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Free Clinics and the Affordable Care Act

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The Patient Protection &
Affordable Care Act (ACA)
WHAT DOES
HEALTH REFORM MEAN
FOR CABRINI CLINIC
& FOR OUR PATIENTS?
OUTLINE
пЃ¶ WHAT IS THE ACA?
пЃ¶ HOW WILL ACA HELP THE UNINSURED?
пЃ¶ WHO WILL REMAIN UNINSURED AFTER 2014?
пЃ¶ HOW WILL ACA AFFECT OUR PATIENTS &
OUR CLINIC?
пЃ¶ WHAT DO WE NEED TO DO TO PREPARE FOR
ACA?
п‚— Medicaid eligibility will be expanded to
ACA:
What
are some
of the
Benefits?
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п‚—
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п‚—
childless adults and to 133% of FPL
Above 133% of FPL, low and middle
income people and small businesses
will get subsidies to make insurance
affordable
Children can stay on parents’ plan until
26 years old
No lifetime or annual caps
No denials based on pre-existing
conditions
No co-pays or deductibles for
preventive care
80% of premium must be spent on
enrollees
Insurance companies have to justify
rate increases
Does ACA help
Free Clinics?
Some free clinics receive liability coverage
f o r t h e i r v o l u n t e e r h e a l t h p r o f e s s i o na ls
through the
Federal Tort Claims Act (FTCA).
ACA makes FTCA more attractive to
free clinics by extending that coverage to
board members, officers, employees,
and individual contractors,
but not to the clinic entity itself.
ACA:
What are
some of
the
Barriers?
п‚— The Supreme Court ruled that
States can “opt out” of
Medicaid Expansion
п‚— Political target
п‚— Critical shortage of Primary Care
Providers, especially PCPs who
accept Medicaid
п‚— The rising cost of health care
How will ACA help
the Uninsured?
пЃ¶ January 1, 2014, 30 million (of 53 million)
uninsured will be eligible for coverage
пЃ¶ Eligibility for Medicaid will increase
from 35% of Federal Poverty Level in MI
to 133% of FPL across the nation
пЃ¶ Childless adults will be eligible
This will help many of the patients we serve.
2012 Federal Poverty Levels
2013 FPL
100%
MI - 35%
133%
400%
Individual
$11,490
$ 4,022
$15,282
$45,960
Family of 4
$23,550
$ 8,243
$31,322
$94,200
Timeline
for ACA
2010
2012
2011-2014
2014
п‚— President Obama signed ACA into
law. Implementation is over the
next few years.
п‚— The Supreme Court ruled that
Medicaid Expansion is optional for
the states.
п‚— Planning and implementation at
federal and state levels. Numbers of
uninsured continue to grow.
п‚— Up to 30 million will become eligible
for coverage, either through
Medicaid expansion or the
exchanges.
Timeline for
ACA cont’d.
2014-2019
2019
п‚— Eligible persons will be enrolled in
Medicaid and other programs
beginning Oct. 1, 2013. The numbers
of uninsured will gradually decline.
п‚— The newly insured will try to find a
medical home, but face a critical
shortage of Primary Care Providers,
especially PCPs accepting Medicaid.
п‚— The number of uninsured will level
off to those who are not eligible for
coverage through ACA,
approximately 29M persons.
Medicaid Expansion
is Critical!
THE SUPREME COURT OF THE USA RULED THAT
EXPANSION OF MEDICAID IS OPTIONAL,
STATE BY STATE.
GOVERNOR SNYDER RECOMMENDS MEDICAID
EXPANSION FOR MICHIGAN, BUT THE STATE
LEGISLATURE TOOK IT OUT OF HIS BUDGET.
FREE CLINICS NEED TO ADVOCATE FOR
MEDICAID EXPANSION
IN MICHIGAN AND OTHER STATES
п‚— Undocumented immigrants
Even with
Medicaid
Expansion,
who will
remain
uninsured?
п‚— Naturalized citizens here < 5 yrs.
п‚— Choose to pay the penalty rather than
п‚—
п‚—
п‚—
п‚—
And where
will they
find care?
п‚—
acquire insurance
Eligible but unenrolled
Coverage is not affordable
In between coverage, due to income
change
Those <133% of FPL in states that opt
out of M/A expansion
Citizens who cannot pull together the
documentation required to apply
п‚— Many uninsured clients of our
ACA:
Implications
for
Free Clinics
п‚—
п‚—
п‚—
п‚—
free clinic may be eligible for
Medicaid
Our clients will need help
through the transition
Potential negative impact on our
donors and volunteers?
Potential negative impact on our
relationship to area hospitals?
We need to re-evaluate our
mission and services, and educate
our community on the impact of
ACA.
What is the experience
of free clinics in states where
most of the uninsured received coverage?
пЃ¶
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VT, WI, and MA received federal waivers to expand Medicaid
for uninsured. What happened to free clinics in these states?
None closed; in fact volume continued to grow.
Free Clinics helped enroll and navigate patients through the changes.
Patients moved in and out of coverage as their income changed, e.g.
with seasonal jobs. They required a lot of help navigating the system.
PCP shortage, especially of PCPs who will accept Medicaid, resulted in
some free clinics providing care to Medicaid patients but not billing.
Dental Care and Rx Assistance remain huge gaps in service.
What Questions Should We Be Asking?
п‚— Will Michigan opt for expansion of Medicaid?
п‚— What will be the impact of the ACA on our clinic?
п‚— How many of our patients will receive insurance coverage
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under ACA? Where will they find care?
Who will remain uninsured in our community?
Will our clinic be needed post-2019? Whom will we serve?
What do we need to do to prepare for ACA changes?
What options are open to us for the future?
Are we eligible to be a FQHC, and should we consider
becoming or partnering with a FQHC?
What if ACA is not implemented?
Other questions?
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