The Affordable Care Act (ACA) In Texas 1 1
Migrant Health Promotion (MHP) Our Mission Migrant Health Promotion provides culturally-appropriate health education, outreach and sustainable community development to farmworker, migrant, border, and/or other underserved or isolated communities throughout the nation. Through increased knowledge and skill building, individuals and families are empowered to live healthy lives. Strategic Plan: 2011-2015 Engage in policy discussions to support our mission, including defining and evaluating MHP's role at the national, state, and local levels in the development of Accountable Care Organizations (ACOs) and Health Care Reform. Continue expanding and ensuring holistic services to populations served by our mission nationwide. Broaden and diversify the funding streams for programs that fulfill our mission. Establish integrated, comprehensive national trainings to support Promotora Models as Programs in appropriate settings. 2
TEXAS DEMOGRAPHICS 3
UNINSURED RATES IN TEXAS 6.1 million or 23.3% uninsured Texans 4 1.2 million or 15.3% uninsured children (under age 19) in Texas Highest uninsured rate in the nation by SEVERAL percentage points compared to other states. Texans are less likely to get job-based health insurance than average Americans (50% v.s. 55%). 31% of working age Texans are uninsured 4
WHY IS THIS A PROBLEM FOR TEXANS? Where do uninsured people go for medical care? Who pays these healthcare costs? Uncompensated Care Increased Hospital Rates Increased Insurance Premiums Expanded Medicaid coverage would have decreased the number of uninsured, levels of uncompensated care, and ultimately, insurance premiums. 5
CURRENT MEDICAID COVERAGE IN TEXAS Disabled, 418,368 CHIP, 583,151 Elderly, 320,467 Poor Parents, 143,406 Medicaid Children, 2,540,312 TANF Parent, 82,660 Maternity 93,531 HHSC data, August 2012 6
MEDICAID S FINANCIAL IMPACT IN TEXAS The 4:6 matching rate would have brought more Federal money into Texas than the state dollars we currently spend. With the Expansion the match would have been 100% for 3 years, then phase down to 1:9 (for expansion populations only). Result: saving LOCAL as well as STATE money. (It would have significantly reduced the amount counties and cities spend on indigent care, hospital districts, incarceration etc.) Medicaid Expansion in Texas would have significantly reduced the burden of UNCOMPENSATED CARE on hospitals, insurance companies, and insured individuals. Medicaid Expansion would have added approximately 88,895 nurses and 32,959 family doctors to the medical workforce of the state increasing access for Texans. 7
Texas Demographics After Enrollment 8
CMS FUNDING FOR ACA IMPLEMENTATION CMS will fund a minimum of two Navigator Grants in Texas amounting in over $8 million for Healthcare Marketplace enrollment into the Federally Facilitated Exchange (FFE). Texas HHSC has implemented a 24/7 call center to enroll Texans by phone and answer questions related to the FFE. Approximately 66 FQHCs in Texas will receive $9 million in funding to do face-to-face enrollment into the FFE through Promotores(as)/CHWs. 9
ACA PROSPECTIVE IN LATINO COMMUNITIES 75% of participants felt that the ACA was good for Latinos in the US. 81% believed undocumented workers should be able to access benefits of the ACA. Many participants felt that their ability to get and keep health coverage would improve but feared that cost would increase. While Latinos felt they received accurate information on ACA from Hospitals and Doctors, they preferred getting their information from friends, family and trusted members in their community. Survey also highlights the need for outreach work in a nondiscriminatory way, as Hispanics have most to benefit from ACA. Indicated Barriers: language, literacy, culture competency, complicated applications, logistical, transportation, and computer literacy, etc. Source: An April 2013 Nationwide phone survey conducted by Latino Decisions and Robert Wood Johnson Foundation of 800 Latino adults provides insight into Latino knowledge and perception of ACA. 10
SOCIAL FABRICS OF TEXAS HEALTHCARE An oppressed population without insurance due to opting out of Medicaid Expansion. High levels of uncompensated care for hospitals and local governments. High population of undocumented citizens left without insurance and afraid to enroll in any type of social service due to immigration status. Need for nontraditional ways to educate rural populations on ACA and Marketplace Enrollment, through Promotores(as)/CHWs. Changing landscape in coordinated care in Texas will enhance healthcare delivery for Texans who are eligible and enroll in the Texas FFE. 11
LINKS & RESOURCES Healthcare.gov Cuidadodesalud.gov Marketplace.cms.gov Q&A National Email: ExternalAffairs@HHSC.gov Q&A Texas Email: RO6HHSRD@HHSC.gov 12
C. LEROY CAVAZOS SENIOR MANAGING DIRECTOR OF POLICY & CONTRACTS MIGRANT HEALTH PROMOTION EMAIL: LCAVAZOS@MIGRANTHEALTH.ORG PHONE: (956)844-9628 13