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Regular-Health & Human Services # 40.
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| Board of Supervisors |
Employment & Social Services |
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| Subject |
| Receive report regarding Department of Employment & Social Services and Health Department preparation for implementation of the Affordable Care Act. (No general fund impact) (Smith/Cook) |
| Recommended Action |
| Receive report regarding Department of Employment & Social Services and Health Department preparation for implementation of the Affordable Care Act. |
| Strategic Plan Goal(s) |
Advance innovation
Collaborate to maximize success
Enhance and sustain the safety net
Provide fiscally sound, dynamic and responsive services |
| Reason for Recommended Action/Background |
The Patient Protection and Affordable Care Act (PPACA), commonly called Obamacare or the Affordable Care Act (ACA) was signed into law on March 23, 2010. It represents the most significant government expansion and regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965. On June 28, 2012, the United States Supreme Court upheld the constitutionality of most of the ACA.
The ACA is aimed at increasing the rate of health insurance coverage for Americans and reducing the overall costs of health care. It provides a number of mechanisms including mandates, subsidies and tax credits to employers and individuals to increase the coverage rate.
The ACA requires most US citizens and legal residents to have health insurance. In Yolo County, we expect this to impact approximately 7,000 residents. The expanded eligibility will include coverage for single, adult U.S. citizens under the age of 65 who are at or below 138 percent of the Federal Poverty Level and have resided in the U.S. for at least five years. Currently, these residents may be covered under the County Medical Services Plan (CMSP)or Path2Health.The county will retain responsibility for health care services to low-income adult residents not eligible to any other health care program. In 2010, California enacted legislation to implement the provisions of the ACA by creating a health care marketplace called Covered California.The open enrollment period for this health insurance exchange will run from October 1, 2013 through March 31, 2014. DESS will dedicate six (6) experienced Public Assistance Specialists (PAS) to this enrollment and eligibility determination task. During the open enrollment period, Medi-Cal eligibility will be determined utilizing the CalWIN system currently in place. Residents who are determinted not to be eligible to Medi-Cal will then need a second eligibility determination to be performed for Covered California plans via the CalHEERS system. These six (6) dedicated staff will be trained on the CalHEERS system prior to the beginning of open enrollment. The CalHEERs system does not integrate with CalWIN at this point, which will necessitate double data entry for applicants determined ineligible for Medi-Cal. Once the systems are integrated, we will stage in training for our other PAS staff.
We have Call Center in place, the technology for which will aid in managing the increased volume of applicants and ongoing beneficiary caseload. In addition, we may pursue a shared services agreement with other counties in the CalWIN Consortium to provide after-hours assistance.
During the first two years of the ACA, the Federal Medical Assistance Percentages (FMAP) - or federal matching rate - to the State will be 100 percent for newly eligible plan participants. It will incrementally decline to 90 percent by 2020 and will remain at that rate for future years. |
| Other Agency Involvement |
| None |
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| Fiscal Impact |
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