Affordable Care Act - The future is now.


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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.

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  • *Primarily Childless Adults
  • *Silver is the mid-range plan. **Average individual cost for a Silver plan is estimated to be approximately $321/mo before subsidies. Subsidies will be on a sliding scale basis.
  • Affordable Care Act - The future is now.

    1. 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. 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. 3. Community Health Partnership
    4. 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. 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. 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. 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. 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. 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:
    10. 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. 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. 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. 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. 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. 15. References                 Alameda Health Consortium California Department of Health Care Services California Mental Health Directors Association California Primary Care Association Community Clinic Consortium 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. 16. Thank You! Dolores Alvarado (408) 556-6605