The Affordable Care Act (ACA): Training of Trainers (TOT) for Community-Based

Organizations

October 2013

Objectives

At the end of this training, you will be able to:1.Understand some of changes under the Affordable Care Act (ACA) and how health care coverage will expand through Medicaid and the new insurance exchange2.Identify who may be eligible for Medicaid and insurance subsidies3.Tell people how to sign up themselves or get help to do so

ACA: The Big Picture

http://kff.org/health-reform/video/youtoons-obamacare-video/

Insurance through Employers1/2 the Population

• If already covered by employer, not much is changing – still get coverage from employer

• New advantages: caps on out-of-pocket expenses, free preventative care, can’t inflate prices for sick employees

• Bigger changes for large companies (50+ employees) that don’t offer coverage now - must offer insurance or face penalty (but penalty is delayed to 2016)

• Smaller employers (<50 employees) – don’t have to offer coverage and don’t face penalties, but get incentives to do so – they purchase on the marketplace and get tax breaks

Coverage through Government 1/3 of the Population

• Seniors on Medicare – not much will change. Already have help with prescription drugs and preventative care

• Medicaid is expanding to cover more people, especially poor adults not currently eligible – both men and women, not just pregnant women and parents

• States have option to expand Medicaid or not – about half are expanding, including Colorado. Federal government pays almost all of the cost in the early years.

Buying Insurance on Your Own (1 in 10 people)• If not covered by employer or

employer’s coverage is too expensive, you can buy on marketplaces – Ours is Connect for Health Colorado.

• Insurers compete, you choose how much coverage you want and how much you want to pay for it (Bronze to Platinum Plans)

• All plans cover a set of services –e.g. hospital and doctor visits, maternity care, mental health care, prescription drugs.

• Tax credits to make the insurance more affordable if you don’t have other options and your income is below a certain level

Buying Insurance on Your Own (1 in 10 people)• Catastrophic policies available until age 30• You can’t be denied or charged more based on pre-existing conditions• Men and women will pay the same price, unlike today• Most will pay less (e.g. older people), some more (e.g younger

people) – but get better and more secure insurance. • Must buy during open enrollment periods – through March

31, 2014• Pay fines if you don’t have insurance, waivers for special

circumstances

Historic Opportunities with the ACA“Sick Care” System• Exclusionary• Episodic• High-costUninsured in Denver:

2011:17%

(American Community Survey)

“Health Care” System• Inclusive • Comprehensive• Preventive• Lower-Cost

2016:Reduced to 6%

(Projections based on American Community Survey)

Wellness & PreventionWellness & PreventionSick Care (Before ACA)

Expansion of Health Coverage in 2014 under ACAMedicaid: Based solely on income

0-133% of FPL: $15,282 for single $31,322 for family of 4

Insurance: Subsidies for insurance purchased at Connect for Health Colorado:133-400% of FPL: $45,900 for single $94,200 for family of 4

No Denials for Pre-Existing Conditions

Key Exclusion for All New Coverage: Undocumented persons and some legal residents.

Individual Insurance Mandate: Everyone must have health coverage or pay a penalty on 2014 federal tax return - $95 or 1% of annual income

Free Preventive Services without Co-Pays under ACA

Selected Preventive Services

Pregnancy and Newborns Screening for anemia and infections; vitamin supplementation; breastfeeding support and counseling; newborn screening

Well Child Care Screening for autism, hearing, vision, depression, obesity, lead; all recommended vaccinations

Bone Health Osteoporosis screening

Sexual Health Screening for STDs and intimate partner violence; STD prevention counseling; Contraception

Infections Hepatitis C & HIV testing; all recommended vaccinations for adults

Mental Health Depression screening

Cardiovascular Disease Screening for high blood pressure, diabetes, high cholesterol and obesity; dietary and obesity counseling

Cancer Screening for breast, cervical and colon cancer; counseling about sun exposure

Substance Use Tobacco use screening and cessation services; alcohol misuse screening and counseling

More information available at www.Healthcare.gov

Uninsured in the Denver Metro Area

Source: Colorado Health Access Survey, 2011

Who Lacks Insurance Now in Denver?Roughly 1 in 5 Denver residents are uninsured:

Where in Denver will More People Qualify for Coverage?

In darker shaded areas more people will qualify

for Medicaid and

insurance exchange subsidies

How Will Expanded Coverage Affect Your Organization?• Many uninsured patients and people with CICP who already

receive care at your organization may be eligible for Medicaid or the Exchange• Having more people covered will help your organization to

continue providing services

Barriers to Enrollment

• Lack of knowledge of the ACA • Political opposition to the ACA • Uncertainty about the details of the ACA• 150 plans to choose from on the Exchange • Chance of higher co-pays for clinic visits and

medications for those previously on CICP Z rating• Minimal penalty for choosing not to enroll - $95 or

1% of household income in 2014.

Overcoming Barriers to Enrollment

• Assisting individuals to sign up for Medicaid and the Exchange• Accurate and widely available information about

how the ACA will help individuals• Consistent public messages about

the benefits of health insurance

What You Can Do to Help Get People EnrolledIdentify•Most uninsured people in Denver will qualify for Medicaid or Exchange subsidies•Nearly all people with CICP will qualify for Medicaid (CICP E rating or lower and some with F rating) or Exchange subsidies•Many parents whose children have Medicaid or CHP+ will be eligible for the new coverage programs.

Household Size

Medicaid: Up to 133% of FPL

Subsidies on the Exchange:Up to 400% of FPL

1 $15,282 $45,960

2 20,628 62,040

3 25,975 78,120

4 31,322 94,200

5 36,668 110,280

6 42,015 126,360

7 47,361 142,440

8 52,708 158,520

For each additional

person, add $5,347 $16,080

What You Can Do to Help Get People Enrolled

Advise•Tell patients and clients about the importance of health insurance •Advise them what forms of coverage they might be eligible for

What You Can Do to Help Get People EnrolledRefer to Phone and Online Enrollment SitesGive patients and clients information about how to check their eligibility and sign up for Medicaid or subsidized insurance by phone or online

Phone: Toll-free: 1-800-221-3943TDD: 1-800-659-2656

Apply Online: Colorado.gov/PEAK

Phone: Toll-free: 1-855-PLANS4YOUToll-free: 1-855-752-6749

Apply Online: ConnectforHealthCO.com

What You Can Do to Help Get People EnrolledRefer to In-Person Enrollment Assistance SitesRefer clients to organizations that can assist with enrollment in Medicaid or purchasing insurance on the insurance exchange. Sites may have interpreters to help clients enroll.

Lists of sites available at: colorado.gov/apps/maps/hcpf.map

List of sites available at: connectforhealthco.com/let-us-help/assistance-network/

What You Can Do to Help Get People Enrolled

Tell People What Documents They Need•Social Security numbers, or document numbers for legal immigrants (bring card if possible)•Employer and income information for every member of the household who needs coverage (for example, from pay stubs or W-2 forms) •Policy numbers for any current health insurance plans covering members of the household •Information on job-based plans that anyone in the household is eligible for.

Medicaid and Connect for Health Colorado Enrollment Assistance Sites in Denver

Enrollment Services at Denver HealthDenver Health and its Community Health Centers throughout Denver are in-person assistance sites for both Medicaid and the insurance exchange. A person may enroll at the main location or in other locations shown here.

Call for an appointment:303-602-2300

Main Location:Denver Health Pavilion M723 Delaware StDenver, CO 80204

Same day walk-in appts are available at this location on first-come, first-serve basis

Other Locations on Campus: Women’s Care Clinic, Pavilion C790 Delaware StDavis Pavilion, Pavilion D700 Delaware StTB and Immunization Clinic Registration, Denver Public Health, Pavilion H605 Bannock St

Enrollment Locations at Denver Health Community Health CentersFor appointments call 303-602-2310 after 2PM daily

La Casa Health Center4545 Navajo St.Denver, CO 80211

Park Hill Health Center4995 E. 33rd Ave.Denver, CO 80207

Lowry Health Center1001 Yosemite St.Denver, CO 80230

Westside Health Center1100 Federal Blvd.Denver, CO 80204

Eastside Health Center501 28th St.Denver, CO 80205

Montbello Health Center12600 E. Albrook Dr.Denver, CO 80239

Westwood Health Center4320 W. Alaska St.Denver, CO 80219

Summary• ACA offers insurance coverage options for

better access to care• Insured people in Denver could increase to

94%• Expanded coverage will help Denver’s safety

net organizations continue to serve the needs of Denver residents• There are many enrollment resources to help

people get insurance• You can help by letting people know about

the benefits of insurance and telling them how to sign up or get help to sign up

83% Had Coverage

in 2011

83% Had Coverage

in 2011

% of D

enver Residents Insured%

of Denver Residents Insured

11%Gain coverage through ACA

11%Gain coverage through ACA

94%