County prepares to implement the Affordable Care Act
What it means to Plumas residents
“It’s not about political beliefs; it’s about access to health care,” Public Health Director Mimi Hall said during a Sept. 24 interview about implementing the Affordable Care Act in Plumas County. “This entire effort is geared toward people who haven’t had coverage.”
She and Social Services Director Elliott Smart said their county agencies are ready to help county residents navigate their health care options.
“My staff has undergone extensive training,” Smart said. “As this plays out, there will be speed bumps, but the public can call us with questions.”
Hall said in any transition of this magnitude it will take a couple of years to work out all of the details.
Oct. 1 marked the first day of open enrollment, with new services set to go into effect Jan. 1, 2014.
“This is a culture shift nationwide,” Hall said, and explained that health care providers will be rewarded for keeping people out of the hospital. “They will be paid for outcomes rather than ‘widgets,’” which is her term for various tests and procedures.
Hall and Elliott said the goals of the Affordable Care Act are to expand health care access, reduce the cost per capita, and improve the quality of care.
Who will be affected?
The change will affect Medi-Cal recipients, uninsured individuals and small businesses that now may be able to provide health insurance for their employees.
Medi-Cal clients will enroll in one of two managed care programs and more people will become Medi-Cal eligible.
In a report that Hall and Smart presented to the Board of Supervisors on Sept. 17, the pair wrote, “Our review suggests that the expansion of Medi-Cal will benefit many of Plumas County’s low income and working (but low income) citizens because it will include persons whose income is at or below 167 percent of poverty where the current limit under Path2Health is 138 percent of poverty.”
|Affordable Care Act|
Who: Medi-Cal recipients and the uninsured
What: Access to health care
When: Enrollment period is now through March 30, 2014
For more information: Go to CoveredCA.com or call 800-300-1506
Poverty level varies by the number of people in a household, but as an example a three-person household would qualify for Medi-Cal if the income is less than $26,952 and for assistance through Covered California if the income is between $26,952 and $78,120. (See chart for more examples.)
Additionally, mental health and alcohol and drug services will now be covered by Medi-Cal.
To determine eligibility and options, residents are directed to contact Covered California, via the website Covered California at CoveredCA.com, or by calling 800-300-1506.
Hall said that she visits the website and calls the 800 number regularly to learn more about what the public will encounter when they try to access information.
“I have always reached a live person,” she said, “and they are knowledgeable.”
She encourages everyone to visit CoveredCA.com and learn about available options.
This information, taken from the website, helps explain what the public can expect.
“Beginning in October 2013, legal residents of California will be able to get health coverage through a new, easy-to-use marketplace called Covered California.
“Covered California will offer health insurance plans, which cannot be canceled or denied, at an affordable price.
“Californians can shop for the plans online or see if they are eligible for Medi-Cal, and Covered California will provide in-person and phone assistance for those who need it.”
Health insurance plans, with four levels of coverage and their associated costs, can be compared on the site.
In addition to information about health insurance plans and their costs, individuals will learn about the level of assistance that is available to help them pay premiums.
Small businesses also have options and can buy insurance for their employees and receive tax credits to help offset the cost.
Medicare recipients are not impacted by this change, nor are individuals who have insurance provided by their employer, unless their out-of-pocket cost exceeds 9.5 percent of their household income.
In addition to the state website and phone assistance, residents can call the county social services office at 283-6351.
The Affordable Care Act requires telephone access to health exchanges for all citizens from 7 a.m. to 8 p.m. weekdays and 8 a.m. to 2 p.m. Saturdays. Rather than staffing an exchange, Plumas County is contracting with Shasta County to handle the after-hours and Saturday calls.
Smart explained that Shasta County would provide a “warm hand-off” to his department on the next business day so that his staff can follow up with the caller.
People can enroll from now through March 30, 2014, when open enrollment ends.
In upcoming years, open enrollment will be from Jan. 1 through March 30, but those whose circumstances change — such as through loss of employment — can enroll in a health plan outside of the open enrollment period.
Both Hall and Smart want the public to know that the situation will be evolving, but they encourage people to visit CoveredCA.com for more information.
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