The Basics

• Approach
• Individual Mandate
• Employer Requirements
• Expansion of Public Programs
• Premium & Cost-Sharing subsidies to Individuals
• Insurance & Finance Health Reform
• Health Insurance Exchanges
• Benefit Design
• Changes to Private Insurance
• State Role
• Health System Performance
• Prevention Wellness
• Long Term Care
• Other Investments

Summary:

The Affordable Care Act (ACA) requires most U.S. citizens and legal residents to have health insurance.

 

States are required to create state-based American Health Benefit Exchanges through which individuals can purchase coverage with premium and cost sharing credits available to individuals/families with income between 133-400% of the federal poverty level (the poverty level is $19,530 for a family of three in 2013) and create separate Exchanges through which small businesses can purchase coverage.

CLASS Act

A national, voluntary insurance program for purchasing community living assistance services
and supports (CLASS program) is to be established. Following a five-year vesting period, the program will provide individuals with functional limitations a cash benefit of not less than an average of $50 per day to purchase nonmedical services and supports necessary to maintain community residence. The program is financed through voluntary payroll deductions: all working adults will be automatically enrolled in the program,
unless they choose to opt-out. This provision was repealed by the American Taxpayer Relief Act of 2012.

 

Medicaid

• The Medicaid Money Follows the Person Rebalancing Demonstration program through
  September 2016 will be extended (effective 30 days following enactment) and allocate $10 million per year for five years to continue the Aging and Disability Resource Center initiatives (funds appropriated for fiscal years 2010 through 2014).
  
• States are provided with new options for offering home and community-based services through a Medicaid state plan rather than through a waiver for individuals with incomes up to 300% of the maximum Supplemental Security Income (SSI) payment and who have a higher level of need and permit states to extend full Medicaid benefits to individual receiving home and community-based services under a state plan. (Effective October 1, 2010)
  
• The Community First Choice Option in Medicaid was established to provide community-based attendant
  supports and services to individuals with disabilities who require an institutional level of care. States with an enhanced federal matching rate of an additional six percentage points for reimbursable expenses are provided in the program. (Effective October 1, 2011)
  
• The State Balancing Incentive Program was established to provide enhanced federal matching payments to eligible states to increase the proportion of non-institutionally-based long-term care services. Selected states will be eligible for FMAP increases for medical assistance expenditures for non-institutionally based long-term services and supports. (Effective October 1, 2011 through September 30, 2015)

 

Skilled Nursing Facility Requirements

Skilled nursing facilities under Medicare and nursing facilities are required under Medicaid to disclose
information regarding ownership, accountability requirements, and expenditures. Standardized
information will be published on nursing facilities to a website so Medicare enrollees can compare the facilities. (Effective dates vary)

 

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