Making Health Reform Real at the Local Level

Report
What to Expect and How to be Prepared
A presentation for CHIs, members and partners
Why Do We Need it to Work?
 So that California children and families have access to
health care and other services necessary for their
health and well-being
2
Goals of the Presentation
 ACA Policy Changes
 Role of CHIs and Partners
 Preparing for Implementation
3
4
Intent of the ACA
 Expand access to health care
 End health insurance abuses
 Improve health care affordability
 Enhance the quality of health care
5
California’s Coverage Landscape
20
Population (in millions)
15
Pre-Reform
Post-Reform
10
5
0
Employer Coverage
Individual Coverage
Medi-Cal
(Includes Healthy
Families Transition)
Uninsured
Type of Coverage
6
COUNTY’S Coverage Landscape
20
Population (in millions)
15
Pre-Reform
Post-Reform
10
5
0
Employer Coverage
Individual Coverage
Medi-Cal
(Includes Healthy
Families Transition)
Uninsured
Type of Coverage
7
Individual Mandate
 Takes effect January
2014
 Penalty enforced on
income tax filings
 Ensures a healthy
Health Insurance Penalty Phase-In Schedule
Pay the greater of the two amounts
Year
Percentage of Income
Set Dollar Amount
2014
1%
$95
2015
2%
$325
2016
2.5%
$695
insurance pool
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How the ACA Impacts Our Work
 Medi-Cal expansion
 Eligibility and enrollment processes and systems
 Covered California
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The Medi-Cal Expansion
 All individuals up to 133% FPL
 Children ages 6-18 between 100% and 133% FPL
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Eligibility and Enrollment
 New MAGI formula
 “No wrong door”
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Covered California
 A new health insurance marketplace
 CalHEERS
 Qualified Health Plans
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New Features of the Exchange
 Tax credit and cost-sharing subsidies
 Guaranteed issue
 Community rating
 Purchasing pool
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http://www.coveredca.com/media/4648/Covered_California_Getting_Covered_fact_sheet_English.pdf
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Education and Outreach
 Extensive education and outreach campaign
 20,000 to 30,000 assistors and navigators
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Navigators and In-Person Assistors
 Responsibilities include:
 Distribute fair and impartial information
 Facilitate enrollment
 Provide referrals to Consumer Assistance Programs
 Provide culturally, linguistically appropriate information
 Navigators also conduct public education
17
Certified Application Counselors
 Role defined by CMS
 Exchange will certify staff and volunteers
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A Cautionary Note
 Reimbursement for enrollment in QHP, not Medi-Cal
 The California Endowment payment partnerships:
 $13M in FY 2013-14 for assistor fees
 $6.5M in FY 2014-15 for retention assistor payments
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How to Get Ready for 2014
 Pursue partnerships
 Collect data
 Organize trainings
 Understand eligibility
 Track funding
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Pursuing Partnerships
 Re-educate traditional CHI base
 Seek out new partners
 Connect with Health and Human Services Agency
 Connect with health plans
 Advocate for those left out of coverage
22
Collecting Data
 Learn about the newly eligible
 Who are they/where are they?
 How can you reach them?
 Share successes with stakeholders
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Categories of Uninsured Workers
in California
 Adult students (18+)
 Construction
 Restaurants/food service
 Crop production
 Landscaping services
 Private households
761,000
563,000
517,000
167,000
141,000
111,000
Source: American Community Survey, U.S. Census Bureau, 2010
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Organizing Trainings
 Assess where workforce is, where it needs to be
 Personalize this presentation
 Prepare staff for new roles
 Network with your peers
25
Understanding Eligibility
 Educate staff on new changes
 Identify how changes impact procedures
 Identify what data matching is planned
 Plan new outreach efforts
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Tracking Funding
 Current sources
 Community partners
 Foundations
 Health plans
 New sources
 Assister Reimbursement Program
 Navigator Grants
 Community Outreach Grants
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It’s Happening Now!
 Know how you fit into the solution, explain your role
 Prepare CAAs for new roles
 Get up to speed on social media
 Link back to CCHI
 Do your homework!
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There Will Be Bumps in the Road
 Getting enrollment and retention right
 Preparing for the residually uninsured
 Building a strong health workforce, ensuring access
 Getting enough uptake in Covered California
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For More Information:
 Contact name, organization
Contact information
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Additional Resources






CCHI: www.cchi4families.org
Kaiser Family Foundation: www.healthreform.kff.org
Healthcare and You: www.healthcareandyou.org
Federal Health Reform: www.healthcare.gov
California HealthCare Foundation: www.chcf.org
The Exchange: www.healthexchange.ca.gov and
www.coveredca.org
 The Health Consumer Alliance: www.healthconsumer.org
 State Refor(u)m: www.statereforum.org
 Enroll America: www.enrollamerica.org
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Parting Advice…
“It is not the strongest of the species that
survives nor the most intelligent, but rather the
one most adaptable to change.”
Charles Darwin
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