The document provides an overview of the Affordable Care Act (ACA) and its implementation in California. It discusses how the ACA expands Medicaid (Medi-Cal) coverage and creates health insurance exchanges to cover the uninsured. It also addresses eligibility, enrollment, plan options, and the roles of social workers in outreach and advocacy.
The document discusses California's implementation of the Affordable Care Act. It aims to achieve universal coverage through Medicaid expansion and private health plans on the state's health insurance exchange. While coverage will increase, some groups like unauthorized immigrants will remain uninsured. The state is promoting enrollment through navigators and assisters. It is also working to protect consumers through insurance market reforms and establish essential health benefits. Accountable care organizations are being developed to coordinate care delivery and lower costs. Community health workers play an important role in care coordination and outreach.
Affordable care act NASW Annual Conference 2013Janlee Wong
The document discusses how the Affordable Care Act (ACA) affects health insurance coverage in California. It notes that around 15% of Californians are affected by the ACA because they previously lacked health insurance or had unaffordable coverage. The ACA expands Medicaid eligibility and provides subsidies for private health plans purchased through the state's health insurance exchange, Covered California. It outlines the various plans offered through Covered California and the eligibility criteria for financial assistance. The document also discusses the role of social workers and community health workers in supporting the implementation of the ACA.
This document provides an overview of key elements of the Affordable Care Act (ACA), including who is covered, what is covered, who pays for coverage, and how to get covered. It discusses the goals of universal coverage and affordable health plans. It also outlines provisions such as health insurance exchanges, Medicaid expansion, essential health benefits, accountable care organizations, and impacts on employers and individuals.
The document discusses Accountablecare Service Organization (ASO), which aims to establish accountable care organizations (ACOs) under the new Medicare program rules. ASO provides a complete "ACO-in-a-Box" toolkit and services to help qualify as an ACO, including business planning, legal services, electronic medical records, cost-savings programs like clinical trials and generic prescriptions, marketing services, and wellness partner programs focused on preventative care and community involvement. The goal is for ACOs established with ASO's help to save up to $960 million in healthcare costs over three years while improving quality of care.
The purpose of the webinar is to learn more about the value of the Medicaid expansion and how it could impact Ohio. We will also share resources to help you talk about the issue in your community.
Affordable Care Act - The future is now. adityaullal1
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.
The document discusses key issues related to health reform implementation for safety net health systems. It provides an overview of the National Association of Public Hospitals and Health Systems (NAPH), which advocates for safety net hospitals. The document outlines provisions of the Affordable Care Act related to coverage expansion, exchanges, provider payments, and innovation opportunities. It identifies challenges and questions for safety net health systems to consider regarding health reform implementation.
The document discusses California's implementation of the Affordable Care Act. It aims to achieve universal coverage through Medicaid expansion and private health plans on the state's health insurance exchange. While coverage will increase, some groups like unauthorized immigrants will remain uninsured. The state is promoting enrollment through navigators and assisters. It is also working to protect consumers through insurance market reforms and establish essential health benefits. Accountable care organizations are being developed to coordinate care delivery and lower costs. Community health workers play an important role in care coordination and outreach.
Affordable care act NASW Annual Conference 2013Janlee Wong
The document discusses how the Affordable Care Act (ACA) affects health insurance coverage in California. It notes that around 15% of Californians are affected by the ACA because they previously lacked health insurance or had unaffordable coverage. The ACA expands Medicaid eligibility and provides subsidies for private health plans purchased through the state's health insurance exchange, Covered California. It outlines the various plans offered through Covered California and the eligibility criteria for financial assistance. The document also discusses the role of social workers and community health workers in supporting the implementation of the ACA.
This document provides an overview of key elements of the Affordable Care Act (ACA), including who is covered, what is covered, who pays for coverage, and how to get covered. It discusses the goals of universal coverage and affordable health plans. It also outlines provisions such as health insurance exchanges, Medicaid expansion, essential health benefits, accountable care organizations, and impacts on employers and individuals.
The document discusses Accountablecare Service Organization (ASO), which aims to establish accountable care organizations (ACOs) under the new Medicare program rules. ASO provides a complete "ACO-in-a-Box" toolkit and services to help qualify as an ACO, including business planning, legal services, electronic medical records, cost-savings programs like clinical trials and generic prescriptions, marketing services, and wellness partner programs focused on preventative care and community involvement. The goal is for ACOs established with ASO's help to save up to $960 million in healthcare costs over three years while improving quality of care.
The purpose of the webinar is to learn more about the value of the Medicaid expansion and how it could impact Ohio. We will also share resources to help you talk about the issue in your community.
Affordable Care Act - The future is now. adityaullal1
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.
The document discusses key issues related to health reform implementation for safety net health systems. It provides an overview of the National Association of Public Hospitals and Health Systems (NAPH), which advocates for safety net hospitals. The document outlines provisions of the Affordable Care Act related to coverage expansion, exchanges, provider payments, and innovation opportunities. It identifies challenges and questions for safety net health systems to consider regarding health reform implementation.
The document provides an overview of accountable care organizations (ACOs) including:
1) ACOs aim to tie provider reimbursements to quality and reduce total cost of care for assigned patients.
2) Key stakeholders include providers, payers (primarily Medicare), and patients (primarily Medicare beneficiaries).
3) The concept of ACOs originated in 2006 but builds on prior models. Successful implementation remains challenging.
4) The Patient Protection and Affordable Care Act supports the development of ACOs and other innovative models.
This document provides an overview of a presentation on legal rights for people who are poor or have disabilities. The presentation covered topics including the Affordable Care Act, Pennsylvania welfare sanction policy, consumer law basics, and Social Security Disability benefits. It began with opening remarks and then consisted of multiple sessions presented by legal experts on each topic. The presenters discussed major provisions of laws and policies, explained key concepts, and outlined processes and issues clients may face. The goal was to educate attendees on important legal rights and help them understand complex social programs.
The document discusses the similarities and differences between the Massachusetts health reform law known as "Romneycare" and the federal Patient Protection and Affordable Care Act known as "Obamacare". Both laws require individuals to have health insurance, create state-based health insurance exchanges, and provide subsidies for lower-income households. However, the ACA covers more people nationwide and optionally expands Medicaid eligibility, while Romneycare only expanded coverage for certain groups in Massachusetts. The document also outlines some perceived pros and cons of the ACA.
The document discusses major changes that will occur in 2014 under the Affordable Care Act (ACA) and their predicted effects. It outlines provisions of the ACA including no denial of coverage for pre-existing conditions, Medicaid expansion, health insurance exchanges, and individual mandates. It predicts that 1.8-2.7 million uninsured Californians will gain coverage, but 3.1-4 million will remain uninsured, including undocumented immigrants and those who do not enroll despite being eligible. Safety net clinics will need to educate patients about options and continue serving the uninsured. Outreach efforts will be critical to enrollment and the law's success.
United Health Group Measures of Quality, Affordability, Accessibility and Usa...finance3
This document discusses measures of quality, affordability, accessibility, and usability in healthcare as promoted by UnitedHealth Group. It provides numerous statistics on clinical quality reports sent to physicians, accredited health plans, individuals with access to specialized care networks, annual healthcare spending represented, prescription drug savings, and uninsured eligible for new benefits programs. Overall, the document aims to showcase UnitedHealth Group's efforts in science-based decision making, cost-effective relationships, consumer-driven products, and organized services to improve the healthcare system.
This document provides an overview and summary of a presentation on planning for success in the transition to Medicaid managed care. The presentation covers the growing trend of states transitioning Medicaid programs to managed care, challenges with integrating high-needs populations, lessons from early adopters, and how providers can plan for success. Key points include that over 70% of Medicaid enrollees are now in managed care plans, states are using managed care to improve outcomes, control costs and test new payment models, and providers should engage with plans, understand contracting and billing requirements, and document any issues that arise.
The Affordable Care Act is a comprehensive health reform law that was passed in 2010. It expands access to health insurance coverage through Medicaid expansion, health insurance exchanges, and prohibiting denial of coverage for pre-existing conditions. It also enhances Medicare benefits, provides consumer protections, and focuses on prevention, wellness, and public health. The law aims to increase the number of Americans with health insurance and decrease the cost of health care.
Please Help Me Understand the Affordable Care Act....No Politics Please!!!!HRBIMS
The document defines key terms related to the Affordable Care Act, provides some statistics, discusses the year 2015, and notes that forms can be found. Specifically, it defines terms like essential health benefits, grandfathered health plans, and the health insurance marketplace. It also outlines the different categories of health plans in the marketplace based on costs and covers.
Got Healthcare? Affordable Care Act PP (July 2013)Kevin Kane
The Affordable Care Act presentation that Citizen Action of Wisconsin presents with around the state. How the ACA impacts you and how to talk about it.
Rising healthcare costs are driving large-scale changes in the health insurance market. Insurers are merging with health systems to better manage costs. New market entrants like Oscar, Clover, and Nuna are using data and technology to improve care coordination. Private insurance exchanges allow larger employers to define contributions for workers to purchase plans. The use of high-deductible health plans paired with health savings accounts is increasing as a way for consumers to have more control over healthcare spending. Upcoming bipartisan legislation aims to further reforms to HSAs to accommodate chronic disease prevention and wellness.
mHealth Israel_US Health Insurance Overview- An Insider's PerspectiveLevi Shapiro
Presentation about the US Health Insurance Sector by Lori Rund, VP, Product Management and Market Intelligence at Health Alliance Plan, a managed care organization owned by the Henry Ford Health System, with 650,000 lives. Lori is responsible for the identification, concept building, researching and business case developments for new products, services and markets. She develops and leads comprehensive market intelligence functions to help the organization better understand industry trends and identify business opportunities.
Prior to joining Health Alliance Plan, Lori was Director of Product Development and Market Intelligence at Health Alliance Medical Plans in Illinois and Director of Market Research and Strategy at Carle Clinic Association, also in Illinois.
Federally Qualified Health Centers (FQHCs) provide critical primary care services to underserved communities but face funding challenges. They save billions for the healthcare system through reduced emergency room visits and hospitalizations. While the Affordable Care Act increased funding, cuts to Medicaid and state funding threaten their ability to meet growing demand. Private donations are needed to sustain FQHC programs and services that improve health outcomes and drive local economic growth through jobs and purchases.
The document discusses how the Affordable Care Act's insurance reforms could support primary care. It outlines the AAFP's policy of ensuring all Americans have health coverage and access to team-based primary care. The AAFP recommends that health insurance exchanges require plans to provide this type of primary care. The document also discusses issues around defining essential health benefits, coordinating exchanges with Medicaid, the impact of exchanges in Illinois, and questions for family physicians around exchanges.
The Medicaid Advisory Committee submitted recommendations to the Oregon Health Policy Board to reduce coverage disruptions caused by churn between the Oregon Health Plan (Medicaid) and private Qualified Health Plans. The committee reviewed evidence on churn's historical impacts and characteristics of those likely to churn under the Affordable Care Act. It recommended strategies to simplify Medicaid eligibility processes, align income calculation periods between Medicaid and tax credits, study 12-month continuous Medicaid eligibility, and establish performance metrics to monitor churn. Additional long-term recommendations included facilitating care transitions between plans and promoting alignment between Medicaid coordinated care organizations and commercial plans.
Aetna Presentation Social Determinants of Latino HealthDanny Santibanez
Social Determinants of Hispanic/Latino Health
Daniel Santibanez, MPH, RD, University of North Florida
September 23, 2005 - UNF Hispanic Health Issues Seminars
This is part 8 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of the Duval County Health Department.
This document summarizes a white paper about integrated benefit programs for dual eligible beneficiaries (those eligible for both Medicare and Medicaid). It discusses the high costs of care for dual eligibles, various existing programs that coordinate Medicare and Medicaid benefits, and features of recent dual eligibility demonstration programs. Key programs mentioned include the Financial Alignment Initiative testing capitated and managed fee-for-service models in 12 states, and State Innovation Model initiatives investing $1 billion in delivery system reforms across 38 states/territories. The document examines guidance from CMS on desired elements of future dual eligibility demonstration programs.
IHC -- Health reform: What it means and what's nextGalen Institute
This document summarizes key points about the current state of health reform and what may happen next:
- The Affordable Care Act aims to expand coverage to 32 million more Americans but 23 million will remain uninsured. It establishes insurance mandates and exchanges and cuts Medicare spending.
- While early benefits of the law are popular, the law remains unpopular due to concerns about higher costs for taxpayers and consumers. Up to 80 million Americans could be forced to change their health plans.
- Implementation of the law faces challenges through legal challenges, heavy regulation, and political debates during the 2012 election.
- Opportunities exist to reshape the policy debate and push for a more dynamic, personalized system that engages
The Affordable Care Act: Success or Failure?
Janet Coffman, MPP, PhD
Edward Yelin, PhD
GME Grand Rounds 4/15/14
UCSF San Francisco
http://medschool2.ucsf.edu/gme/
This document summarizes key aspects of health care reform related to homeless families and youth. It discusses how the Affordable Care Act expands Medicaid eligibility for youth and reduces costs for families. It then provides details on Medicaid eligibility categories and coverage groups impacted by the reforms. The rest of the document outlines core Medicaid concepts, different means of covering services including waivers and managed care, and concludes with an overview of Louisiana's permanent supportive housing program.
The document provides an overview of accountable care organizations (ACOs) including:
1) ACOs aim to tie provider reimbursements to quality and reduce total cost of care for assigned patients.
2) Key stakeholders include providers, payers (primarily Medicare), and patients (primarily Medicare beneficiaries).
3) The concept of ACOs originated in 2006 but builds on prior models. Successful implementation remains challenging.
4) The Patient Protection and Affordable Care Act supports the development of ACOs and other innovative models.
This document provides an overview of a presentation on legal rights for people who are poor or have disabilities. The presentation covered topics including the Affordable Care Act, Pennsylvania welfare sanction policy, consumer law basics, and Social Security Disability benefits. It began with opening remarks and then consisted of multiple sessions presented by legal experts on each topic. The presenters discussed major provisions of laws and policies, explained key concepts, and outlined processes and issues clients may face. The goal was to educate attendees on important legal rights and help them understand complex social programs.
The document discusses the similarities and differences between the Massachusetts health reform law known as "Romneycare" and the federal Patient Protection and Affordable Care Act known as "Obamacare". Both laws require individuals to have health insurance, create state-based health insurance exchanges, and provide subsidies for lower-income households. However, the ACA covers more people nationwide and optionally expands Medicaid eligibility, while Romneycare only expanded coverage for certain groups in Massachusetts. The document also outlines some perceived pros and cons of the ACA.
The document discusses major changes that will occur in 2014 under the Affordable Care Act (ACA) and their predicted effects. It outlines provisions of the ACA including no denial of coverage for pre-existing conditions, Medicaid expansion, health insurance exchanges, and individual mandates. It predicts that 1.8-2.7 million uninsured Californians will gain coverage, but 3.1-4 million will remain uninsured, including undocumented immigrants and those who do not enroll despite being eligible. Safety net clinics will need to educate patients about options and continue serving the uninsured. Outreach efforts will be critical to enrollment and the law's success.
United Health Group Measures of Quality, Affordability, Accessibility and Usa...finance3
This document discusses measures of quality, affordability, accessibility, and usability in healthcare as promoted by UnitedHealth Group. It provides numerous statistics on clinical quality reports sent to physicians, accredited health plans, individuals with access to specialized care networks, annual healthcare spending represented, prescription drug savings, and uninsured eligible for new benefits programs. Overall, the document aims to showcase UnitedHealth Group's efforts in science-based decision making, cost-effective relationships, consumer-driven products, and organized services to improve the healthcare system.
This document provides an overview and summary of a presentation on planning for success in the transition to Medicaid managed care. The presentation covers the growing trend of states transitioning Medicaid programs to managed care, challenges with integrating high-needs populations, lessons from early adopters, and how providers can plan for success. Key points include that over 70% of Medicaid enrollees are now in managed care plans, states are using managed care to improve outcomes, control costs and test new payment models, and providers should engage with plans, understand contracting and billing requirements, and document any issues that arise.
The Affordable Care Act is a comprehensive health reform law that was passed in 2010. It expands access to health insurance coverage through Medicaid expansion, health insurance exchanges, and prohibiting denial of coverage for pre-existing conditions. It also enhances Medicare benefits, provides consumer protections, and focuses on prevention, wellness, and public health. The law aims to increase the number of Americans with health insurance and decrease the cost of health care.
Please Help Me Understand the Affordable Care Act....No Politics Please!!!!HRBIMS
The document defines key terms related to the Affordable Care Act, provides some statistics, discusses the year 2015, and notes that forms can be found. Specifically, it defines terms like essential health benefits, grandfathered health plans, and the health insurance marketplace. It also outlines the different categories of health plans in the marketplace based on costs and covers.
Got Healthcare? Affordable Care Act PP (July 2013)Kevin Kane
The Affordable Care Act presentation that Citizen Action of Wisconsin presents with around the state. How the ACA impacts you and how to talk about it.
Rising healthcare costs are driving large-scale changes in the health insurance market. Insurers are merging with health systems to better manage costs. New market entrants like Oscar, Clover, and Nuna are using data and technology to improve care coordination. Private insurance exchanges allow larger employers to define contributions for workers to purchase plans. The use of high-deductible health plans paired with health savings accounts is increasing as a way for consumers to have more control over healthcare spending. Upcoming bipartisan legislation aims to further reforms to HSAs to accommodate chronic disease prevention and wellness.
mHealth Israel_US Health Insurance Overview- An Insider's PerspectiveLevi Shapiro
Presentation about the US Health Insurance Sector by Lori Rund, VP, Product Management and Market Intelligence at Health Alliance Plan, a managed care organization owned by the Henry Ford Health System, with 650,000 lives. Lori is responsible for the identification, concept building, researching and business case developments for new products, services and markets. She develops and leads comprehensive market intelligence functions to help the organization better understand industry trends and identify business opportunities.
Prior to joining Health Alliance Plan, Lori was Director of Product Development and Market Intelligence at Health Alliance Medical Plans in Illinois and Director of Market Research and Strategy at Carle Clinic Association, also in Illinois.
Federally Qualified Health Centers (FQHCs) provide critical primary care services to underserved communities but face funding challenges. They save billions for the healthcare system through reduced emergency room visits and hospitalizations. While the Affordable Care Act increased funding, cuts to Medicaid and state funding threaten their ability to meet growing demand. Private donations are needed to sustain FQHC programs and services that improve health outcomes and drive local economic growth through jobs and purchases.
The document discusses how the Affordable Care Act's insurance reforms could support primary care. It outlines the AAFP's policy of ensuring all Americans have health coverage and access to team-based primary care. The AAFP recommends that health insurance exchanges require plans to provide this type of primary care. The document also discusses issues around defining essential health benefits, coordinating exchanges with Medicaid, the impact of exchanges in Illinois, and questions for family physicians around exchanges.
The Medicaid Advisory Committee submitted recommendations to the Oregon Health Policy Board to reduce coverage disruptions caused by churn between the Oregon Health Plan (Medicaid) and private Qualified Health Plans. The committee reviewed evidence on churn's historical impacts and characteristics of those likely to churn under the Affordable Care Act. It recommended strategies to simplify Medicaid eligibility processes, align income calculation periods between Medicaid and tax credits, study 12-month continuous Medicaid eligibility, and establish performance metrics to monitor churn. Additional long-term recommendations included facilitating care transitions between plans and promoting alignment between Medicaid coordinated care organizations and commercial plans.
Aetna Presentation Social Determinants of Latino HealthDanny Santibanez
Social Determinants of Hispanic/Latino Health
Daniel Santibanez, MPH, RD, University of North Florida
September 23, 2005 - UNF Hispanic Health Issues Seminars
This is part 8 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of the Duval County Health Department.
This document summarizes a white paper about integrated benefit programs for dual eligible beneficiaries (those eligible for both Medicare and Medicaid). It discusses the high costs of care for dual eligibles, various existing programs that coordinate Medicare and Medicaid benefits, and features of recent dual eligibility demonstration programs. Key programs mentioned include the Financial Alignment Initiative testing capitated and managed fee-for-service models in 12 states, and State Innovation Model initiatives investing $1 billion in delivery system reforms across 38 states/territories. The document examines guidance from CMS on desired elements of future dual eligibility demonstration programs.
IHC -- Health reform: What it means and what's nextGalen Institute
This document summarizes key points about the current state of health reform and what may happen next:
- The Affordable Care Act aims to expand coverage to 32 million more Americans but 23 million will remain uninsured. It establishes insurance mandates and exchanges and cuts Medicare spending.
- While early benefits of the law are popular, the law remains unpopular due to concerns about higher costs for taxpayers and consumers. Up to 80 million Americans could be forced to change their health plans.
- Implementation of the law faces challenges through legal challenges, heavy regulation, and political debates during the 2012 election.
- Opportunities exist to reshape the policy debate and push for a more dynamic, personalized system that engages
The Affordable Care Act: Success or Failure?
Janet Coffman, MPP, PhD
Edward Yelin, PhD
GME Grand Rounds 4/15/14
UCSF San Francisco
http://medschool2.ucsf.edu/gme/
This document summarizes key aspects of health care reform related to homeless families and youth. It discusses how the Affordable Care Act expands Medicaid eligibility for youth and reduces costs for families. It then provides details on Medicaid eligibility categories and coverage groups impacted by the reforms. The rest of the document outlines core Medicaid concepts, different means of covering services including waivers and managed care, and concludes with an overview of Louisiana's permanent supportive housing program.
The document provides an overview of health care reform under the Affordable Care Act and how it impacts people living with HIV/AIDS in California. Key points include:
- The status quo has led to an access to care crisis for people with HIV as few have employer insurance. Health care reform aims to expand coverage and protections.
- Reforms include an individual mandate, Medicaid expansion, subsidies through insurance marketplaces, and protections like prohibiting denial of coverage for pre-existing conditions.
- In California, the Medi-Cal program will expand up to 138% of the federal poverty level and higher incomes can purchase plans through Covered California with subsidies.
- Transitions lie ahead for those currently
FLAACOs 2014 Conference - Shift in the Payer Movement in the Provider Space t...MARCYINC
Shift in the Payer Movement in the Provider Space to Augment the Movement of Value Based Integrated Payments - The Evolution to Health Solutions presented by Jon Gavras, MD at the FLAACOs Fall 2014 Conference
The Affordable Care Act requires Medicare patients to pay out-of-pocket for colorectal cancer screenings if a polyp is found and removed. However, if no polyp is found, patients pay nothing. This creates a disincentive for screenings and is an unintended consequence that needs fixing. Earlier cancer detection through screening reduces costs and saves lives. Representatives need to be educated on this oversight so they can quickly correct the Medicare policy and remove barriers to important cancer screenings.
Explore how the Affordable Care Act and creation of state level and national exchanges has impacted member risk profiles and demand for small-group and individual health plans.
William Shrank: Payment reform activities at CMSNuffield Trust
The document discusses activities at the CMS Innovation Center to test new payment and service delivery models. It outlines several initiatives to improve care coordination, such as ACO models and medical home programs. It also discusses initiatives to improve care quality like Partnership for Patients and reduce costs through bundled payments. Rapid-cycle evaluation is highlighted as important to provide feedback to support continuous quality improvement and identify successful models to scale nationally.
ACA: A Step Toward Healthcare For All (Dr. John Cavacece, DO)Zach Jarou
Presented to the American Medical Student Association (www.AMSA.org) at Michigan State University's College of Human Medicine (MSU CHM) on Tuesday, March 20, 2012
The document summarizes key provisions of the Affordable Care Act (ACA) and how it aims to improve access to affordable health care. It discusses how the law expands coverage to millions of uninsured Americans through Medicaid expansion and health insurance exchanges. It also outlines important consumer protections now required of health plans, such as prohibiting denial of coverage due to pre-existing conditions. The document also highlights how the ACA strengthens Medicare and aims to reduce health care costs.
View this powerpoint delivered by Rita Landgraf, secretary of the Division of Health and Social Services for the State of Delaware about the Health Care Reform Legislation. This presentation was given on June 2, 2010 at the Delaware State Chamber of Commerce's End-of-Session Legislative Brunch at Dover Downs.
Medicaid: An Edge of Your Seat View of Medicaid Risk Adjustment by Merrill Ha...Altegra Health
WellCare Health Plans is a large managed care organization that serves over 3.3 million Medicaid and Medicare members nationwide. It has over 176,000 providers and 67,000 pharmacies in its network. WellCare serves 1.8 million Medicaid members across 9 states, as well as over 1.5 million Medicare members, including those in Medicare Advantage plans, Prescription Drug Plans, and Medicare Supplement plans. The company aims to enhance members' health, provide quality and cost-effective care, and create a rewarding work environment for its 5,700 associates located across the country.
The document summarizes key provisions of the Affordable Care Act (ACA). It discusses how the ACA aims to reduce health care costs, provide Americans with access to affordable health coverage, strengthen Medicare and Medicaid, and modernize the health care system. It outlines significant changes to private health insurance including prohibiting denial of coverage for pre-existing conditions and requiring coverage of essential health benefits. The ACA also provides tax credits to help individuals and small businesses purchase insurance and strengthens Medicaid.
The best of both worlds: Uniting universal coverage and personal choice in he...AEI
The document proposes a new health care reform plan called "Best of Both Worlds" that aims to balance universal coverage with personal choice. It would create a national health insurance exchange with standardized basic plans and income-based premium supports. It also calls for removing the tax exemption for employer-provided health insurance and implementing a safety-net tax to finance minimum emergency care for all Americans. The plan is estimated to reduce spending compared to the Affordable Care Act while expanding access and protecting low-income and sick individuals.
This document discusses state health care policy issues in 2012, including:
1. State budgets have faced large cumulative budget gaps between 2002-2013 totaling over $820.5 billion, putting pressure on states to cut programs.
2. The Affordable Care Act provides opportunities for states through expanding Medicaid eligibility and benefits, establishing health insurance exchanges, and pilot programs.
3. Key policy issues for states in 2012 include implementing health reform, addressing ongoing budget shortfalls, and debating scope of practice and workforce laws.
Introduction to the new Illinois Medicare-Medicaid Alignment Initiativebjlederman1
The document summarizes Illinois' Medicare-Medicaid Alignment Initiative to integrate care and financing for dual eligible beneficiaries (9 million Americans enrolled in both Medicare and Medicaid). It aims to improve quality of care while lowering costs by 1-5% annually through care coordination and capitated managed care plans. Key aspects include voluntary enrollment of 135,825 beneficiaries in capitated financial models, unified processes, and testing through the Center for Medicare and Medicaid Innovation's financial alignment demonstrations in six states.
This document provides a summary of Virginia's Medicaid program and the status of health care reform efforts in the state. It outlines Virginia's Medicaid eligibility levels, enrollment trends, expenditures, and service delivery structure. It then discusses the state's goals for Medicaid reform, including implementing the Affordable Care Act expansion and establishing a more efficient, coordinated system. The document reviews the progress and estimated savings of Virginia's multi-phase Medicaid reform plan, including initiatives involving the dual eligible population, program integrity, and behavioral health services.
Upon completion of this discussion forum, participants will:
- Learn about governmental programs and eligibility criteria for accessing care
- Gain tools to reduce and manage outstanding medical costs
- Better understand benefits of the ACA relative to cancer care
- Become informed of laws protecting their right to health coverage
- Understand the Social Security Disability approval process
Health Access Care4All California PowerPoint 12 10-2018Nancy Marisa Gomez
This document summarizes a convening held by Health Access California on December 10, 2018 to discuss efforts to expand health care access and affordability in the state. The meeting brought together over 60 organizations and discussed legislative priorities around protecting consumers from federal attacks on the ACA, expanding coverage to all Californians, and reducing health care costs. Bills introduced to expand Medi-Cal coverage to undocumented adults were discussed. Stakeholders also reviewed opportunities and challenges in the new legislative session under a new governor to further progress toward universal and affordable coverage.
The document summarizes Washington State's Healthier Washington initiative, which aims to transform Medicaid (Apple Health) delivery over five years through three main strategies:
1) Integrating physical and behavioral healthcare and moving to value-based payments through Accountable Communities of Health.
2) Providing long-term services and supports to delay need for intensive care.
3) Supporting housing and employment through Medicaid benefits.
A major focus is applying an equity lens to reduce disparities and address social determinants of health like housing, by engaging communities and considering equity in project selection. The goals are better health outcomes while saving costs through a smarter, transformed system.
Harvard's Robert Greenwald on Texas MedicaidOneVoiceTexas
Robert Greenwald, JD, Clinical Professor of Law and Director of Center for Health Law and Policy Innovation at Harvard Law School, presented an in-depth analysis forum of the federal health reform Affordable Care Act and associated transformation of the Texas Medicaid system. On January 24 in Austin, he spoke to sever audiences on the challenges and opportunities specific to Texas including why the Affordable Care Act’s Medicaid expansion is so important to the provision of cost- effective, high quality care and treatment to low income uninsured Texans.
Professor Greenwald has over 20 years of experience in the fields of health law and policy. His Center is recognized as a national leader in Affordable Care Act implementation and in efforts to improve healthcare access and health outcomes for the uninsured and underinsured.
One Voice Texas and the Harris County Healthcare Alliance sponsored the event.
The lcsw licensing process revised 2015Janlee Wong
This document provides an overview of the licensing process for becoming a Licensed Clinical Social Worker (LCSW) in California. It outlines the key requirements including completing a master's degree in social work, registering as an Associate Social Worker, gaining 3,200 hours of supervised clinical experience, completing additional coursework in areas like law and ethics, and passing two state exams. It provides guidance on finding qualified supervisors and notes important deadlines like renewing the Associate registration annually. The goal is to help social workers understand all the necessary steps to become licensed in California.
This document outlines the top ten social work issues according to the National Association of Social Workers (NASW). These issues include title protection, implementation of the Affordable Care Act, licensure, social action/social justice, advocacy, compensation, jobs, social work image, ethics, and workforce development. For each issue, background information is provided on NASW's stance and activities. Examples of current advocacy efforts at the state level are also listed. The overall purpose is to inform social workers about the most pressing issues in the field and ways to get involved.
This document provides an overview and objectives of a workshop on law, ethics, and social justice perspectives for social workers. The workshop aims to help social workers understand legal prescriptions and mandates regarding key issues, obtain a social justice perspective, and learn how to teach these topics. It reviews definitions of social work and clinical social work, protective issues and mandated reporting, ethical standards, licensing, and various social justice topics. Caveats are provided that the information does not constitute legal advice and various codes of ethics and scopes of practice are discussed for social workers and therapists in California. The role of psychotherapy and its effectiveness is debated in different contexts such as child welfare and community mental health.
This document summarizes a training for the Central Valley Unit (CVU) of NASW. It discusses strategies for the CVU around financial resources, outreach, communication, and event planning. For outreach, the focus is on effectively engaging the 6 counties of the CVU region. Communication strategies include the use of social media, the statewide calendar, chapter newsletter, and email. Event planning covers identifying engaging events, registration, payment, and advertising. The training also addresses ongoing leadership recruitment and development.
The document discusses international social work and perspectives from various scholars and practitioners. It addresses the meaning of international social work, new agendas in the field including terrorism and global warming, and lessons for social work education. International social work is defined as addressing problems between nations or across boundaries, with a focus on the well-being of all people worldwide regardless of nationality. It is suggested social work adopt a more global vision, understand issues in context, embrace human rights from below, incorporate post-colonial studies, be more value-based, and deconstruct privileged perspectives from the West. Examples from Costa Rica and Scotland illustrate opportunities to learn about social problems in other countries and compare human services between nations.
This document outlines the agenda and objectives of an ethics workshop for social workers sponsored by the National Association of Social Workers (NASW). The workshop aims to familiarize participants with social work ethics values, principles, standards, and the NASW Code of Ethics. It includes exercises for discussing perceived ethical dilemmas and how to apply different ethical frameworks. Participants are encouraged to reflect on their own beliefs and consider issues like cultural competence, respect for clients and colleagues, and anti-discrimination. The workshop also addresses navigating ethical conflicts that may arise between organizational demands and professional values.
This document discusses opportunities for social workers under the Affordable Care Act and the importance of Medicaid expansion. It summarizes key provisions of the ACA, such as dependent coverage until age 26 and prohibiting pre-existing condition exclusions starting in 2014. The document urges social workers to help enroll uninsured clients and advocate for Medicaid expansion in their states to reduce health disparities and provide coverage to low-income individuals. Social workers are well-positioned to help with enrollment and address psychosocial needs not met by other professions.
This document discusses social work advocacy and policy issues. It covers topics like the impact of budget cuts, fights to resist cuts through political advocacy, title protection for social workers, and various bills being advocated for and against in the California legislature. The overall message is about the importance of social workers engaging in policy and advocacy work to influence decisions that impact the populations they serve.
This document discusses some of the ethical considerations social workers should take into account regarding social media. It notes that while social media provides benefits like free communication and networking, it also challenges traditional notions of confidentiality and dual relationships. Clinicians need to avoid venting about clients online or sharing confidential details that could identify clients. Social media also makes it difficult to prevent clients and clinicians from finding personal information about each other online. The document questions how ethics may need to evolve as social media becomes more integrated and asks social workers to consider their own social media use and boundaries.
1. Affordable Care Act
Janlee Wong, MSW
NASW California
October 2014
Google: slideshare Janlee Wong
2. Course Objectives
• Understand what the Affordable Care Act is
and how it is implemented in California
• How it affects you
• How it covers the uninsured
• How it reforms both service delivery and
financing incentives
• What are the roles of social workers and how
to get involved (advocacy)
3. California has the eighth
largest proportion of
uninsured in the nation
and the largest total
number of uninsured. Only
three states (Massachusetts,
Hawaii, and Minnesota) have
uninsured rates under 10%.
*All numbers reflect the non-elderly
population, under age
65.
Source: Employee Benefit
Research Institute estimates of
the 2009 – 2011 Current
Population Survey, March
Supplements.
4. What is the ACA
• Affordable Care Act or “Obamacare”
• First successful major national reform enacted
since Medicare (1935) and Medicaid (1965)
• First step towards “universal” healthcare
• Expands “single payer” Medicaid (MediCal)
• NASW policy goal is universal single payer
healthcare system
5. ACA Market Reforms (31)
• Insurers are prohibited from setting lifetime limits on essential health
benefits, such as hospital stays, beginning with new policies issued.
Approximately 12 million people in California are no longer subject to these
limits as a result of the act, according to federal estimates.
• Insurers are no longer allowed to re-examine a customer’s initial application
to cancel, or “rescind,” their coverage due to unintentional mistakes or
minor omissions.
• Dependent children up to age 26 must be offered coverage under a parent’s
insurance plan. Federal data indicates that more than 435,000 young adults
in California have gained coverage as a result of this provision of the act.
• Insurers may not exclude children under the age of 19 from coverage due to
a pre-existing medical condition.
• Insurers are now required to spend the vast majority of premium dollars
on medical care and quality improvement activities, and a smaller, limited
amount on overhead expenses such as marketing, profits, salaries,
administrative costs and agent commissions.
6. ACA Accomplishments (9)(12)
• More uninsured covered (fell from 20% to 15%
nationwide)
• More Latino uninsured covered (fell from 36%
to 23% - 2013-2014) In CA Latinos make up
60% of the uninsured
• 25% reduction in uncompensated hospital
care ($5.7 billion)
8. Getting California Covered
• 2.6 million Californians qualify for federal
financial assistance
• Another 2.7 million Californians will benefit
from guaranteed covered coverage
• Estimated 2.3 million California residents will
enroll in a health plan through the Exchange
(Covered California) by 2017
9. Getting California Covered
• 2014, employers with 25 or fewer employees
– possible eligibility for tax credits
• 2014, employers with 50 or fewer employees
can buy plans in the Exchange
• 2015, employers with 100 or fewer employees
can buy plans in the Exchange
10. Income & ACA
$9 per hour min. wage =$15,750 annually, $13 per hour = living wage in US
$15 per hour min. wage = $26,250 annually or twice the federal poverty threshhold
12. MediCal (Medicaid)
• Another almost 1.5 million Californians are
eligible for expanded Medi-Cal, which will be
open to all individuals under 65 with incomes of
up to $16,000 for an individual and about
$32,500 for a family of four
• End of categorical rules, eligibility based on
income,
• Bye bye asset test (except for foster care children,
SSI/SSDI, elderly)
• Spend down continues
13. Special Medi-Cal Eligible Populations
• Homeless
• Aged out transitional foster youth
• Parolees, probationers
– Oakland, Alameda county expects to enroll some
18,000 Medicaid-eligible inmates and detainees in
the coming years
14. Dual Eligibles (26)
• Coordination of Care (new “duals” offices)
• Prescription Drugs (elimination of cost sharing, Part
D for home and community based care clients)
• Medicare Advantage Plans (improved quality
measures)
• Long-Term Care and Chronic Illness (Medical Homes)
15.
16.
17. Poor Outreach
• 50% of those still uninsured five years after
the ACA takes effect will qualify for coverage
under the Medi-Cal expansion or for health
benefit exchange subsidies, but they will not
be aware that they qualify because of poor
outreach. Medi-Cal is California's Medicaid
program (5)
18. Enrollment: Social Workers Can Help
Nov. 15 to Feb. 15, 2015
• Champions for Coverage.
Marketplace.cms.gov/technical-assistance-resources/
assisterprograms/champion-apply.
hmtl
• Enroll America: www.enrollamerica.org
• Certified Application Counselor:
marketplace.cms.gov, “About Assister
Programs”
• Local Help Directory: localhelp.healthcare.gov
19.
20. Health Benefits Exchange
“Covered California”
• Quasi-governmental organization, specifically
an "independent public entity not affiliated
with an agency or department.“
• Contracting with Plans: Contract with carriers
so as to provide health care coverage choices
that offer the optimal combination of choice,
value, quality, and service.”
• For individuals and families ineligible for
Medicaid but below 400% of poverty
21. Healthcare Marketplace
• For those who don’t get insurance through
their employer
• Not qualified for Medi-Cal
• Want low cost affordable health insurance
plans
• Want subsidies (tax credits) depending on
income (below 144% of poverty) or below $25
per hour for an individual
22. Exchange (Marketplace)
Individual Mandate
• Conservative ideas from the Heritage
Foundation (let insurers compete and
consumers can choose)
• First implemented in the Massachusetts
Health Connector exchange
• ACA: Consumer choice; plans have the same
basic benefits; managed care features –
restricted networks, high out of network care
costs, tax subsidies (credits)
23. Competition (13)
• California saw reduced insurer participation
from 12 to 10 carriers on its exchange
• Some think it doesn't suggest
disenchantment, but rather that weaker
players are dropping out of a very competitive
market.
• Nationally, HHS Secretary Burwell reported
there will be a 25% increase in the number of
insurers participating in the exchanges.
24. Walmart, Target, Home Depot
• ACA labeled a “job killer” because employers
would rather lay off employees than pay for
health care for part timers.
• Companies have cut benefits for part-timers but
not laid them off.
• Walmart cut benefits for 30,000 employees,
Home Depot, 20,000
• Most cut health for part-timers but many of their
employees pay less for ACA benefits than in
company plans
25. Limited Networks, Providers
• Health insurers offer limited or restricted
networks of providers in their plans
• Many lack accurate information on who are
their providers
• The drastic shortage of primary care
physicians has not materialized
• Care is limited in rural, remote areas
26. Exchange Marketplace Report Card (21)
• Sufficient numbers of enrollees? Met its goal of 8
million enrollments through the exchanges during
the 2014 coverage season (21)
• Attract enough healthy young people to offset
the cost of older or sicker enrollees? Meeting
goal (22).
• Sufficient interest by insurance companies? More
insurers interested. (23)
• Continued challenges: Consumer skepticism,
partisan opposition and court challenges (21)
28. 18 state run exchanges, 8 state/Fed partnerships
29. Which plans were selected 2015 (25)
1. Anthem Blue Cross of
California
2. Blue Shield of California
3. Chinese Community Health
Plan
4. Health Net
5. Kaiser Permanente
6. L.A. Care Health Plan
7. Molina Healthcare
8. Sharp Health Plan
9. Valley Health Plan
10. Western Health Advantage
1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance
use disorder services, including
behavioral
health treatment
6. Prescription drugs
7. Rehabilitative and habilitative
services and devices
8. Laboratory services
9. Preventive and wellness
services and chronic disease
management
10. Pediatric services
30. Accountability
• Have sufficient clinicians — doctors, hospitals and other providers
— to meet the needs of the consumers who enroll in their plan
• Ensure that each enrollee has had a preventive health and wellness
visit during the first year of enrollment
• Identify and proactively manage all “at-risk” enrollees
• Determine enrollees’ health status and proactively develop a plan
to manage their individual health care needs
• Promote the use of best practice models for continuity of care and
care coordination that are proven to improve quality of care
• Be transparent about plan performance at the point of enrollment,
specifically regarding standard measures of prevention, access and
clinical effectiveness
• Be certified by the National Committee for Quality Assurance or
URAC (formerly known as the Utilization Review Accreditation
Commission) to meet quality standards
31. Pediatric Dental
• Covered California, the state's health
insurance exchange, has said it will offer five
stand-alone pediatric dental plans for 2014 as
well as what's called a "bundled" plan in
which insurers pair a stand-alone dental plan
with a medical plan.
32. Pediatric Dental
• Anthem Blue Cross of California.
• Blue Shield of California.
• Delta Dental of California.
• Liberty Dental Plan of California.
• Premier Access Dental and Vision.
• Small Business Health Options Program Shop
(SHOP) plans
33. Vision
• Vision benefits will be available for children
embedded in health plans.
• Covered California is considering combining
pediatric vision and dental plans in the future
34. Affordability
• Effective Jan. 1, 2014, insurance companies
may consider only three factors to determine
the cost of your premium: age, geography and
family size. Your health history may no longer
be considered in setting premiums.
35. Subsidies and the Exchange
• 5 million Californians qualify to get insurance on the
Exchange.
• Half of them are eligible for government subsidies,
which are federal tax credits that will offset the cost of
their monthly premium
• The subsidies are available to those who earn $15,850
to about $46,000 a year. A family of four is eligible if
they earn between $32,500 to $94,200 a year
• The more you make, the smaller the subsidy. The less
you make the more assistance you’ll get
• Based on your adjusted gross income plus any tax-exempt
income you might have.
36. What Metal?
• Platinum plans have the highest premium, yet
pay 90% of covered health care expenses.
Bronze plans have the lowest premium, but
pay only 60% of covered health expenses. It’s
important to think about how much health
care you will need when choosing a level.
• Shop and Compare:
https://www.coveredca.com/shopandcompare/#healthplans
37. Health Benefits Exchange Plans
Bronze, Silver, Gold & Platinum (2015)
Bronze 60 Silver 70 Gold 80 Platinum90
Healthcare Cost Coverage 60% 70% 80% 90%
Copay Primary Care Visit $60 $45 $30 $20
Deductible Individual to
$5,000 -
$2,000 -
Family
$10,000
$4,000
None None
Specialty Care Visit $70 $65 $50 $40
Urgent Care Visit $120 $90 $60 $40
Meds Generic $15 $15 $15 $5
Lab 30% $45 $30 $20
ER $300 $250 $250 $150
Max Out of Pocket
$6,250 to
$6,250 to
$6,250 to
Individual to Family
$12,500
$12,500
$12,500
$4,000 to
$8,000
Monthly Premium Monthly
Family of 2*
$896 $1,128 $1,336 $1,484
*Ages 60 years old; Burbank area, LA Care Health Plan
39. Does the ACA Affect You?
• Maybe, I already have health insurance through
my employer, family member or programs such
as Medicare and Medicaid. (85%)
• Yes, my employer doesn’t provide health
insurance
• Yes, I’m below 400% of poverty, ineligible for
Medicaid (due to income) and don’t have health
insurance
• Yes, I was previously ineligible for Medicaid but
now I am eligible
• No, I’m undocumented
40. Covered CA Affordable? +4.2% (24)
• The overall weighted average increase is 4.2 percent
• 16% of Covered California consumers (217,000 people) will
see the premium of their health plan stay constant or
decrease (with most decreases of 1 percent to 3 percent, but
some decreases of up to 14 percent)
• 35 % (489,000 people) will see premiums increase a small
amount — less than 5 percent
• 36% (495,000 people) will see premium increases of 5 percent
to 8 percent (with most of those being about 6 percent)
• 13 % (186,000 people) will see premium increases of more
than 8 % (with almost 90 percent of these in the 8-10 percent
range)
42. Consumer Assistance and Outreach
• Grants to community groups and a
comprehensive advertising campaign aimed at
attracting new consumers and encouraging
them to enroll in the state’s health benefit
exchange
• Network of Certified Enrollment Counselors,
Certified Insurance Agents and county
eligibility workers
43. Covered California Certified Enrollment Entities
• American Indian Tribe or Tribal Organizations
• Chambers of Commerce
• City Government Agency
• Community Clinics
• Community Colleges and Universities
• Faith-Based Organizations
• Labor Unions
• Non-Profit Community Organizations
• Ranching and farming organizations
• Resource partners of Small Businesses
• School Districts
• Tax Preparers
• Trade, industry, and professional organizations
For complete list:
http://hbex.coveredca.com/enrollment-entities/PDFs/Navigator-Funding.pdf
44. Role of Social Worker - Policy
• Social workers should be included in the
interdisciplinary care teams across a broad array
of health care settings
• Social workers are likely the only professionals
devoted to meeting the psychosocial needs of
patients and families
• Social workers extend the team to allow
members to participate at the top of their
licenses
• Social workers are experienced in outreach to
disadvantaged populations
45. Roles of Social Worker - Practice
• Directors, Managers, Elected and appointed
officials
• Clinical social workers – mental and behavioral
health services
• Medical social workers – care coordination and
case management, medically related social
services, patient and family education, discharge
planning, advance care planning, community
outreach and engagement
• Outreach, community organizers, advocates
46. Models of Care
• Accountable Care Organizations
• Integrated comprehensive acute care
• Integrated comprehensive primary care
• Coordinated medical and behavioral health
care
47. Characteristics
• A strong primary care/medical home/health home
foundation
• Multidisciplinary health care teams
• Targeted care coordination interventions (focused
especially on individuals with multiple chronic
conditions)
• Integration with behavioral health and substance use
treatment
• Sophisticated information systems that include
electronic medical records
• Formal partnerships with “medical neighbors”
48. Accountable Care Organizations
(ACOs)
• ACO is a network of hospitals, clinics, physician
practices and other providers who work together
to provide coordinated, integrated care for an
assigned population of individuals and who
receive financial compensation for meeting
specific patient outcomes.
• Goal: Reduce or control the growth of healthcare
costs while maintaining or improving the quality
of care
49. Accountable Care Organizations
(ACOs) (29)
• There were more than 600 ACOs nationwide
at the start of the year, and they are being
touted as a key strategy for curbing U.S.
health-care costs. The fundamental idea is
that doctors and hospitals are rewarded for
keeping and making patients healthy, rather
than a “fee for service” approach where they
earn more for prescribing lots of tests or
scheduling appointments regardless of how a
patient fares.
50. Industry ACO Example (29)
• UW Medicine as well as Providence Health &
Services and Swedish Health Services have each
recruited a network of hospitals and clinics and
formed their own ACOs. Boeing has separate
contracts with each to provide care for Puget
Sound-area employees beginning next year.
• These employer-driven ACO arrangements, with
no insurance company involved, are believed to
be among the first in the nation to use this
approach and could serve as models elsewhere.
51. Integrated Comprehensive Primary Care
Southwest Virginia Community Healthcare Systems, Inc
Patient visit Prim. Care
Physician (PCP)
PCP screens for
behavioral health issue
Positive Negative
Referral to
behavioral
health
consultant
PCP
continue
with
medical
visit
52. Medical Home (28)
• The medical home is the model for 21st
century primary care, with the goal of
addressing and integrating high quality health
promotion, acute care and chronic condition
management in a planned, coordinated, and
family-centered manner.
53. Medical Home Building Blocks (28)
1. Care Partnership Support
Empowers children, youth and families to manage their health and healthcare
2. Clinical Care Information
Assures delivery of effective, efficient clinical care & patient self-management support
3. Care Delivery Management
Promotes clinical care that is consistent with patient and family preference and scientific
evidence
4. Resources & Linkages
Mobilizes community resources to meet patient and family needs
5. Practice Performance Measurement
Addresses the organization and promotion of safe and high quality care
6. Payment & Finance
Matches quality care and NCQA recognition with payment / solid return on investment
54.
55. Medical Home Implementation (28)
• Riverside County Public Health Department
plans to implement a patient centered
medical home at its primary care clinics.
• Ventura County's Medi-Cal beneficiaries are
expected to be assigned to medical homes
through Gold Coast Health Plan
• Los Angeles County community clinics will be
transformed into PCMHs through L.A. Care
Health Plan
56. Social Work Advocacy
NASW and California Deans and Directors got a social worker included
on the California Workforce Investment Board, Health Workforce
Development Council (8)
• Standardize, strengthen and expand curricula and training programs
to increase access and consistent competencies for Community
Health Workers/Promotores, Medical Assistants, Social Workers,
Nurses, Direct Care Workers and other workers.
• Change regulations to allow the services of Community Health
Workers/Promotores to be reimbursable with government and
private payers.
• Develop supportive payment structure and policies targeted at
increasing the attractiveness of primary care as a career path and
retention of primary care providers.
• Ensure adequate payment for primary care and preventive services
with appropriate adjustments in payment incentives.
57. Advocate Role of Social Worker
• Be a voice for social work in the health care
plan’s development of ACOs
• Advocate for comprehensive benefits
including psychosocial services
• Advocate for horizontal integration of health
and human services benefits
• Serve as a resource for identifying hard to
reach populations
58. Look Out For
• Be on the look out for creep back to bias
against those with pre-existing conditions or
chronic diseases (high drug costs, limited
networks and specialty hospitals, services)
59. US Supreme Court Cases
• Individual mandate is legal (it’s a tax)
• States can’t be forced to open
exchanges
• Allows closely held private corporations
to be exempt from contraceptive
mandate due to religious beliefs of the
owners (Hobby Lobby). Employers must
let workers know if they remove
coverage
60. Lower Court Cases (10)
• Judge Ronald White, a George W. Bush
appointee, invalidated an Internal Revenue
Service rule interpreting the Patient
Protection and Affordable Care Act to allow
the premium tax credits in states that have
not established their own exchange. “The
court holds that the IRS Rule is arbitrary,
capricious, an abuse of discretion or otherwise
not in accordance with law,” White wrote.
61. The Uninsured Unauthorized (5)
A recent report by the UC-Berkeley Center for Labor
Research and Education and the UCLA Center for
Health Policy Research on California residents who
will remain uninsured after the ACA takes effect
found that:
• 66% of the remaining uninsured will be Latino;
• 60% of the remaining uninsured will have limited
English proficiency; and
• 62% of the remaining uninsured will live in
Southern California.
62.
63. Senate Bill 1005
• SB 1005 by Sen. Ricardo Lara (D-Bell Gardens)
would create the California Health Exchange
Program for All Californians, which would be
overseen by Covered California. The federally
funded exchange is not allowed to cover the
undocumented so state funds would be used
for that portion of the population covered in
the new exchange.
• Passed Senate Health Committee, May 2014.
64. My Health LA (27)
• Los Angeles County will provide access to a
primary care doctor for nearly 150,000 uninsured
Los Angeles County residents, including many
who are ineligible for Obamacare coverage
because they lack legal immigration status.
• My Health L.A., as the $61-million program for
the uninsured is called, will assign uninsured
patients to a "medical home" at one of around
150 community clinics
65. Glossary
Accountable Care Organizations ACO
• A network of hospitals, clinics, physician
practices and other providers who work
together to provide coordinated, integrated
care for an assigned population of individuals
and who receive financial compensation for
meeting specific patient outcomes.
66. Glossary
Actuarial Value
• A health insurance plan’s actuarial value is the percentage
of total average costs for benefits that a plan covers. All
Covered California health insurance plans have an actuarial
value assigned to them: Bronze, Silver, Gold or Platinum.
• As the metal category increases in value, so does the
percent of medical expenses that a health plan covers. This
means the Platinum plans cover the highest percentage of
health care expenses.
• These expenses are usually incurred at the time of health
care services — when you visit the doctor or the
emergency room, for example. The health insurance plans
that cover the greatest percentage of health care expenses
also usually have higher premium payments.
67. Glossary
Copayment
• A fixed amount (for example, $15) you pay for
a covered health care service, usually when
you receive the service. The amount can vary
by the type of covered health care service.
68. Glossary
Cost Sharing
• The share of costs covered by your insurance
that you pay out of your own pocket. This
term generally includes deductibles,
coinsurance and copayments, or similar
charges, but it doesn’t include premiums,
balance billing amounts for non-network
providers, or the cost of non-covered services.
69. Glossary
Coinsurance
• Your share of the costs of a covered health care service,
calculated as a percentage (for example, 20 percent) of
the allowed amount for the service.
• You pay coinsurance plus any deductible you owe.
• For example, if the health insurance plan’s allowed
amount for an office visit is $100, and you have met
your deductible for the year, your coinsurance payment
of 20 percent would be $20.
• The health plan pays the rest of the allowed amount.
70. Glossary
Medical Homes (31)
A mode of care that includes
(A) personal physicians;
(B) whole person orientation;
(C) coordinated and integrated care;
(D) safe and high-quality care through evidence informed
medicine, appropriate use of health information
technology, and continuous quality improvements;
(E) expanded access to care; and
(F) payment that recognizes added value from additional
components of patient-centered care. 5
71. Glossary
Out of Pocket Limit
• The most you pay during a policy period (usually
a year) before your health insurance or plan
begins to pay 100 percent of the allowed amount.
• This limit never includes your premium, balance-billed
charges or health care your health
insurance plan doesn’t cover.
• Some health insurance plans don’t count all of
your copayments, deductibles, coinsurance
payments, out-of-network payments or other
expenses toward this limit.
72. Glossary
Premium and Assistance
Premium
• The amount that must be paid for your health insurance or plan.
You or your employer, or both, usually pay it monthly, quarterly or
yearly.
Premium Assistance
• Also known as the Advanced Premium Tax Credit, this is financial
assistance eligible consumers may receive when enrolling in a
Covered California health insurance plan, to assist them in paying
their monthly premium costs.
• The amount of premium assistance an individual may receive is
determined based on his or her income as a percentage of the
federal poverty level. Tax credits are also available to small
businesses with fewer than 25 full-time-equivalent employees to
help offset the cost of providing coverage.
73. Glossary
Subsidy
• Cost-sharing subsidies and premium
assistance reduce the cost of premiums and
out-of-pocket expenses for health coverage
that qualifying individuals and families
purchase through Covered California.
74. ACA Is Changing
• Check various websites for up to date changes
http://www.healthcare.gov/
http://www.chcf.org/publications/2010/05/the-affordable-
care-act-in-california
79. Resources
26 U.S. Department of Health & Human Services News Division 202-690-6343
media@hhs.gov www.hhs.gov/news May 07, 2014
27 http://www.latimes.com/local/lanow/la-me-ln-remaining-uninsured-los-angeles-
20141006-story.html
28 http://www.pediatricmedhome.org/
29
http://seattletimes.com/html/localnews/2023842772_acoboeingprovidenceuwxml.html
30
https://www.cms.gov/eHealth/downloads/Webinar_eHealth_December6_HealthITIn
novation.pdf
31 Patient Protection and Affordable Care Act §3502(c).t