The Affordable Care Act:

What Does It Mean for You and Your Health Clinic?

August 28, 2012 Series 3 of 4

Acronyms
ACA AI/AN FPL IHCIA I/T/U Affordable Care Act American Indian/Alaska Native Federal Poverty Level Indian Health Care Improvement Act Indian Health Services, Tribal and Urban Indian organization programs/providers CHIP Childrens Health Insurance Program

Basic Health Insurance Terms

Premium: The amount paid to an insurance company, usually on a monthly basis, for health insurance coverage.

Out-of-pocket costs: Health care costs paid by the patient. These include copayments, coinsurance, and deductibles.
Deductible: A specific dollar amount paid by the user each year before your health insurance plan starts to make payments for a claim. Not all health insurance plans require a deductible. Exclusions: Things not covered by the health insurance policy. Make sure to check the fine print of the health insurance policy for which conditions are excluded.

Basic Health Insurance Terms cont.

Benefit: Any service or supply (an office visit or a prescription drug) your health insurance plan will pay for. Co-payment (copay): The dollar amount paid for a medical service or supply according to your insurance plan. ($20 for sick visit) Pre-existing condition: A health problem or diagnosis that you had before applying for health insurance or before the effective date of your new health plan. By 2014, companies will be unable to deny you coverage based on pre-existing conditions. Lifetime maximum: Refers to the amount of money the health insurance policy will pay for the entire life plan.

The Health Care Law

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (ACA) The ACA protects the right of all Americans, including American Indians and Alaska Natives, to access affordable health care
More than 32 million in this country who would otherwise not have health insurance will have access to health coverage

Recent Supreme Court Decision

On June 28, 2012 the Court upheld minimum coverage requirement Precluded Medicaid expansion requirement Protected IHCIA and implementation efforts to date

The Federal Trust Responsibility

The ACA fulfills the federal trust relationship and strengthens tribal sovereignty through: o Protection of the IHS system o Providing equal access to quality care o Expansion of tribal governments role in health care decisions

ACA Benefits American Indians & Alaska Natives

o Permanent reauthorization of the IHCIA o Strengthens the Indian Health Service system authorities o Greater access to health insurance coverage

What Does the ACA Mean for Your Clinic

New sources of funding for tribal facilities Quality health care for citizens

Stronger role for tribal governments

You Can Improve Your Local Facilities

Third-party billing Offer services to non-IHS eligible beneficiaries Share facilities and services with VA and DOD Expand workforce

ACA Can Help Expand Your Workforce

The NHSC & IHS offers
Loan Repayment Programs Scholarship Programs
To learn more visit: http://www.nhsc.hrsa.gov/ http://www.ihs.gov/loanrepayment/ http://www.scholarship.ihs.gov

You Can Compact or Contract

Community Health Aide Programs Dental Health Aid Therapists Dialysis Programs Long Term Care Alternative Health Care Delivery Models Transportation for Health Services Expanded Behavioral Health Care Options

Medicaid Benefits with ACA Implementation

More AI/ANs will qualify for Medicaid under the expansion

No Medicaid premiums or cost sharing when receiving services from an I/T/U

Medicaid Eligibility and Enrollment Streamlined

Is Your Staff Ready for Reform

Outreach & Education Efforts Will Help! Focus on Eligibility and Enrollment Capacity ACA Trainings Newspaper Articles Radio PSAs

Covering Preventative Services with No Deductible or Co-Pay

Cancer screenings such as mammograms & colonoscopies Vaccinations such as flu, mumps & measles Blood pressure screening Cholesterol screening Tobacco cessation counseling and interventions Birth control Depression screening And more

You Can Educate About the State Exchanges

No co-pay or deductibles Monthly enrollment Tribes can choose to pay premiums for Tribal citizens

You Can Work to Implement the Law

Policymakers need your help State-Based Insurance Exchanges State Medicaid Expansion Federally Facilitated Exchanges

What You Can Do

1. Improve your local health care 2. Educate tribal citizens 3. Increase access to care 4. Expand your authority the compacting and contracting 5. Meet tribal needs through the state and federal consultation process

Learn More At
http://www.tribalhealthcare.org http://www.HealthCare.gov

http://www.IHS.gov

National Indian Health Outreach & Education (NIHOE) Initiative

NIHOE National Partners

* With generous support from the Indian Health Service

13 NIHOE Area Coordinators

National Indian Health Board Tyra Baer Tribal Health Care Reform Project Coordinator Tbaer@nihb.org