1 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: 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 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.
2 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. 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 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 También proporciona servicios preventivos gratuitos. 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. Disminución del Tiempo de Espera: Más doctores y servicios, significará tener que esperar menos para recibir servicios. 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. 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. 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. 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.
3 Inmigrantes Permanentes seguirán calificando para Medi-Cal: Residentes permanentes seguirán siendo elegibles para Medi-Cal sin tiempo de espera. 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. 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.
4 Key Legislation for 2013 Health Care Reform Implementation Extraordinary Session Bill / Author Sponsor Description CPEHN Position Status 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. Support Senate Health SBx1 1 (Hernandez) 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. Support Passed Senate Floor SBx1 3 (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. Support Passed Senate Floor Access to Health Care Bill / Author Sponsor Description CPEHN Position Status AB 50 (Pan) 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. Support Assembly Appropriations AB 209 (Pan) 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. Support Assembly Floor
5 AB 411 (Pan) CPEHN Medi-Cal Data Analysis: Requires Medi- Cal managed care health plans to analyze quality data by race, ethnicity, and primary language Support Assembly Floor AB 422 (Nazarian) 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. Support Assembly Floor AB 505 (Nazarian) CPEHN Medi-Cal Language Access: Codifies current language access requirements on Medi-Cal managed care health plans. Support Assembly Floor SB 22 (Beall) Mental Health Parity: Ensures compliance with and implementation of state and federal mental health parity laws. Support Senate Appropriations, Suspense File SB 189 (Monning) 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. Support Senate Floor SB 204 (Corbett) CPEHN Translated Prescription Drug Labels: Requires the use of translated directions for taking medications on prescription drug labels. Support Senate Appropriations 5/13/2013 SB 353 (Lieu) 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 Senate Appropriations, Suspense File
6 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) 2% Latino Figure 2: Adult Population Eligible for Subsidies in Covered California by English Proficiency (2013) 34% 13% 4% 47% African American Asian/Pacific Islander White Native American/Alaska Native/Multiple Race 40% 60% Native English Speaker/Very Well Limited English Proficiency: Well/Not Well/Not at All
7 Language barriers may reduce LEP participation Eligible LEP individuals are projected to enroll at lower rates than their non-lep counterparts. Of the 60 LEP adults eligible for subsidies in Covered California, 56% are predicted to enroll by 2019 if language were 55 not a barrier (Figure 3). However, without appropriate and effective multilingual outreach and education 50 efforts, just 46% are expected to enroll. The difference 45 between these two estimates shows that there is the potential to enroll upward of 119,000 more LEP 40 individuals in Covered California if enrollment is conducted with proactive outreach efforts directed toward the LEP population. Figure 3: Percentage of Subsidy-Eligible Adults Enrolled in Covered California (2019) Language needs are addressed Language needs are not addressed Projected languages spoken CalSIM also provides insight into the LEP adults projected to receive subsidies in Covered California in 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. ii 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.
8 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. 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 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 Medi- Cal. 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. 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.
9 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 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 It also provides preventive services for free. 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. Shorten Wait Times for Services: More doctors and services will mean shorter wait times for care. 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. 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 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. 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. Lawful Immigrants Keep Medi-Cal: Lawful immigrants are still eligible for Medi-Cal without a waiting period. 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. Insurance Exchange Closed to Undocumented Immigrants: Undocumented immigrants cannot buy insurance from the exchange and are exempt from the requirement to have health insurance.
10 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). How the state chooses to reach out to and educate those who are eligible for Medi-Cal will have a significant impact on enrollment. Simplifying enrollment procedures, implementing a robust culturally and linguistically outreach effort, and preenrolling individuals from existing health and human services programs are critical to maximizing participation. Even with these strategies in place, projections based on the California Simulation of Figure 2: By English Proficiency Insurance Markets (CalSIM) estimate that only 55% of those who are newly eligible for Medi-Cal, or 780,000 people, will enroll in 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. 8% 48% 35% Predicted Population Eligible for Medi-Cal Expansion in % 4% Figure 1: By Race/Ethnicity 65% 33% White Latino African American A&PI Other & Multiple Race Speaks English Very Well Speaks English Less Than Very Well
11 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 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 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 i In 2012, 138% of the Federal Poverty Level was $15,415 for an individual and $31,809 for a family of four. ii California HealthCare Foundation. California s Uninsured: Treading Water. December 2012.Accessed at iii National Health Law Program. 10 Advocacy Steps to Support a Medicaid Expansion in Your State. September Accessed at January 2013
12 Overview of the Affordable Care Act (ACA) Sarah de Guia, CPEHN Director of Government Affairs May 15, 2013
13 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.
14 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
15 Who s Eligible? 2.7 million uninsured Californians, newly eligible for coverage and tax credits through Covered California 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.
16 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
17 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
18 Tax Credit Subsidies - Individuals Tax credits for those between 133%-400% FPL without employer coverage % FPL: 2% of income % FPL: 3 4% of income % FPL: 4 6.3% of income % FPL: % of income % FPL: % of income % FPL: 9.5% of income
19 California s Health Benefit Exchange Covered California California establishes 1 st 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:
20 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)
21 What you can do Help get Californians ready for coverage in 2014 Conduct outreach and education 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
22 How CPEHN can help Keep you up-to-date Include you in our advocacy efforts Identify critical opportunities Be a resource
23 Contact us at CPEHN (510) or (916)