1. Healthcare

Cómo la Reforma de Salud le Beneficiará a Usted y
las Familias Latinas en California
Todas las familias Latinas se podrán beneficiar de la nueva ley de salud. Esto es cierto tanto para
las personas que no tienen seguro médico, como las que reciben Medi-Cal o Medicare, e
inclusive para las que tienen seguro privado.
Si usted no tiene seguro médico, la ayuda viene en camino. Si usted es una persona de edad
avanzada, se beneficiará de los descuentos que Medicare otorgará para medicinas y de los
cuidados preventivos que podrá recibir de manera gratuita. Si usted tiene seguro médico, puede
conservar su doctor y su tranquilidad, al saber que las compañías aseguradoras no podrían
cancelar o limitar su cobertura cuando se enferma o necesita de servicios. No importa si usted
tiene o no seguro médico, la nueva ley de salud también promueve estilos de vida saludables a
través de programas de bienestar en nuestros trabajos y a través de subsidios comunitarios para
aumentar el acceso a comidas saludables y promover la actividad física.
• Si usted necesita seguro médico – Habrá más opciones a precios que sí se
pueden pagar
• Si usted tiene Medi-Cal o Medicare – Tendrá acceso a más y mejores servicios
• Si usted tiene seguro privado – Tendrá una cobertura que sí puede pagar sin
preocupación.
Si usted Necesita Seguro habrá más opciones a precios que sí se pueden pagar
Al proporcionar más opciones de cobertura a un precio accesible, la nueva ley de salud ayudará a
miles de Latinos a obtener cobertura. Los residentes permanentes podrán ser elegibles para lo
siguiente:
ƒ Para Adultos Jóvenes – Podrán permanecer en el plan de seguro médico familiar
hasta la edad de 26 años:
De manera inmediata, los adultos jóvenes podrán permanecer en el plan de salud de sus
padres hasta la edad de 26 años. Esto ayudará a uno de cada tres Latinos jóvenes que no
tenían seguro médico en el 2007.
ƒ Expansiones a Medi-Cal podrían ayudarle a usted o su familia:
Comenzando en el 2014, si usted es un adulto soltero/a y gana menos de $14,431 o si tiene
una familia de 4 miembros y gana $29,367, podrá ser elegible para Medi-Cal. Esta
expansión le proporcionará cobertura a más de un millón de Latinos en California. El
Medi-Cal de embarazo y emergencias seguirá estando disponible para todas las personas de
bajos ingresos sin importar su status migratorio.
ƒ El “Intercambio de Seguro de Salud” (Exchange) le proporcionará a usted cobertura
privada a un precio accesible:
También comenzando en el 2014, si usted es soltero/a y gana menos de $43,400, o si tiene
una familia de 4 miembros y gana $88,200, usted podrá comprar cobertura a un precio
accesible en el “Interacambio de Seguro de Salud.” Su pago
mensual no costará más del 10% de su ingreso, el gobierno
pagará el resto. Los niños ciudadanos y residentes
permanentes de padres indocumentados también podrán
obtener cobertura a través del “Intercambio.” Los
inmigrantes indocumentados no podrán comprar seguro en el
“Intercambio” y estarán exentos del mandato de tener seguro
médico.
ƒ Los pequeños negocios también recibirán ayuda para que
sus empleados obtengan seguro médico:
500,000 pequeños negocios en California podrán obtener créditos de impuestos para poder
proporcionar cobertura de salud a sus empleados.
Si usted tiene Medi-Cal o Medicare – Aumenta el Acceso y Mejores Servicios
ƒ Ayuda para las personas mayores que están en Medicare: La nueva ley cierra el “hoyo
de la dona” de Medicare, ayudando a cientos de miles de Latinos a pagar por sus medicinas
recetadas, esto comenzará en el 2011. También proporciona servicios preventivos gratuitos.
ƒ Más Doctores y Especialistas para Servir a Usted: Los pagos a doctores aumentarán bajo
la nueva ley. Esto significa que habrá más doctores y especialistas para servirle.
ƒ Disminución del Tiempo de Espera: Más doctores y servicios, significará tener que
esperar menos para recibir servicios.
ƒ Apoyo para la Red de Seguridad: La ley otorgará un estimado de $1.4 billones de dólares
a los centros comunitarios de California, los cuales sirven a cientos de miles de Latinos.
Si usted tiene seguro privado – Tendrá tranquilidad y una cobertura que sí puede pagar
Para los 5.5 millones de Latinos en California que tienen seguro médico privado, su seguro
médico será más seguro, más económico y le ayudará a mantenerse saludable.
ƒ Dándole paz y tranquilidad: Las compañías de seguro ya no podrán negarle cobertura por
condiciones pre-existentes ni le podrán cancelar su póliza cuando usted se enferma. Esta
provisión entrará en vigor este otoño para los niños y en el 2014 para los adultos.
ƒ No habrá límites de por vida para cuidado de salud: Comenzando este otoño, la nueva
ley prohibe a las aseguradoras el limitar cuanto cuidado de salud las personas pueden
recibir. Nadie se tendrá que preocupar de perder su casa o de irse a la bancarrota si usted o
alguien querido se enferma.
ƒ Dándole prioridad a la Prevención: Comenzando este otoño, todas los nuevos planes de
seguro médico tendrán que ofrecer servicios preventivos gratuitos, como chequeos y
examenes.
Si usted es un inmigrante: Hay beneficios disponibles para usted
Todos los beneficios de la reforma de salud estarán disponibles a todos los residentes
permanentes y todos se beneficiarán de la expansión de servicios en los centros comunitarios.
ƒ Inmigrantes Permanentes seguirán calificando para Medi-Cal: Residentes permanentes
seguirán siendo elegibles para Medi-Cal sin tiempo de espera.
ƒ Inmigrantes Permanentes podrán ser elegibles para el “Intercambio”: Residentes
permanentes podrán ser elegibles, sin tiempo de espera, para créditos de impuestos y
subsidios para poder comprar seguro médico en el “Intercambio.”
ƒ El “Intercambio de Seguro” no estará disponible para inmigrantes indocumentados:
Inmigrantes indocumentados no pueden comprar seguro en el “Intercambio” y están
exentos del requisito de tener seguro de salud.
Key Legislation for 2013
Health Care Reform Implementation – Extraordinary Session
Bill /
Author
Sponsor
Description
Medi-Cal Expansion: Expands eligibility
for Medi-Cal to childless adults making up
to 138% of the Federal Poverty Level
($15,856 per year for an individual) in
accordance with federal health
care reform.
ABx1 1 (J.
Perez)
Medi-Cal Expansion: Expands eligibility
for Medi-Cal to childless adults making up
to 138% of the Federal Poverty Level
($15,856 per year for an individual) in
accordance with federal health
care reform.
SBx1 1
(Hernandez)
Bridge Option: Creates a bridge option
to allow low-cost health coverage to be
provided in Covered California for
individuals and families transitioning
between it and Medi-Cal.
SBx1 3
(Hernandez)
CPEHN
Position
Status
Support
Senate Health
Support
Passed Senate
Floor
Support
Passed Senate
Floor
Access to Health Care
Bill /
Author
AB 50 (Pan)
AB 209
(Pan)
Sponsor
Description
Medi-Cal Simplification: Requires the
Department of Health Care Services to
establish an eligibility process that allows
a hospital to make preliminary Medi-Cal
determinations and applicants to have an
option to prepopulate or electronically
verify applications.
Medi-Cal Quality and Transparency
Act: Requires the Department of Health
Care Services to develop a plan to
monitor, evaluate, and improve the quality
and accessibility of health care and dental
services provide through Medi-Cal
managed care.
CPEHN
Position
Status
Support
Assembly
Appropriations
Support
Assembly Floor
AB 411
(Pan)
AB 422
(Nazarian)
AB 505
(Nazarian)
CPEHN
Medi-Cal Data Analysis: Requires MediCal managed care health plans to analyze
quality data by race, ethnicity, and
primary language
St.
John's
Well
Child
and
Family
Center
and
CPEHN
Health Care Notifications in School
Lunch Program: Updates notifications
about the National School Lunch Prorgram
sent to parents with information about the
new health insurance options available
through the expansion of Medi-Cal and
Covered California.
CPEHN
Mental Health Parity: Ensures
compliance with and implementation of
state and federal mental health parity
laws.
SB 22
(Beall)
Wellness Programs: Prohibits a health
plan or insurer from offering a wellness
program, incentive, or reward in a group
health plan contract or insurance policy
unless specified requirements are
satisfied.
SB 189
(Monning)
SB 204
(Corbett)
SB 353
(Lieu)
Medi-Cal Language Access: Codifies
current language access requirements on
Medi-Cal managed care health plans.
CPEHN
Translated Prescription Drug Labels:
Requires the use of translated directions
for taking medications on prescription
drug labels.
Health
Access
and
CPEHN
Protecting Consumers through Health
Reform Implementation: Provides the
Department of Insurance with the
authority to review and approve marketing
materials. Also requires health plans and
insurers that market in non-English
languages to provide translated
documents in those languages.
Support
Assembly Floor
Support
Assembly Floor
Support
Assembly Floor
Support
Senate
Appropriations,
Suspense File
Support
Senate Floor
Support
Senate
Appropriations
5/13/2013
Support
Senate
Appropriations,
Suspense File
Achieving Equity by Building a Bridge
from Eligible to Enrolled
(Updated January 2013)
Introduction
In January 2011, California became the first state in the country to establish a health insurance
exchange, a key component of the Affordable Care Act (ACA) that will provide individuals and small
businesses an opportunity to shop for and buy comprehensive health insurance. Low- to moderateincome families, between 133% and 400% of the Federal Poverty Level (FPL),i will be eligible for
tax credits to help keep the costs of coverage affordable in Covered California (California’s Health
Benefit Exchange).
Developed by the California Pan-Ethnic Health Network (CPEHN), this fact sheet updates data released
in a previous report, Achieving Equity by Building a Bridge from Eligibility to Enrolled, using the UC
Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research’s
California Simulation of Insurance Markets (CalSIM) model.ii
The CalSIM model is used to estimate the effects of specific provisions of the ACA on family and
employer decisions about insurance coverage in California. While communities of color and people
who speak English less than very well (limited English proficient, or LEP) represent a significant
portion of those eligible for subsidies in Covered California, initial findings suggest that they may be
less likely to enroll.
Over a million LEP adults eligible for subsidies in Covered California
Over 2.7 million adult Californians will be eligible to receive federal tax credits to purchase affordable
health coverage in Covered California.iii Of these eligible adults, 66% (about 1.8 million) will be people
of color (Figure 1) and 40% (about 1.09 million) will speak English less than very well (Figure 2).iv
Figure 1: Eligible Population for Subsidies
in Covered California by Race/Ethnicity
(2013)
Figure 2: Adult Population Eligible for
Subsidies in Covered California by English
Proficiency (2013)
Latino
2%
40%
African American
34%
47%
4%
Native English
Speaker/Very
Well
Asian/Pacific Islander
White
13%
60%
Native American/Alaska
Native/Multiple Race
Limited English
Proficiency:
Well/Not Well/Not
at All
Language barriers may reduce LEP participation
Figure 3: Percentage of Subsidy-Eligible
Eligible LEP individuals are projected to enroll at
Adults Enrolled in Covered California
lower rates than their non-LEP counterparts. Of the
(2019)
60
LEP adults eligible for subsidies in Covered California,
Language
56% are predicted to enroll by 2019 if language were
55
needs are
not a barrier (Figure 3). However, without appropriate
addressed
50
and effective multilingual outreach and education
Language
efforts, just 46% are expected to enroll. The difference
45
needs are not
between these two estimates shows that there is the
addressed
40
potential to enroll upward of 119,000 more LEP
individuals in Covered California if enrollment is
conducted with proactive outreach efforts directed toward the LEP population.
Projected languages spoken
CalSIM also provides insight into the LEP adults projected to receive subsidies in Covered California
in 2019. Though these enrollees are predominantly Spanish-speaking (81%, over 405,000), a
significant number speak other languages. More than 95,000 people speak a language other than
English or Spanish at home, with roughly 30,000 speaking Chinese, 15,000 Vietnamese, and 10,000
Korean.v
Recommendations
Our health care system must adapt to meet the needs of California’s diverse population. To ensure that
all eligible Californians are enrolled in health insurance programs, have equal access to affordable
coverage and care, and receive quality services, the following recommendations must be implemented:
• Target resources for consumer assistance to those with the highest need. Resources must
be designated for in-person assistance to communities with the highest needs who may lack
access to the internet and other traditional methods of enrollment, including low-income
populations, immigrants, LEP, and persons with disabilities.
• Invest in culturally and linguistically appropriate marketing and outreach. While the
recent availability of $40 million in funds from Covered California is an important first step,
ongoing resources should be made available to community organizations, ethnic media, and
others who have experience marketing to communities of color.
• Involve communities of color in decision-making processes. Communities of color must be
an integral partner in these processes to inform policy decisions that will have an impact on
access to coverage and care.
• Strengthen data collection efforts to help identify and address disparities. As new systems
are developed it is critical to build a more effective data collection infrastructure and identify
ways to improve current systems to better understand and reduce disparities.
• Invest in primary care and workforce diversity in underserved areas. With more than 4
million newly eligible for coverage under the ACA, California needs to be ready to meet the
new demands for care, such as strengthening the capacity of our safety net providers.
• Promote prevention and wellness. We must use this historic opportunity to transform our
health care system into one that invests in health equity by keeping people well and ensure that
federal and state resources allocated for prevention programs are preserved.
i
In 2012, 400% of the Federal Poverty Level was $44,680 for a single adult and $92,200 for a family of four.
Findings are based on CalSIM, version 1.8 Base scenario and CalSIM, version 1.8 Base scenario adjusted for LEP.
iii
This does not include nearly a million Californians who are prohibited from purchasing coverage with their own money due to
their citizenship status.
iv
Data on English proficiency is only for adults 18 and older.
v
The projected languages spoken are based on a more conservative estimate assuming that language is a barrier to enrollment.
ii
How Health Reform Benefits You
and California’s Latino Families
All Latino families stand to benefit from the new health care law. This is true whether you are
uninsured, have Medi-Cal or Medicare, or private insurance.
If you have no health insurance, help is on the way. If you’re a senior, you’ll benefit from
Medicare rebates on drugs and free preventive care. If you have health insurance, you can keep
your current doctor and peace of mind, knowing that insurance companies cannot drop or limit
your coverage when you’re sick and need it. Whether you have insurance or not, the new health
care law also promotes healthy living through worksite wellness programs and community grants
to increase access to healthy foods and physical activity.
• If you need insurance – More options for affordable coverage
• If you have Medi-Cal or Medicare – Increased access and better services
• If you have private insurance – Peace of mind and affordable coverage
If You Need Insurance – More Options for Affordable Coverage
By providing more options for affordable coverage, the new health care law will help many
thousands of Latinos obtain coverage. Lawful immigrants will be eligible for all the provisions
below.
ƒ For Young Adults – You Can Stay on Your Family’s Plan until Age 26:
Beginning immediately, young adults will be able to stay on their parent’s health plan
through the age of 26. This will help the one in three Latino youth who went without health
insurance during 2007.
ƒ Medi-Cal Expands to Help You and Your Family: Starting in 2014, if you make less
than $14,431 as a single adult or $29,367 for a family of four, you’ll be eligible for MediCal. This expansion will provide coverage for more than one million Latinos in California.
Prenatal care and emergency Medi-Cal is still available to all low-income persons
regardless of immigration status.
ƒ The Health Insurance Exchange Will Provide You with
Affordable Private Coverage: Also starting in 2014, if you
make less than $43,400 as a single adult or $88,200 for a
family of four, you will be able to buy affordable coverage
from an insurance exchange. Your premium will cost no
more than 10% of your income – the government will cover
the rest. Citizen or lawfully present immigrant children of
undocumented parents can get coverage through the
exchange. Undocumented immigrants cannot buy insurance
from the exchange and are exempt from the requirement to have insurance.
ƒ Your Small Business Employer Will Get Help to Cover You: 500,000 small businesses
in California will be able to get tax credits to help provide coverage for their employees.
If You Have Medi-Cal or Medicare – Increased Access and Better Services
ƒ Help for Seniors on Medicare: The law closes the Medicare “donut hole,” helping
hundreds of thousands of Latinos pay for their prescription drugs, starting in 2011. It also
provides preventive services for free.
ƒ More Doctors and Specialists to Serve You: Payments to doctors will be increased under
the new law. This means there will be more doctors and specialist to serve you.
ƒ Shorten Wait Times for Services: More doctors and services will mean shorter wait times
for care.
ƒ Supporting Our Safety Net: The law will bring in an estimated $1.4 billion dollars to
support California’s community health centers, which serve hundreds of thousands of
Latinos.
If You Have Private Insurance: Peace of Mind and Affordable Coverage
For the 5.5 million Latinos in California who have private insurance, your health insurance will
be more secure, affordable, and help keep you healthy.
ƒ Giving You Peace of Mind: Health insurers will no longer be able to deny coverage for
pre-existing conditions or drop it when you get sick. This provision applies to children
starting this fall and to all adults in 2014.
ƒ No Lifetime Caps on Care: Starting this fall, the new law prohibits insurers from limiting
how much they will have to pay for care. No one will have to worry about losing their
house or going bankrupt if you or someone you love gets sick.
ƒ Putting Prevention First: All new private insurance plans will have to cover preventive
services – such as screenings and tests – for free, starting this fall.
If You Are an Immigrant: Benefits Are Available
All the benefits of health reform are available to lawful immigrants and everyone will have
access to expanded community health services.
ƒ Lawful Immigrants Keep Medi-Cal: Lawful immigrants are still eligible for Medi-Cal
without a waiting period.
ƒ Lawful Immigrants Eligible for Help in the Exchange: Lawful immigrants will be
eligible for tax credits and subsidies to purchase insurance in the exchange without a
waiting period.
ƒ Insurance Exchange Closed to Undocumented Immigrants: Undocumented immigrants
cannot buy insurance from the exchange and are exempt from the requirement to have
health insurance.
Medi-Cal Expansion:
What’s at Stake for Communities of Color
Since the establishment of Medicare and Medicaid in the ’60s, our country has prioritized protecting
vulnerable populations – our elderly, children, poor, blind, and disabled. But not all low-income people
are eligible for Medicaid, and in California, the primary population left out – childless adults – are
predominantly from communities of color.
With the landmark signing of the Patient Protection and Affordable Care Act (ACA), we are finally
closing this gap after almost 50 years. In 2014, nearly everyone making up to 138% of the Federal
Poverty Level (FPL)i will be eligible for Medi-Cal (California’s Medicaid program).
California’s communities of color have a large stake in how the state expands Medi-Cal. We cannot let
this opportunity pass us by – we must make sure that California expands the program to its fullest,
conducts culturally and linguistically appropriate outreach, and streamlines the eligibility process so that
everyone who is eligible is enrolled.
The Imperative for Communities of Color
In California, communities of color represent 60%
of the population but account for 75% of the
uninsured.ii As a result, communities of color make
up a large majority of Californians who will be
newly eligible for coverage under the Medi-Cal
expansion. Of the approximately 1,420,000 nonelderly adults who will be newly eligible to receive
Medi-Cal, 2 out of 3 (67% or 950,000) are from
communities of color (see Figure 1). Over one-third
(35% or 500,000) of the newly eligible will speak
English less than very well (see Figure 2).
Predicted Population Eligible
for Medi-Cal Expansion in 2014
Figure 1: By Race/Ethnicity
7%
8%
4%
White
33%
Latino
African
American
A&PI
48%
Other &
Multiple Race
Figure 2: By English Proficiency
How the state chooses to reach out to and educate
35%
Speaks
those who are eligible for Medi-Cal will have a
English Very
significant impact on enrollment. Simplifying
Well
enrollment procedures, implementing a robust
culturally and linguistically outreach effort, and preSpeaks
enrolling individuals from existing health and
English Less
65%
Than Very
human services programs are critical to maximizing
Well
participation. Even with these strategies in place,
projections based on the California Simulation of
Insurance Markets (CalSIM) estimate that only 55% of those who are newly eligible for Medi-Cal, or
780,000 people, will enroll in 2014. Without these efforts, 300,000 Californians, 70% of whom would
be from communities of color, are expected not to enroll in Medi-Cal despite being eligible.
The Imperative for the State
The Medicaid expansion through the ACA is a tremendous opportunity for California to dramatically
decrease its uninsured population at minimum cost to the state. The newly eligible Medi-Cal enrollees will
be fully funded by the federal government from 2014 through 2017, slowly decreasing to 90% by 2020.
The influx of federal dollars means expanding Medi-Cal is a cost-effective way for the state to lower
health care costs by enabling Californians to get the care they need and stay healthy. It will also create a
healthier workforce and benefit state and local economies by sustaining jobs in the health sector.iii
Policy Recommendations
1. Implement the Full Expansion of Medi-Cal: The ACA provides an historic opportunity to reduce
health disparities in our state by ensuring access to health coverage for individuals and families up to
138% FPL. The full expansion of Medi-Cal will result in lower health care costs and better health
outcomes as more and more Californians are able to access critical primary and preventive services
in place of more costly emergency room care.
2. Maximize Medi-Cal Enrollment: We must take advantage of the changes in Medi-Cal by using
fast, confidential, and effective methods to ensure timely enrollment. For example, we should
identify and pre- or auto-enroll those we know will be eligible for Medi-Cal now. We must also
maximize enrollment of eligible individuals under the Low-Income Health Program (LIHP), county
programs established to provide health care to uninsured adults who will transition to Medi-Cal in
2014.
3. Simplify Enrollment Processes: Strong collaboration between state and local government agencies
and providers should be encouraged so that programs such as the LIHP, CalFresh, and others that
already collect data on citizenship and income can share this data and accelerate enrollment.
Additionally, individuals should be allowed to attest to this information when documentation is
unavailable or obtaining the data will cause undue hardship. This will allow quick verification of
eligibility for public benefits and avoid unnecessary delays in application processing.
4. Ensure Culturally and Linguistically Appropriate Services from Outreach to Care: With a
large portion of the newly eligible speaking English less than very well, we must provide accurate,
thorough, and easily understandable information in multiple languages to not only help them sign-up
for Medi-Cal but also get the care they need. Additionally, we must prioritize training and
certification of medical interpreters and prepare our health care professionals to work with
California’s diverse communities.
Methodology
The California Simulation of Insurance Markets (CalSIM), developed by the UC Berkeley Center for
Labor Research and Education and the UCLA Center for Health Policy Research, uses four data sets to
model employer and individual behavior to estimate the impact of the ACA on the enrollment of
individuals in insurance coverage in California. CalSIM findings presented in this fact sheet are based
on CalSIM Version 1.8. For further details on the methodology, please visit www.healthpolicy.ucla.edu.
i
In 2012, 138% of the Federal Poverty Level was $15,415 for an individual and $31,809 for a family of four.
California HealthCare Foundation. California’s Uninsured: Treading Water. December 2012.Accessed at
http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/C/PDF%20CaliforniaUninsured2012.pdf.
iii
National Health Law Program. 10 Advocacy Steps to Support a Medicaid Expansion in Your State. September 2012. Accessed at
www.healthlaw.org/images/stories/10_Advocacy_Steps_for_Medicaid_Expansion_September.pdf.
ii
January 2013
Overview of the Affordable Care Act
(ACA)
Sarah de Guia, CPEHN
Director of Government Affairs
May 15, 2013
Major Provisions of the ACA
Expands Medicaid Coverage
– Increases Medicaid eligibility (Medi-Cal in California) to
133% FPL
– Allows states to cover parents and childless adults
– Reduces paperwork and eligibility requirements
Establishes “Health Benefit Exchange” – a
marketplace for individuals and small businesses to
purchase insurance.
Creates tax credits for those between 133%-400%
FPL unless affordable employer coverage offered.
Additional Provisions of ACA
Protects Employer-based Coverage
Reforms the Private Insurance Market
Promotes Prevention and Health Equity
Creates a “Bridge to Reform” through Low
Income Health Programs
Prevents denial of coverage based on a preexisting condition
Permits young adults to remain on parental
coverage until age 26
Who’s Eligible?
2.7 million uninsured Californians, newly eligible for
coverage and tax credits through Covered
California.
1.42 million uninsured Californians newly eligible for
Medi-Cal
Citizens and legal permanent residents (LPRs),
including those below 133% FPL if not eligible for
Medicaid. Undocumented immigrants are excluded.
Limited exemptions for financial, religious reasons,
and undocumented immigrants.
What kind of health coverage will be
available?
Must include at least the following services:
–
–
–
–
–
–
–
–
–
–
Ambulatory patient services
Emergency
Hospitalization
Maternity and newborn
Mental health & substance use disorder
Prescription drugs
Rehabilitative and habilitative
Laboratory
Preventive and wellness and chronic disease management
Pediatric services including oral and vision
Scope of Benefits
Must offer 5 different tiers
–
–
–
–
–
Bronze benefits = 60% actuarial value
Silver benefits = 70% actuarial value
Gold benefits = 80% actuarial value
Platinum: benefits = 90% actuarial value
Catastrophic coverage offered for those 30 years or younger &/or
those exempt from mandate
Tax credit subsidy is based on taxpayer’s monthly household
income compared to monthly premium for Silver plan
Limits on Out-of-Pocket Costs:
–
–
Individuals: $5,950
Families: $11,900
Tax Credit Subsidies - Individuals
Tax credits for those between 133%-400% FPL without
employer coverage
–
100-133% FPL: 2% of income
–
133-150% FPL: 3 – 4% of income
–
150-200% FPL: 4 – 6.3% of income
–
200-250% FPL: 6.3 – 8.05% of income
–
250-300% FPL: 8.05 – 9.5% of income
–
300-400% FPL: 9.5% of income
California’s Health Benefit
Exchange – Covered California
California establishes 1st Health Benefit Exchange
–
Includes Cultural and linguistic requirements & Board diversity
Health Exchange Board Mission Approved
–
–
–
Increase the number of insured Californians.
Improve health care quality, lower costs.
Reduce health disparities and promote prevention and wellness through an innovative,
competitive marketplace that empowers consumers to choose the health plan and providers
that give them the best value.
Important Decisions Being Made:
–
–
–
–
–
Information Technology
Qualified Health Plans
Eligibility and Enrollment
Service Center
Marketing, Outreach and Education
Follow Covered California: http://www.healthexchange.ca.gov/Pages/Default.aspx
Unresolved business…
Implementing the Medi-Cal Expansion
Integrating Applications for Health & Social Services
Pre-enrollment in State Exchanges
Enacting Individual Market Reforms (Gov. Signed Bills 5/9/13)
What you can do
Help get Californians ready for coverage in 2014
Conduct outreach and education
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Partner with the Exchange, DHCS and MRMIB to ensure
culturally and linguistically appropriate outreach and education
Connect the newly eligible with other services
Help to resolve complaints and dispel misinformation
Have a say in the implementation process
How CPEHN can help
Keep you up-to-date
Include you in our advocacy efforts
Identify critical opportunities
Be a resource
Contact us at CPEHN
(510) 832-1160 or (916) 447-1299
[email protected]
www.cpehn.org