Dolores Alvarado Townhall presentation at ICC Milpitas Oct 24, 2013 Dolores Alvarado currently serves as the CEO of Community Health Partnership of Santa Clara County, a consortium of nonprofit community health centers and clinics that promote affordable, accessible, and quality care for residents of the county. Previously, she served as Executive Manager in the Santa Clara County Public Health Department. She is a recognized leader for health services throughout the Bay Area and the state and a respected advocate on behalf of low-income and medically underserved communities. With a track record of over 30 years of experience, Dolores brings a diverse perspective from her previous work in a community health center, family planning clinic, county hospital, and university-affiliated adolescent clinic. Dolores obtained a Masters in Public Health in Maternal and Child Health and a Masters in Social Work with an emphasis in Community Health from the University of California, Berkeley.

1. The Affordable Care Act:
The Future is Now
Dolores Alvarado
Chief Executive Officer
Affordable Care Act Town Hall
India Community Center
October 24, 2013

2. Community Health Partnership

Founded in 1993 - Consortium
organization composed of 11
community health organizations, with a
total of 42 sites in Santa Clara and San
Mateo Counties

Health Care Safety Net for over
166,000 patients
 Low-Income
 Majority of patients have incomes
< 200% FPL

Health Center Patients in 2012
 Rate of unsponsored/uninsured is
5-60%
 451,883 Total Encounters

3. Community Health Partnership

4. Community Health Partnership

Our mission is to
advocate for affordable
and accessible health
services for our diverse
and multicultural
communities
regardless of
background, and to
support our members
in achieving these
goals.

5. Community Health Partnership

Preparing for 2014
 Health
Care
Coverage
 Quality Improvement
 Patient Centered
Health Home
 Electronic Health
Record Systems
and Data Analytics
 Workforce Models
 Advocacy

6. The Affordable Care Act (ACA)


Mandates consumer
protection from the health
insurance industry
Improves health care quality
while lowering costs

Demonstration Projects




Accountable Care
Organizations
Patient Centered Medical
Home
Payment Reform
Expands health coverage
and access



Medicaid/Medi-Cal
New Health Insurance
Markets/Covered California
Individual Mandate

7. ACA- Consumer Protections






No more annual or lifetime caps on health insurance
No rescinding of coverage due to chronic health conditions
No discrimination for pre-existing conditions
 Children-began in 2010
 Adults and Gender-1/1/2014
Provides no-cost preventive care and prescription discounts
 New plans must cover preventive services without deductible
or co-pay
 MediCare rebates and free preventive care
Young adults can stay on parents’ coverage until age 26
All individual and small group plans both inside and outside the
health insurance marketplaces must cover mental health
treatment at the same level as other types of care.

8. MediCal Expansion

MediCal (MediCaid) is a Government sponsored health
insurance program for low income individuals. However,
up until now, many people who met the income
requirements did not qualify for MediCal*
•
The ACA, expands MediCal eligibility to childless adults
(19-64) who make less than 138% FPL
 Individuals making up to $15,400/year
 Family of four making up to $32,500/year
 In CA, lawfully present immigrants that meet MediCal
income eligibility will be transferred to Covered CA
with benefits and costs similar to being in MediCal

9. Covered California
(Health Benefit Exchange)





An on-line “market-place” that will offer a variety of approved
health plans at various prices and benefit levels
Assistance available online, over the phone, and in-person
through Covered California Certified Enrollment Entities and
Counselors
Open enrollment (October 1, 2013-March 31, 2014)
Four types of plans will be offered: Bronze, Silver, Gold and
Platinum*
Subsidies will be available to individuals whose income is
Unsubsidized
Monthly
between 138%-400%Percent of
of FPL** Annual
•
Income
monthly
premium
premium after
subsidy
$35,137
$1187
$117
399%
Family of four:
FPL
150%

$93,700
$1187
$742
Covered California Website: www.coveredca.com

10. Changes in 2014 for Californians
with no Health Insurance
Individual
Family of Four
Coverage Options
Cost
Up to $15,856
Up to $32,499
Eligible for Medi-Cal.
Low-income Californians, who are
U.S. citizens as well as most legally
present immigrants can enroll in
Medi-Cal.
Small co-payments for
selected services.
Up to $45,960
Up to $94,200
Eligible to buy subsidized private
coverage through Covered
California.
The portion of a premium
that an individual or family
will have to pay will not
exceed a specified
percentage of income. Yearly
limits on out-of-pocket costs
also apply.
$45,961 and
above
$94,201 and
above
Required to buy private coverage.
Consumers in this income category
are ineligible for a subsidy.
Individuals who remain
uninsured will be liable for
penalties unless they qualify
for certain exemptions.

11. ACA Coverage Expansion in
Santa Clara County
Beginning in January 2014, Santa Clara County
uninsured individuals will benefit from new low-cost
health insurance programs
20,000 Low Income Health Program
participants will transition to MediCal
28,000 New MediCal enrollees
92,000 Covered CA eligible
Medi-Cal
Covered California
Remaining Uninsured
28,000
92,000
140,000
Remaining Uninsured in Santa Clara County, Regional
and County Estimates, UC Berkeley Labor Center and
UCLA Center for Health Policy Research

12. The ACA and Immigrants

Undocumented Immigrants
 Not
able to buy health insurance in the individual
market of the state insurance exchange
 Not able to apply for tax credits for premiums or
co-payments
 Not eligible for federal Medicaid, CHIP, or
Medicare
 Exception:
Eligible for Emergency Medicaid
(“Restricted Medi-Cal)
 Eligible family members of undocumented family can
apply for these federal health programs
 States can still choose to cover a broader group of
immigrants in their state-funded health programs
 Can
seek care at community health centers

13. Community Health Centers




Certified Enrollment
Counselors
Offer team-based
care as Patient
Centered Health
Homes
Community based
and led (Patient
Majority Boards)
Sliding scale fees
for uninsured

14. System Impact

Individuals and families with health
insurance/coverage are more likely to seek preventive
care



Decrease in costly emergency room use



Chronic disease management
Early detection
Uncompensated care drives up the hospital and health
insurance costs
Larger, diverse pool of participants (including young
and healthy) will eventually bring down health
insurance costs
Patient Centered Medical Home, Accountable Care
Organizations, Payment Reform will promote
efficiencies in the health care delivery system

15. References
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


Alameda Health Consortium
California Department of Health Care Services
California Mental Health Directors Association
California Primary Care Association
Community Clinic Consortium
CoveredCA.com
Healthcare.gov
Health Access
Insure the Uninsured Project (ITUP)
Kaiser Family Foundation
National Alliance on Mental Illness (NAMI)
National Association of Community Health Centers
National Immigration Law Center
Robert Wood Johnson Foundation
Substance Abuse and Mental Health Services Administration (SAMHSA)
Western Center on Law & Poverty

16. Thank You!
Dolores Alvarado
(408) 556-6605
www.chpscc.org
dolores@chpscc.org