Medicare taxes on higher income families $318. Cadillac tax on high-cost plans $111. Employer mandate $106

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2 ACA Changes Created new way of counting Medicaid income Removed asset tests for some Medicaid groups Increased Medicaid income levels for children Raised age limit for coverage of children who age-out of foster care Created presumptive eligibility for hospitals Established new adult group (see Supreme Court decision) Implemented many new taxes

3 ACA Taxes Provision (in billions) Medicare taxes on higher income families $318 Cadillac tax on high-cost plans $111 Employer mandate $106 Annual tax on health insurance providers $102 Individual mandate $55 Annual tax on drug manufacturers/importers $34 Excise tax on medical device manufacturers/importers $29 * National figures

4 Supreme Court Decision National Federation of Independent Business v. Sebelius June 2012 Ruled that existing federal Medicaid dollars can t be withheld if state does not expand to new adult population Left intact other ACA provisions, including new taxes Created state option to expand coverage through Medicaid

5 ACA Mandatory Expansion Income Limits for Medicaid, CHIP and Tax Credit Eligibility No Optional Medicaid Expansion Federal Poverty Level % 0% 50% 100% 133% 200% Eligibility Categories: Children 0-5 Children 6-18 Pregnant Women Adults > 65 People w/ Disability Adults w/ Children Adults w/o Children No Medicaid Coverage Available Available to 400% FPL Tax Credit Eligibility Minimum = current Medicaid eligibility = current CHIP eligibility = mandatory ACA changes to Medicaid eligibility = eligible for Medicare = eligible for Tax Credits for use in the Exchange (up to 400% of FPL)

6 ACA Optional Expansion Income Limits for Medicaid, CHIP and Tax Credit Eligibility Optional Medicaid Expansion Federal Poverty Level % 0% 50% 100% 133% 200% Eligibility Categories: Children 0-5 Children 6-18 Pregnant Women Adults > 65 People w/ Disability Adults w/ Children Adults w/o Children Available to 400% FPL = current Medicaid eligibility = current CHIP eligibility = mandatory ACA changes to Medicaid eligibility = optional Medicaid ACA expansion eligibility = eligible for Medicare = eligible for Tax Credits for use in the Exchange (up to 400% of FPL)

7 Utah s Uniques Jobs Low unemployment rate Health Lower prevalence of disease Lower than average healthcare expenditures Insurance Competitive insurance market Higher percentage of population on employer-sponsored insurance Higher percentage of population underinsured Lower percentage of population on Medicaid

8 Principles and Strategies Promote Individual Responsibility Charge premiums for adults over the poverty level Collect co-pays from all adults Automatically enroll adults that can work in a job program Offer incentives for healthy behaviors

9 Principles and Strategies Support Private Markets Use employer-sponsored insurance when available Provide assistance to buy private market plans Use Avenue H, Utah s small business health exchange, to facilitate plan selection and enrollment

10 Principles and Strategies Maximize Flexibility Use savings achieved from Utah s current waiver program to support quality improvement efforts Allow Medicaid children to join parents on private plans Establish three year pilot program that allows the state to evaluate the effectiveness of Healthy Utah

11 Principles and Strategies Respect the Taxpayer Recoup some of the ACA taxes that Utahns are already paying Terminate plan if federal funding fails to be provided as promised

12 Who is Covered?

13 Enrollment Process

14 10 Essential Health Benefits 1. Ambulatory patient services; 2. Emergency services; 3. Hospitalization; 4. Maternity and newborn care; 5. Mental health and substance use disorder services, including behavioral health treatment; 6. Prescription drugs; 7. Rehabilitative and habilitative services and devices; 8. Laboratory services; 9. Preventive and wellness services and chronic disease management; and 10. Pediatric services, including oral and vision care. * Plan must meet requirements of the Mental Health Parity and Addiction Equity Act

15 Justice Services Medically Frail members involved in the justice system receive services to the same extent they are generally available in Medicaid today (excludes coverage while member is in the jail or prison) Premium Assistance Private plans generally do not cover court-ordered services for members involved in the justice system

16 Contact Information Nate Checketts Health Reform Coordinator Medicaid and Health Financing Utah Department of Health