Affordable Care Act (ACA)

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Affordable Care Act (ACA)
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What is the Affordable Care Act?

• Patient Protection and Affordable Care Act
  (PPACA), a.k.a. ACA
• Federal health care reform law
• March 23, 2010 signed into law by President Obama
• Goals
• Expand coverage
• Control health care costs
• Improve health care delivery system

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What does it do?

• Requires coverage regardless of pre-existing
  conditions or gender
• Intended to increase rate of individuals covered
  by insurance through
• Creation of insurance exchanges and expansion of
  Medicaid eligibility
• Mandates on employers and individuals
• Premium subsidies
• Tax credits
• Intended to decrease number of uninsured
  individuals

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What does it establish?

• Facilitates provision of qualified health
  coverage
• Mandates health benefit exchanges (also known as
  Marketplaces) by January 2014 in every state
• Regulatory overhaul of the U.S. healthcare system

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State Requirements Insurance Exchanges

• Choose an Insurance Exchange Option by December
  14, 2012
• 3 options

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What role will be played by the FFM?

• The federally facilitated exchange is also
  referred to as the FFE or federally facilitated
  marketplace (FFM).
• Individuals may apply for insurance through the
  Exchange.
• The Exchange will determine eligibility for
• Advanced Premium Tax Credit (APTC)
• Cost Sharing Reductions (CSR)

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What are APTC and CSR?

• Advance Premium Tax Credit (APTC) A new tax
  credit to help individuals and families afford
  health coverage purchased through the Exchange.
• Cost Sharing Reduction (CSR) A discount that
  lowers the amount paid out-of-pocket for
  deductibles, coinsurance, and copayments.

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How does ACA affect DPW?

• What Has DPW Already Done Related to ACA?
• Extended Medicaid Drug Rebates to drugs paid by
  Medicaid Managed Care Organizations.
• Implemented several new program integrity and
  provider enrollment screening processes.
• Began paying increased payments to Medicaid
  primary care providers.
• Implemented a recovery audit contract to identify
  payment issues and recoup overpayments.
• Implemented payment policies for hospitals that
  prohibited payment for a Health-Care Acquired
  Condition, such as infections acquired at the
  hospital.

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How does ACA affect DPW?

• One goal of ACA is to provide a seamless and
  simplified enrollment process for all Insurance
  Affordability programs. Pennsylvania will
  accomplish this requirement for simplified
  enrollment by providing multiple ways to apply,
  including
• Exchange
• Electronic Application
• Paper Application
• New Pennsylvania paper application form called
  the PA 600HC
• COMPASS Updated to comply with ACA
• Phone Applications
• There is no wrong door when
• applying for Medical Assistance
• and other Health Care Plans!

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How does ACA affect DPW?

• The Modified Adjusted Gross Income (MAGI)
  standard will now be used for Medicaid
  eligibility.
• MAGI will apply to adults, children, pregnant
  women, parents, caretaker relatives, and
  individuals eligible for family planning
  services.
• MAGI does NOT apply to SSI recipients children
  in foster care individuals eligible based on
  being aged, blind, or disabled working disabled
  or individuals in a facility/eligible for home
  and community based care.

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What is Early MAGI?

• PA applied for an Early MAGI waiver to start MAGI
  October 1, 2013 rather than January 1, 2014.
• Early MAGI will increase efficiency and reduce
  duplicative processes in the County Assistance
  Offices.

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How does ACA affect DPW?

• Medicaid Eligibility Changes
• Children ages 6-18 - Income up to 133 of Federal
  Poverty Level (FPL)
• Former foster care children up to age 26
• ACA will NOT change eligibility or benefits for
  our waiver programs for individuals with physical
  and intellectual disabilities.

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System Updates and Enhancements

• COMPASS
• System design, screening, eligibility questions
  and routing
• Ability to link to Federal Exchange
• Ability to obtain information from data matches
  in real time
• CIS/eCIS/PROMISe
• Medicaid eligibility rules under ACA
• System design and screen changes

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Consumer Service Center (CSC)

• The Commonwealth has taken steps to ensure that
  the needs of its citizens are met under the new
  Federal ACA mandate.
• CMS mandates the availability of a call center to
  take applications on the phone for ACA.
• The CSC opened on October 1, 2013 to answer
  questions about ACA and take COMPASS applications
  for health care only.

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Critical Milestones

• October 2013
• Enrollment applications under the new Modified
  Adjusted Gross Income (MAGI) eligibility rules
  begin to be accepted
• January 2014
• Exchange coverage begins for Pennsylvania

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Questions and Comments

• More information on Pennsylvanias implementation
  of the Affordable Care Act is available at
  www.dpw.state.pa.us.