc). Current beneficiaries move to MAGI March

12 Modified Adjusted Gross Income What is MAGI? MAGi is a methodology for how income is counted and how household composition and family size are determined MAGI is not a number on a tax return MAGI is based on federal tax rules for determining adjusted gross income (with some modification)

13 Modified Adjusted Gross Income MAGI = Adjusted Gross Income (AGI) plus: Any foreign earned income excluded from taxes Tax-exempt interest; and Tax-exempt social security income Family = Taxpayer and all claimed dependents Family size = Number of individuals in the family Household income = The sum of the taxpayer s MAGI plus the MAGI of tax dependents in the family if required to file

14 Modified Adjusted Gross Income Key differences compared to current Medicaid methods: Child support income received is NOT counted Self-employment and farm income IS counted Scholarships, fellowship grants and awards used for education purposes NOT counted American Indian and Alaska Native income derived from distributions, payments, ownership interests, and real property usage rights NOT counted Lump sum payments counted in month received

15 Modified Adjusted Gross Income Rules for non-filers Mirror rules for tax filers to maximum extent Will need to provide income verification in-person at county office; electronic real-time determination will not be available through CalHEERS at this time

16 Non-MAGI Applicants All submission modes (in person, phone, mail, electronic) DHCS has retained eligibility determination authority Additional info will be necessary Non-MAGI applicants will be eligible for MAGI Medi-Cal, if applicable, until a final determination is made on non-magi eligibility

17 Medi-Cal Questions??

18 What we know now. Covered California

19 Covered California COMMERCIAL insurance market Also called Exchange, Marketplace, or HBEX Available to everyone over 138% FPL Premium tax credits and cost-sharing subsidies available to some Premium tax credits up to 400% FPL Premium tax credits and cost-sharing subsidies up to 250% FPL

20 Covered California

21 Premium Tax Credits

22 Cost-Sharing Subsidies Available to individuals under 250% FPL Only available in silver level Paid directly to QHPs

23 Eligibility Sum-Up

24 Questions about Eligibility?

25 Enrollment Single Streamlined Application for Medi-Cal, Healthy Families, and Covered California Modernizes eligibility verification; relies primarily on electronic data sources CalHEERS (California Healthcare Eligiblity, Enrollment, and Retention System) Covered California uses open enrollment period; rolling enrollment for Medi-Cal

26 Enrollment By phone Call Centers: Sacramento, Contra Costa, Fresno By mail Online CalHEERS In-Person Assisters, Navigators, Certified Application Counselors, County Eligibility Workers

27 Enrollment Outreach and Education Grantees No application assistance or enrollment function In-Person Assisters Provide application assistance through CalHEERS Paid $58 per successful enrollment/$25 for renewal Navigators Perform outreach and education AND application assistance Grant Funded RFP in June; state work in December

28 Questions about Enrollment?

29 Considerations for Health Centers Enrolling patients Contracting with commercial insurance companies Appealing to newly insured populations (provider of choice)

30 Considerations for Health Centers

31 Considerations for Health Centers Providing Insurance to Employees Nonprofit employers also impacted by mandate to offer affordable health insurance to their employees Penalties for employers with 50 or more full-time equivalent employees who don t offer affordable insurance (FTE = 30 hrs/week) No coverage: $2,000 per year per employee, minus first 30 employees Unaffordable Coverage: $3,000 per year for employees in the Exchange Tax credits are available

32 Questions/Comments Meaghan McCamman (916)