The Affordable Care Act Update

What is so important about the Affordable Care Act (ACA), and what does it do anyway?

With past and future budget deficits for Minnesota being the driving force behind legislative changes, the fear of deep cuts to programs and services is the constant cloud over us all. The ACA has provided between $300-400 million in additional Medicaid dollars, which helped plug the immediate state budget deficit in 2010, and helped protect rehabilitation therapies and limit cuts to providers.

The law also included some key provisions that helped both those with and without disabilities, including:

• A ban on health plans excluding coverage for those with pre-existing health conditions.
• Seniors receive a $250 rebate to help fill the “doughnut hole” in Medicare prescription drug coverage.
• The elimination of lifetime caps on insurance policies.
• Coverage for dependents until they turn 26.
• Insurers will not be able to rescind policies to avoid paying medical bills when a person becomes ill.
• New plans must provide coverage for preventive services without co-pays. All plans must comply by 2018.
• New plans will be required to implement an appeals process for coverage determinations and claims.
• Adoption tax credit and assistance exclusion will increase by $1,000. The bill makes the credit refundable and extends it through 2011.
• Businesses with fewer than 50 employees will get tax credits covering 35 percent of their health care premiums, increasing to 50 percent by 2014.
  
  

But, what’s in it for Courage Center?

Many of the challenges Courage Center has been facing in the last few years is due to the reimbursement rates we receive for our high-level care services. For example, we lose on average $800, for each Medicaid recipient we serve. While we underwrite much of our work through philanthropy - as much as 30%, we cannot continue to sustain this model of operations. Thus, some of the more detailed provisions in the ACA would be very promising to our bottom line if they were able to be implemented. Such provisions include:

• New payment strategies that will give incentives for hospitals and other providers to work with Courage Center.
• Demonstration grant programs focused on those with the most complex disabilities and care needs.
• Research grant dollars focused on wellness and new strategies to provide better care to those with disabilities.
  

Plus, there is much in the ACA that is set to be phased in over the next several years:

• Health coverage for 32 million currently uninsured Americans,
• More insurance choices through new purchasing pools (called “insurance exchanges”),
• New plans must provide coverage for preventive services without co-pays. All plans must comply by 2018,
• States can offer home- and community-based services to the disabled through Medicaid rather than institutional care beginning October 1.
• A 50 percent discount will be provided on brand-name drugs for Prescription Drug Plan or Medicare Advantage enrollees. Additional discounts on brand-name and generic drugs will be phased in to completely close the “doughnut hole” by 2020.
• Medicaid eligibility will increase to 133 percent of poverty for all non-elderly individuals to ensure that people obtain affordable health care in the most efficient and appropriate manner. States will receive increased federal funding to cover these new populations.