THE VIM BULLETIN News from the Clinic MARCH, 2014 It s the month for shamrocks and a glimpse of spring. We continue to stay busy as you ll see in this latest news from VIM. UPDATE ON ACA ENROLLMENT PROGRESS AT VIM 1. Community Partner Portal Access In late February, the Cover Oregon Community Partners (like VIM) began to have access to the website portal that allows us to enroll patients completely online. No more paper applications. No more fillable PDFs. No more faxing. This is the function we anticipated using last October 1, so progress has been made! We are now able to receive a real-time determination of what insurance a patient is eligible for when we finish their application. Patients no longer have the 6-week wait time. In most cases, they can walk out of their enrollment appointment at VIM knowing on the spot that they qualify for Medicaid/Oregon Health Plan, or an insurance plan that they will need to pay for. Receiving this information immediately has decreased frustration for patients and volunteers, increased application accuracy, and made the whole process much more efficient. Access to this portal is only available to Community Partners and certified health insurance agents at this time, not to the general public, so we ve been taking advantage of it as much as possible. 2. Offering Cover Oregon Enrollment Assistance to the Community Since October, the first priority of many Front Desk volunteers has been to enroll VIM patients into Cover Oregon programs. Now that the bulk of this has been accomplished, we are opening our Cover Oregon enrollment assistance program to anyone in the community who needs help. Our volunteers have a tremendous amount of experience, and want to continue to use their skills to get the Affordable Care Act off the ground. If you know someone who still has not signed up for Cover Oregon, please have them call VIM for assistance. Enrollment appointments can be made by calling (541) 330-9001. 3. Cover Oregon Enrollment Update Here s what we know about VIM patients as of March 11 th : 860 Cover Oregon applications have been submitted Glossary of Terms ACA: Affordable Care Act OHP: Oregon Health Plan the state s Medicaid program Cover Oregon: the health insurance marketplace for the state of Oregon QHP: Qualified Health Plan an insurance plan that meets certain guidelines and can be purchased through Cover Oregon
548 patients have been enrolled into the Oregon Health Plan (Medicaid) 117 patients have been enrolled into paid insurance plans with tax credits and subsidies 195 patients are either awaiting their eligibility determination, or we are unsure of their status because we haven t heard back from them after leaving phone message(s) 4 patients have applied for Hardship Exemptions through the Federal process; none have received a reply OPEN ENROLLMENT ENDS MARCH 31 FOR ALL PAID INSURANCE PLANS 4. I keep hearing about a deadline on March 31 st. What is it? March 31 st is the last day to sign up for paid insurance plans either through Cover Oregon or through a private insurance carrier. The March 31 st deadline doesn t mean people have until the 31 st to start the enrollment process for health insurance. It means that they have until March 31 st to have the application completed. 5. What about Medicaid/Oregon Health Plan? Is March 31 st the deadline for that, too? No. Medicaid/Oregon Health Plan (OHP) has open enrollment, meaning a person can sign up for OHP at any point during the year. 6. What if I choose to remain uninsured? Unless you have qualified for a Federal Hardship Exemption, or are in one of the few categories of people who are not required to comply with the Affordable Care Act, you will face a penalty for not having insurance. 7. How much is the penalty? The penalty is based on the family income that is reported on the tax return. It is calculated in one of two ways, and you will pay whichever amount is more. Penalties for this first year will be: $95 for every adult and $47.50 for every child in the family who does not have health coverage (up to a maximum of $285) -or- 1% of taxable income in 2014 (up to a maximum of $3,600 for an individual, or $11,000 for a family of 4). Calculating the tax penalty can be complicated. For example, a family of four making $50,000 in 2014 will pay a penalty of approximately $370. A single person making the same amount in income may also have a penalty of $370. A family of four making $90,000, will have an estimated penalty of about $770, and so may a single person. To help people understand these penalties, the Tax Policy Center has created a calculator to estimate the penalty amount. The link is posted on our website at: www.vim-cascades.org/healthcare-reform. 2
It is also important to note that just one uninsured person in the family can trigger a penalty. If that person is claimed as a dependent on your tax return, and they are uninsured as of March 31 st, then you will have to pay the penalty for that individual. Penalties will be collected when you file your 2014 income taxes. QUALIFIED HEALTH PLANS (QHP) PAID PLANS WITH BENEFITS 8. What is a Qualified Health Plan (QHP)? As we ve mentioned, to avoid a penalty, you must have an insurance plan in place by March 31 st. One type of insurance plan is called a Qualified Health Plan (QHP). In the simplest definition, a QHP is a paid insurance plan that is available only through Cover Oregon. If a person or family applies to Cover Oregon and makes too much money for Medicaid/Oregon Health Plan, they are generally offered the opportunity to purchase a QHP. 9. What s so special about a QHP? QHPs provide tax subsidies and cost sharing benefits to those with incomes between 138 400% of the Federal Poverty Line. This is about $15,850 - $45,960 in income for a single person, and $32,500 - $93,000 for a family of four. The goal is to make these plans as reasonable as possible for the largest amount of people. The tax subsidies and cost-sharing benefits in a QHP are generally factored into the cost of the plans. The cost sharing benefits can include deductibles, copayments and/or out-of-pocket maximum amounts. 10. How does one apply for a QHP? The process starts with a Cover Oregon application. If the person is eligible for an insurance program through the Affordable Care Act, and they are not eligible for Medicaid/Oregon Health Plan, they will be presented with several choices for QHPs that fit their income level. Once the person receives the QHP information, they can choose a plan immediately on their own. Or, they can talk with a Cover Oregon certified insurance broker to help them fully understand the different options, and the pricing structure of each. We recommend that everyone who is eligible for a QHP talk with an insurance broker. The service is free. We have a list of local brokers that have agreed to help VIM patients with this choice at the Front Desk. 11. Are QHPs a form of Cover Oregon insurance? No. Cover Oregon is just a one-stop-shop for all of the QHPs. This makes it easier for people to compare and choose a plan. In Deschutes County, the companies providing the QHP plans include PacificSource Health Plans, Moda Health, LifeWise Health Plan of Oregon, Health Republic Insurance, BridgeSpan Health, Oregon s Health CO-OP, Providence Health Plan, and Trillium. 3
QUALIFYING LIFE EVENTS THE ONLY ENROLLMENT EXCEPTION AFTER MARCH 31ST 12. What is a qualifying life event? After March 31 st, the only way a person can enroll in a paid insurance plan in 2014 is to experience a qualifying life event. A qualifying life event is a change in circumstance that includes marriage, childbirth, adoption, legal separation, divorce, moving to an area that offers different health plan options, loss of employment, etc. 13. What if someone enrolls in a QHP, can t pay their bill, then later wants to re-enroll. Is that considered a qualifying life event? No. It is important to know that voluntarily quitting your insurance, or being terminated for not paying your premiums, are not qualifying life events. Neither is being diagnosed with a serious illness while uninsured. If any of these situations happen while you are uninsured, you will remain uninsured until the next open enrollment period in the fall. This is why it is essential that when anyone signs up for a QHP, they choose a plan carefully, and choose one that they can afford. An article in The New York Times dated February 13 th, 2014, stated that 20% of the people who signed up for QHPs, missed paying their first premium in January. Insurance companies will allow a 90-day grace period before cancelling coverage. We will be watching this closely, knowing that people who lose their insurance may need VIM s help. 14. When is the next enrollment period for QHPs? Right now it is scheduled for November 15, 2014 January 15, 2015. IN THE CLINIC 15. Deadlines and transitions. We are continuing to assist VIM patients, and others, with their Cover Oregon applications and questions. At the same time we are caring for patients. Our patient census remains low, but this is what we expected during this transition. A report dated March 7, 2014 said that over 10,000 Cover Oregon insurance applications are still in process. It also stated that approximately 50,000 Oregonians who completed an initial Cover Oregon application have not picked an insurance program. As mentioned above, those who do not choose an insurance plan by March 31 st will be uninsured for the remainder of 2014. We do not know how many of these individuals live in Central Oregon. 4
VIM S DENTAL CARE EXPANSION PILOT PROGRAM 16. What is the Dental Care Expansion Pilot Program? As we look deeper into the community s healthcare needs, we know that dental care is of high priority. Although basic dental care is covered by Medicaid/OHP, most paid medical insurance plans do not cover dental. Medicare doesn t either, unless it is purchased separately through an Advantage plan by those over age 65. VIM has a very successful partnership with the Dental Assisting Program at Central Oregon Community College (COCC). Through this, hundreds of VIM patients have received basic dental care that has included x-rays, fillings, extractions, and some cleanings. Care is provided by volunteer licensed dentists and dental hygienists in COCC s state-of-the-art dental facility. At the same time, dental assisting students earn practicum time toward their degrees. On March 14th, we began a pilot program for 50 patients that will run through COCC s spring term, ending in early June. We are calling this a pilot because we are trying something new. Where all of VIM patients have access to our dental care program now, we are going to test branching out to another population that previously hasn t qualified for services at VIM. Our goal with the pilot is to provide needed services, while also getting some measurement of the demand for these services in the community. 17. Who can participate in the Dental Pilot? Instead of just working with the un-insured, the Dental Pilot will work with 50 patients who are under-insured. Medical insurance, but no dental insurance. The patients in VIM s Dental Pilot may have medical insurance. But, they must not have dental insurance. Increased income levels. Currently to qualify at VIM, a patient s income must be less than 200% of the Federal Poverty Level (FPL) or about $23,340 for a single person. In this pilot we will increase the income cap to 300%, which is $35,010 for a single person, or up to $47,190 for a couple. Expanded age requirements. Our current age limits are 18 64. For this pilot, there will be no age limit other than a minimum age of 18. This will open access to people age 65 or older who are on a Medicare plan that does not have dental benefits. Same residency requirements. Patients must still live or work in Deschutes, Jefferson or Crook counties. 18. Will the Dental Pilot patients also be eligible for medical care at VIM? Regular VIM medical care services will only be available to people who meet our original eligibility requirements, not the expanded requirements for the 50 patients in the Dental Pilot. We ll have a full report on the pilot in July, and will share our findings then. 5
COVER OREGON ACCOUNTABILITY 19. Cover Oregon Accountability There has been quite a bit of media attention on the Cover Oregon malfunctions. If you ve been following the news you know there is a lot of confusion on what happened, and why. This is especially true because of the amount of taxpayer dollars that were put forth for this website effort that still hasn t fulfilled its original promises. We received a press release on March 3rd, announcing an agreement between Cover Oregon and Oracle, the primary vendor for the website. The goal was to outline an orderly transition of technology development services, and protect current and future Cover Oregon enrollees. In brief, Cover Oregon is withholding $25.6 million of the $69.5 million that Oracle has claimed for technology development work from November 2013 February 2014. Oracle has agreed to continue to provide transition services, maintenance and repairs to the technology infrastructure, under the direction of Cover Oregon. The press release goes on to say that Cover Oregon will convene a group that includes private sector technology experts to advise on the best options to move forward with the next phase of the website. In addition, the U.S. Government Accountability Office (GAO), has agreed to request an audit on how $304 million in federal grants were spent on the Cover Oregon website. Oregon is not the only state being looked at by this investigative arm of Congress. The GAO is looking into problems with state healthcare exchange websites across the country. We will update you as we hear more. Many of you have shared the bulletins that we ve created about VIM s implementation of the Affordable Care Act (ACA) with friends and family. Thank you! We really appreciate your desire to help us clear up the confusion around the ACA. All of the documents you ve received in the last three months can be found on our website at www.vim-cascades.org/healthcare-reform. Yes, please share! Also, we have openings for new patients. If you know of anyone who can use our help for medical or dental concerns, please have them call the Front Desk at (541) 330-9001. We ll have another update in April. Any questions before then, please give us a call. And thank you for your continued support. We re feeling the love! Volunteers in Medicine Clinic of the Cascades (VIM) 2300 NE Neff Road Bend, OR 97701 phone (541) 330-9001 fax (541) 585-9002 www.vim-cascades.org 6