Health Insurance Enrollment

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1 Health Insurance Enrollment September 19,

2 Webinar Recording and Evaluation Survey This webinar is being recorded and will be made available online to view later Recording will also be available at After the webinar, you will receive a notice asking you to complete a webinar evaluation survey. Thank you in advance for completing the webinar evaluation survey. Your feedback is important to us. 2

3 Tips for viewing this webinar: The questions box and buttons are on the right side of the webinar window. This box can collapse so that you can better view the presentation. To unhide the box, click the arrows on the top left corner of the panel. If you are having technical difficulties, please send us a message via the questions box on your right. Our organizer will reply to you privately and help resolve the issue. 3

4 Today s Speakers: Paul Dioguardi Director, Intergovernmental Affairs U.S. Department of Health and Human Services Hon. Jim McDonough Commissioner Ramsey County, MN Hon. Roy C. Brooks Commissioner Tarrant County, TX 4

5 How many people are attending this webinar from your computer? a. 1 b. 2 c. 3 d. 4 e. 5 or more 5

6 Is your state expanding Medicaid? a. Yes b. No c. Not Sure 6

7 What type of Health Insurance Marketplace will your state have? a. Federally-facilitated Marketplace b. State-based Marketplace c. Federal-State Partnership d. Not Sure 7

8 Update on the Affordable Care Act from the US Department of Health and Human Services September 19, 2013

9 The Problem Insurance companies could take advantage of you and turn away the 129 million Americans with preexisting conditions Premiums had more than doubled over the last decade, while insurance company profits were soaring Tens of millions were underinsured, and many who had coverage were afraid of losing it 50 million Americans had no insurance at all 9

10 Accomplishments Since March 23, million Americans no longer have a lifetime dollar limit on essential health benefits 71 million additional Americans now receive many preventive services without cost sharing such as copays or deductibles 3.1 million young adults who were uninsured have gained coverage by being able to stay on their parent s health plan Over 107,000 Americans with pre-existing conditions have gained coverage Over 6 million seniors and people with disabilities have saved more than $5.7 billion on prescription drugs Since January 1, 2011 Free preventive care has been available to seniors, an estimated 34.1 million seniors in 2012 alone The 80/20 rule ensured premium dollars were spent primarily on health care and helped deliver rebates worth $1.1 billion to nearly 13 million consumers 10

11 Introduction to The Marketplace The Marketplace (or Exchange) - Place for individuals and small employers to directly compare private health insurance options known as Qualified Health Plans (QHPs) Can directly compare on the basis of price, benefits, quality, and other factors 11

12 Marketplace Establishment Each state can choose between: State Based Marketplace State creates and runs its own Marketplace State Partnership Marketplace State partners with Federal government to run some Marketplace functions Federally Facilitated Marketplace State has a Marketplace established and operated by the Federal government 12

13 Are all employers required to provide health insurance in 2014? Employers averaging fewer than 50 Full Time Employees (FTEs) are not required to provide health insurance coverage 96% of all employers in the U.S. have fewer than 50 employees Employers averaging 50 or more FTEs may be subject to a shared responsibility payment under certain conditions 13

14 Small Business Health Options Program (SHOP) SHOP is a Marketplace for small businesses and their employees (fewer than 100 employees) States may limit participation to those with 50 or fewer employees for the first 2 years Employer will access the SHOP where its principal business office is located Employer must offer coverage to all full-time employees Sole proprietors buy through the individual Marketplace rather than the SHOP Eligible employers can Define how much they ll contribute toward their employees coverage Have exclusive access to a small business tax credit Benefit from larger pool of participants that helps them get real value for consumer s premium dollars 14

15 When Consumers Can Enroll Marketplace initial open enrollment period starts October 1, 2013 and ends March 31, 2014 Annual open enrollment periods after that start on October 15 and end on December 7 Special Enrollment Periods available in certain circumstances during the year 15

16

17 Finding Enrollment Help In Your Area 17

18 Navigator Program Grant program sponsored by each Marketplace Navigators will Raise awareness about the Marketplace Provide unbiased information about enrollment Help consumers understand health plan differences And help submit consumers choices to the Marketplace Provide culturally/linguistically appropriate information Give referrals May be an agent or a broker if standards are met Can t be paid by issuer for enrolling people in QHPs/non-QHPs Other assistance also may be available beyond Navigators including agents, brokers, and community health centers 18

19 19

20 Application and Eligibility Enroll Submit single, streamlined application to the Marketplace Verify and determine eligibility Eligible for Marketplace or Medicaid/CHIP (Marketplace) Online Phone Mail In Person Supported by Data Services Hub Enroll (Medicaid/CHIP) 20

21

22 Medicaid Eligibility in 2014 Extends option for states to expand Medicaid eligibility to Adults ages with incomes up to 133% of the FPL ($15,282/year for an individual, $31,322/year for a family of 4)* Limits renewals to once every 12 months Ensures Medicaid coverage for all children With incomes up to 133% of the FPL Shifts to a simplified way of calculating income to determine Medicaid/CHIP eligibility Known as Modified Adjusted Gross Income (MAGI) *2013 Amounts 22

23 400% FPL 241% FPL 133% FPL Exchange Subsidies Medicaid Adults Medicaid/CHIP Children Varies by State 0 Adults Children 23

24 Affordable Insurance Programs (2014): Without Expansion For non-elderly, non-disabled individuals, based on current median state eligibility 400% FPL 241% FPL 133% FPL 100% FPL 63% FPL 37% FPL Exchange Subsidies Medicaid/CHIP Children Varies by State 0 Other Adults Jobless Parents Working Parents Pregnant Women Children 24

25 (Consumers) Now - Sign up for and Text Alerts and Get Ready Starting October 1, 2013, you will be able to apply through this site 25

26 Marketplace.cms.gov (Stakeholders) Get the latest resources to help people apply, enroll, and get coverage in

27 Affordable Care Act Implementation: Medicaid Eligibility and Enrollment Presentation by Ramsey County Commissioner Jim McDonough National Association of Counties Webinar September 19,

28 Discussion Outline Minnesota Context Current Status of ACA Implementation and Expanded Enrollment Challenges Future Outlook 28

29 Minnesota Context Minnesota expanded Medicaid. Number of uninsured is rising. Minnesota s electronic marketplace: MNsure 29

30 Minnesota Context State supervised, county administered. A new Medicaid eligibility and enrollment system. Single site for health insurance unsubsidized, subsidized, or Medicaid. 30

31 Current Status A late start with a partisan divide. MNsure to be implemented October 1, 2013, insurance to be effective January 1, Marketing MNsure. 31

32 Current Status Navigators and in-person assisters. Telephone service centers. Additional temporary county staff 32

33 Ongoing Challenges October 1: a huge implementation challenge. Just in time development. 33

34 Ongoing Challenges Increased Medicaid enrollment, plus a new computer system. Rapidly increasing caseloads. Operational issues. 34

35 Future Direction More residents ensured. Reduced complexity. Linking to other services. Additional county resident impacts. 35

36 Thank You for Listening Questions or Comments? 36

37 Health Insurance Enrollment National Association of Counties (NACO) - Webinar September 19, 2013 Presented by: Commissioner Roy C. Brooks Tarrant County

38 Agenda Health Insurance Enrollment 1 Overview of Affordable Healthcare Act (ACA) 2 The State of Texas Analysis Impact on Underserved and Minority Populations Tarrant County Community Outreach and Awareness Timeline

39 Affordable Healthcare Act

40 State of Texas States had the option of establishing their own exchange o In 2012, Gov. Perry announced that Texas the state would not establish its own exchange, nor would Texas expand its Medicaid program to include a larger group of uninsured Texans. o Therefore, by default, the Texas health insurance exchange is run by the federal government..

41 State of Texas Who are the Uninsured in Texas? Texas is the uninsured capital of the United States. More than 6.3 million Texans - including 1.2 million children - lack health insurance. Texas' un-insurance rates, 1.5 to 2 times the national average, create significant problems in the financing and delivery of health care to all.

42 State of Texas Who are the Uninsured in Texas? Health Insurance Coverage of Adults Population Uninsured %Uninsured Rank United States 186,727,700 41,160,200 22% Texas 15,001,7000 4,886,100 33% 1 Health Insurance Coverage of Children 0-18 Population Uninsured %Uninsured Rank United States 79,284,600 7,951,800 10% Texas 7,358,300 1,247,300 17% 1 Health Insurance Coverage of Total Population Population Uninsured %Uninsured Rank United States 305,191,100 49,903,900 16% Texas 24,840,100 6,234,900 25% 1

43 State of Texas The Texas Health Insurance Exchange Texas residents are able to shop for and enroll in health insurance plans at the federal health insurance marketplace portal: o HealthCare.gov and CuidadoDeSalud.gov. All plans offered in the Texas exchange cover essential health benefits based on Blue Cross/Blue Shield of Texas s Best Choice PPO plan.

44 Impact on Underserved and Minority Populations Percentage of Health Coverage by Race

45 Impact on Underserved and Minority Populations Reduction in Health Disparities The law works to eliminate health disparities that minorities face. o Funds research about health disparities o Promotes racial and ethnic diversity or health professionals o Expands community health programs to manage chronic conditions such as diabetes

46 Community Outreach and Collaboration is Key! Awareness Led efforts to coordinate collaboration among: o Department of Health & Human Services o United Way of Tarrant County o Enroll America o Faith-Based and Community Organizations o Tarrant County

47 Community Outreach and Awareness United Way of Tarrant County Recipient of 5.9 million grant to help uninsured Texans understand and navigate the Health Insurance Marketplace (largest award in country) o Will serve 220 Texas Counties and educate people in purchasing health insurance o Employing 6 navigators (for Tarrant County) who will provide face-to-face contacts with a minimum of 3,441 individual estimated for eligibility

48 Community Outreach and Awareness Outreach Efforts Include: Host Community Leaders Roundtable (Faith- Based and Community) and Enrollment Drive. Distribution of information about the Marketplace, via materials, Website and social media platforms. Utilize Constant Contact distribution. Speak at community events and meetings.

49 Community Outreach and Staff Training Awareness Certified Office as Certified Application Counselor (CAC) Organization o Allows staff to help people understand, apply, and enroll for health coverage through the Marketplace. Participate in CMS Health Insurance Marketplace 101 Trainings. Provide computer stations in office(s) to allow constituents to use to enroll in the Marketplace.

50 Final Thoughts Open enrollment begins in the Health Insurance Marketplace on October 1 st and will run through March 31 st. New policies will take effect January Targeted community enrollment events scheduled for: o October 2013 (Community Leaders Roundtable) o November 2013 (Enrollment Drive) o January 2014 (2 nd Enrollment Drive)

51 Question and Answers

52 NACo Resources Health Reform Implementation Site Here you can find: Counties as Employers Toolkit (Updated) Outreach and Enrollment Toolkit for Elected Officials /Toolkit%20with%20Letter.pdf 52

53 HHS Resources Outreach and Enrollment Toolkit for Elected Officials -partner-resources/outreach-and-enrollment-toolkit-forelected-officials.pdf For professionals learning about the Marketplace and helping people apply, please visit the Centers for Medicaid & Medicare Services Resources page Individuals, families, and small businesses can find assistance at: Customer Service Representative available 24/7 at (TTY: ) 53

54 Type your question into the questions box and the moderator will read the question on your behalf during the Q&A session. If we are unable to answer all of the questions during the Q&A session, we will send you the questions and answers in an . 54

55 Upcoming Webinars and Events County Health Rankings Webinar o How can your county s rankings be a starting point to drive community change? Learn about tools and resources available to address community needs. o When: Thursday, October 10 th at 2pm NACO 2013 Roadmaps to Health Forum o Join NACo to explore and identify opportunities develop, enhance, and sustain positive health outcomes in your county o When: October 31 to November 1, 2013 o Where: Dane County (Madison), WI Please contact Katie Bess at for more information. 55

56 2014 Healthy Counties Forum What: This forum will focus on using Accountable Care Communities (ACCs) to mobilize and advance healthy changes rural, mid-size, and large counties? What are counties doing as employers and public health leaders? When: January 30-31, 2014 Where: San Diego County, CA Please contact Emmanuelle St. Jean, MPH, Program Manager, or 56

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