Time to Get Insured: Learn the Who, What, Why, and How to Enroll in Health Insurance through the Medicaid Expansion or the State or Federal Marketplace

Moderator: Jane Tobler
February 12, 2014
2:00 pm CT

Welcome and thank you for standing by. At this time all participants are in a listen-only mode until the question-and-answer session.

At that time if you'd like to ask a question please press Star 1 on your touch-tone phone.

Today's call is being recorded. If you have any objections please disconnect at this time.

And now I would like to turn the call over to Ms. Jane Tobler. Ma'am you may begin.

Jane Tobler: Hello and welcome to Time to Get Insured: Learn the Who, What, Why, and How to Enroll in Health Insurance through the Medicaid Expansion or the State or Federal Marketplace.

Today's Webinar is sponsored by the Substance Abuse and Mental Health Services Administration's Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health, also known as the ADS Center.

SAMHSA is the lead Federal agency on mental health and substance abuse issues and is located in U.S. Department of Health and Human Services.

Please join the ADS Center listserv to learn more about social inclusion including upcoming Webinars, new resources, and events.

This Webinar will be recorded. The presentation, a video archive including closed-captioning and a written transcript will be posted to SAMHSA's ADS Center Web site at promoteacceptance.samhsa.gov by mid-March.

The views expressed in this training event do not necessarily represent the views, policies, and positions of the Center for Mental Health Services, the Substance Abuse and Mental Health Services Administration, or the U.S. Department of Health and Human Services.

Our presentation today will take place during the first hour and will be followed by a 30-minute question-and-answer session. During that time you can ask your questions by phone or use the online question feature at the top of your screen.

We may not get to all questions. If your question is not answered or if you want further information the presenters' contact information is provided at the end of this presentation so you can contact them directly.

The SAMHSA ADS Center supports peer-run organizations and others engaged in public education, outreach, awareness, and support activities through a broad range of Web-based resources and free training events and through individual technical assistance.

Through these efforts of the ADS Center hopes to increase awareness and support implementation and replication of socially inclusive practices, programs, and policies and now on to our teleconference topic.

Enrollment and health insurance under the Affordable Care Act is in full swing. Health insurance coverage is now accessible for many Americans who lacked it through either the new Medicaid expansion or the new Health Insurance Marketplaces.

Under this new law, both are required to provide coverage for mental health and substance abuse conditions with parity to coverage for general health conditions. This is an exciting and important development.

With the ACA opening up new opportunities for individuals using mental health or substance abuse services to receive coverage, the ADS Center team recognized the important need for outreach to ensure that those in need of access to affordable healthcare coverage were well informed about this resource, what it means to them, and how they can enroll.

The current open enrollment period to receive coverage in 2014 will close on March 31, 2014. We hope the information provided during today's training will be useful and helpful to you or your loved ones in assisting you to enroll if you have not done so already or to make informed decisions about your next steps.

We'll begin today's Webinar with a brief overview of the Affordable Care Act, its requirements, and its potential for extending healthcare coverage.

We will then hear about enrollment outreach in Colorado, a State that has its own marketplace and is expanding Medicaid, followed by a presentation on outreach in North Carolina, a State that is participating in the Federal Marketplace and is not expanding Medicaid.

Our goal today is to have listeners understand the new insurance coverage options and get practical advice about enrolling in your State.

Our first presenter is Dr. Ron Manderscheid who serves as Executive Director of the National Association of County Behavioral Health and Developmental Disability Directors and is also an Adjunct Professor at the Department of Mental Health at the Johns Hopkins University Bloomberg School of Mental Health.

During the national healthcare reform debate under the Clinton Administration, Dr. Ron Manderscheid served as a Senior Policy Advisor on National Healthcare Reform in the HHS Office of the Assistant Secretary for Health.

At the same time he was a member of the Mental Health and Substance Abuse Workgroup of the President's Task Force on Health Care Reform.

He has continued this work in support of the implementation of the Affordable Care Act of 2010. Throughout his career Dr. Ron Manderscheid has emphasized and promoted peer and family concerns.

Dr. Manderscheid will be giving an overview of the ACA's insurance expansion provisions and the options for getting coverage. Thank you for joining us today Dr. Manderscheid.

Dr. Ron Manderscheid: Jane, thank you very much and thank you for inviting me to talk about this. I believe that the Affordable Care Act is an exceptional opportunity for mental health consumers, their families, providers in the system—everybody associated with behavioral health care.

Some things that are going on that are very important to us, so the Affordable Care Act will extend insurance coverage for up to 19 million poor people and 20 million near-poor citizens, 19 million people potentially through the Medicaid expansion, and 20 million people through the State Health Insurance Marketplaces.

Based on epidemiological work that's been done in the field we believe that up to 11 million of these people are people who already have a behavioral health condition.

So almost one-third of the people who potentially will be enrolling in health insurance already have a behavioral health condition and today they are without health insurance and will be helped by the Affordable Care Act.

The Affordable Care Act is also a safe harbor for those with severe illnesses. Beginning on January 1st of this year, no one of any age in the United States who's a citizen will be able to be excluded from health insurance because they have a pre-existing condition.

This is a huge gain for behavioral health care and something we can all be very thankful for.

The Affordable Care Act also has a new focus on prevention and promotion and not just disease care. This will come as very welcome news to people in the field particularly consumers and peers who have been working on wellness initiatives.

I have prepared three very short documents to explain: What is the Medicaid expansion, what are Marketplaces, and what is the enrollment process.

So, on each of these. The Medicaid expansion: What is the Medicaid expansion, how does it operate, how would a person enroll in insurance, and what steps can be taken?

Similarly, with the Health Insurance Marketplace: What is the Marketplace, how is it organized, how does it operate, and how can someone enroll?

And then finally, a third piece for people who want to with themselves enroll: How would you actually go about the enrollment process? All three of these documents are available on the Web site you see there at www.behavioral.net.

The Affordable Care Act is about getting health insurance coverage to people and about getting them access to care. So we want to go on now and talk a little bit about how this is going to operate.

The ACA has three principles that are very important to us in behavioral health parity. And they are absolutely the same as the principles in which we operate our own field.

The Affordable Care Act focuses on person-centered care, where the consumer is the true north of the care delivered. The Affordable Care Act focuses on shared decisionmaking where the care plans and goals are jointly developed by the consumer and the provider.

The Affordable Care Act, like in the field of behavioral health, focuses on whole health putting the person's whole health concern together in one place.

Parity plays an essential role in the Affordable Care Act. The essential health benefit which is the underlying concept that drives the benefits in the State Health Insurance Marketplace and the Medicaid benchmark benefit which is the benefit that drives the Medicaid expansion both require that mental health and substance use benefits be at parity with medical and surgical benefits and that the management of the mental health and substance use benefit not be any more restrictive than management of the medical or surgical benefit.

Parity also extends beyond the Qualified Health Plans and the Medicaid expansion to all individual and small-group plans after January 1st of 2014.

So, I'm now going to talk quickly about the insurance reform, how you can get enrolled in insurance, and then some of the important coverage provisions.

First about the Medicaid expansion. Currently, 26 States and the District of Columbia are doing the Medicaid expansion. Enrollment in the Medicaid expansion began on October 1st of 2013.

And for those who enrolled early, their coverage began already on January 1st of 2014.

The Medicaid expansion is intended to cover all uninsured adults up to those with an income of 133 percent of the Federal poverty level. And because the first 5 percent of income is discounted, in effect that means the people up to 138 percent of the Federal poverty level.

The upper income limit to enroll in the Medicaid expansion is about $15,282 or $1,273 per month per individual.

The enrollment process for the Medicaid expansion will operate continuously so it is going to go on all through 2014.

The other way to enroll for people who are eligible is through the State affordable Health Insurance Marketplace. This also began operation on October 1st of 2013 with initial insurance coverage for those who enrolled effective on January 1st of 2014.

The scope here is for all adults above 133 percent of the Federal poverty level again considering the 5 percent discounted income.

So the lower limit here is $15,282 or about $1,273 a month for individuals.

Unlike the Medicaid expansion, the enrollment process for the State Health Insurance Marketplaces will close on March 31st, 2014.

That's a very important fact. So if you are eligible to enroll and you meet these income requirements, you need to become active now and do this. March 31st is going to come very quickly. We're already at the middle of February here.

There are three types of State Health Insurance Marketplaces—Federally Facilitated Exchanges which are operated by the Federal Government, State Partnership Exchanges which are operated jointly by the Federal Government and the States and excuse me, State Partnership Exchanges which are jointly operated by Federal Government and the State, and then State-Operated Exchanges which are operated by the States themselves.

A very important distinction between the Medicaid expansion and the State Health Insurance Marketplaces, if you are living in a State that is not currently doing the Medicaid expansion then your State Health Insurance Marketplace can insure people between 100 percent and 133 percent of the Federal poverty level.

So if you are in such a State and you are within that income range you have an opportunity to enroll in health insurance through your Marketplace.

The income range to do this enrollment is from about $11,490 per year to $15,282 per year or $957 per month to $1,273 per month.

And again, this applies specifically to States and residents in States that are not currently doing the Medicaid expansion.

Here's a picture so you can identify your own State. All of the States shown in orange on this map of the United States are States that are doing the Medicaid expansion.

The States shown in gray are States that are not doing the Medicaid expansion.

So if you are in an orange State, the Medicaid expansion begins, it goes up to 133 percent of the Federal poverty level.

If you are in a gray State, you can enroll in insurance if you are between 100 percent and 133 percent of the Federal poverty level and you can enroll in the insurance through your State Marketplace.

Some changes in coverage mandates that are very important. Certain prevention and promotion services now have no copays or deductibles.

Every Qualified Health Plan offered through the State Health Insurance Marketplace and the Medicaid alternative benefit for the Medicaid expansion include a mandatory prevention and health promotion benefit.

Guaranteed issue means that insurance is available to all people regardless of their pre-existing condition. I said before, that became effective for the entire population of any age on January 1st of this year.

People up to age 26 can now remain covered on their family policies. This is very important for people who graduated from college, who are now out seeking jobs, but don't yet have a job. And currently there are about 3.9 million people who have taken advantage of this particular coverage.

And another very important feature: Health insurance no longer has an annual or lifetime limit. Previously there were almost every health insurance policy had an annual limit and it also had lifetime limit. Typically they would be $1 million, and $3 million. That's no longer true and the Affordable Care Act has changed this.

How can you go about enrolling? There are many people out there who will help you enroll. Health Insurance Navigators are available and are paid for through Federal grants in States that have Federally Facilitated Marketplaces and State Partnership Marketplaces.

All Federally Qualified Health Centers in your States have been given resources to help people enroll in insurance. Peers in your own community who have used behavioral health services can help you enroll in insurance.

Certified application counselors can help you enroll in insurance. Other authorized representatives and in-person assisters are also available.

To find help in your area you see the 800 number here 1–800–318–2596, repeat 1–800–318–2596 or if you're hearing impaired 1–855–889–4325 or you can visit the Web site localhelp.healthcare.gov.

So there are many avenues to get help and I would encourage that you take advantage of those avenues.

Finally, I have prepared an article that gives a summary of the Affordable Care Act. It's about a 10-page article. It's available at the link that you see on this overhead and these overheads will be available on the ADS Web site after the presentation.

If you are interested in getting a quick 10-page overview of the Affordable Care Act, this article is available to you.

So with that I'm going to conclude. Thanks again for inviting me. And I think it's just a very important and wonderful opportunity we have in behavioral health care that we now have the Affordable Care Act and we are actually implementing it.

Jane Tobler: Excellent. Thank you Ron for your work on this, and for giving us a clear overview of this important new law that entails a complicated implementation process.

Our second presenter is Adela Flores-Brennan who joined Connect for Health Colorado in November 2012 as the Assistance Network Manager.

In this role Ms. Flores-Brennan is responsible for implementing statewide programs for local application and enrollment assistance.

She comes to the Marketplace from the Colorado Center on Law and Policy where she spent more than 5 years working on a range of health policy, Federal policy, and legal issues including health reform implementation and Medicaid and Children's Health Insurance Program eligibility and enrollment issues.

Today, Adela will be discussing what's happening in Colorado with health insurance expansion and will give us an example of what individuals need to do to get insured in a State that has its own Marketplace and is expanding Medicaid. Welcome Adela.

Adela Flores-Brennan: Thank you Jane. Thank you for inviting me and having me here today. And thanks to Ron for laying the framework.

I'm going to talk today about what's happening in Colorado. Again I work for the Colorado State-based Marketplace and I oversee a couple of programs that help individuals in communities to get assistance with application and enrollment.

So let me talk about who Connect for Health Colorado is. We are the State-based Marketplace. We had, in Colorado, passed legislation in 2011 to authorize the creation of a State-based Marketplace.

We currently have over 150 plans and 22 dental plans offered in the Marketplace for individuals and families.

And actually as of just this week we have over 73,000 people who are enrolled. So you can see that since I created this slide in January we've increased our enrollment by over 13,000 people.

The way to access Connect for Health Colorado via the Web, is at this link that's presented here, ConnectForHealthCO.com.

I also wanted to point out that Colorado is a State that did approve and implement the Medicaid expansion.

So in Colorado we do have both a Medicaid expansion and a State-based Marketplace available to help people who don't have access to coverage or affordable coverage now find that coverage through either of those available mechanisms.

So I wanted to share with you some information about how to get help applying and just what the process looks like of submitting an application to get health coverage in Colorado.

So I wanted to start with how to get help. First you can go to our Web site as I shared the link with you, ConnectForHealthCO.com. That is always available for browsing around and finding information.

But you can also call our service center. We have an 800 number, 855–PLAN–4–You. And that's 855–752–6749.

And our service center is open 6 days a week 8 o'clock in the morning to 7 o'clock at night, available to help people with answering questions, and they can actually take an application over the phone.

Out in the community we have a couple of different resources. We are working with our broker community here in Colorado and we have nearly 1,500 Certified Brokers who have been trained and certified to work specifically with Connect for Health Colorado and sell the plans that we offer on our Marketplace.

We also have a network of organizations called the Assistance Network and within those organizations we have people who are called Health Coverage Guides.

Those guides are certified and trained by Connect for Health Colorado. And they are available to provide impartial, unbiased support in the community and help you with filling out the application, going through plan selection and through the enrollment process.

These folks are, again they're grant funded through Connect for Health Colorado. They are located at Federally Qualified Health Centers, at mental health centers, at community-based organizations throughout the State. So we have really good coverage in our State for having that in person assistance resource.

Another type of in-person assistance that we have in Colorado is through our Certified Application Counselors. Those folks are also trained to provide application assistance.

And they are located also in a lot of provider organizations like behavioral health organizations, Federally Qualified Health Centers, and hospitals.

They don't receive any grant funds. They do this work as part of their other duties but they are available to help the—their current client navigate the application and enrollment process.

On our Web site as well we have online chat with a service representative so that is available as well if that is a preference. And then as a picture of the side of your screen you'll see just a snapshot of our search tool for agents and brokers and for assistance sites that's available on our Web site.

You can do a ZIP code search to find somebody who is near to you to call for an appointment to get help with the application process.

So it helps to be prepared when starting the application process. So here is a list of information that is useful to you at least to either have available to you or to bring to an appointment.

You'll need of course contact information, your address, phone number, and full name. You'll need Social Security numbers for each applicant or document numbers for people who are lawfully present immigrants.

You will need the information like birth dates, employer information, and employer coverage information.

You'll need some income information like tax returns or pay stubs or W-2s. And then it also helps to have a list of preferred healthcare providers.

With Connect for Health Colorado, you can filter your plan options by preferred healthcare providers. So it helps to have the names or institutions that you prefer to go to.

So how do you get started with this process? On the Connect for Health Colorado Web site, again it's ConnectForHealthCO.com, you can go and shop and compare plans anonymously.

So if you just want to go check out what is available you can go on to the Web site and shop around and look at the plans. You don't have to put in a great deal of information to do that, usually just some basics like your ZIP code so we know which plans to pull up for you.

You can also use an online calculator tool. And you'll see a picture of that tool on this slide to help estimate your eligibility for financial assistance.

In Colorado and with the other Marketplaces around the country there is available a couple of different types of financial assistance that help bring down the cost of monthly premiums and cost sharing.

And I'll explain both of those mechanisms here in a moment. But this tool that I just referenced will help you see what you might qualify for in terms of your premium assistance.

We also have online tools just to help you learn more about what the marketplace is, help answer some basic questions. So, we have an FAQ and then also some information about understanding insurance more generally.

So, let's talk about what types of financial assistance are available through the Marketplace. The first one is called the Advanced Premium Tax Credit.

This tax credit helps to offset the cost of the monthly premium.

So let's provide an example. We have Bob. Bob is from Denver and he's 35 years old. He makes about $22,000 per year.

He finds out that he qualifies for a Premium Tax Credit or APTC of $131 per month. Because of his income, that is how much he qualifies for.

He searches on our Web site and finds a plan called the Colorado Health Ops Bronze plan. That plan costs $194 per month.

When he applies that $131 Premium Tax Credit to the amount of his premium it nets out so that Bob only owes about $63 per month for his plan.

So the way that the Premium Tax Credit works or that it can work is that it can be applied on a monthly basis to help reduce the cost of the premium that the customer owes.

So in Bob's case for a plan that would originally cost $194 he can get a tax credit that brings down his costs to only $63 per month.

And I should say that the Advanced Premium Tax Credit is calculated based on income, which is why you would need to bring some income information to an appointment or have that available when you're applying.

And it also is it available on a sliding scale so that the higher your income goes, the less assistance you will get.

There's also another type of assistance called a Cost Sharing Reduction. This reduction basically comes in the form of an upgraded health plan. And that health plan has lower deductibles and copayments.

Individuals are eligible for a Cost Sharing Reduction if they make an income that is less than 250 percent of the Federal poverty level, so that's $28,725 per year for an individuals.

With the Cost Sharing Reduction you have to buy a Silver-tiered plan. So we sell four tiers of plans, all with the same basic set of benefits, but the coverage is different for each tier. And for a Cost Sharing Reduction you have to purchase that Silver level plan.

So in Bob's example, remember Bob from the previous slide, he's at about 200 percent of the Federal poverty level. If you remember he made $22,000 per year. That puts him at about 200 percent of the Federal poverty level.

With a regular Silver plan he would have to pay about 30 percent of the cost sharing, but with the reduction plan, he would pay only about 13 percent of the cost sharing.

So the plan that he would get with the Cost-Sharing Reduction has the effect of just reducing the amount that he pays out of his pocket for things like the copays and deductibles.

So let's talk about the application process. In Connect for Health Colorado, we do things a little bit differently probably from other States and the Federal Marketplaces.

We're going to start with the ability to shop and compare online. And then the individuals, the customer can decide if they want to apply for financial help.

If they do, if the person does want assistance with the cost of their health coverage, we first need to go and get a Medicaid denial.

So we'll put a person through the Medicaid application process. After that process is over and we've gotten the Medicaid denial we proceed to the calculation of the Advanced Premium Tax Credit and Cost Sharing Reduction. And then the person can proceed to pick a plan and make payment and get enrolled.

So I'll break that down a little bit. From our homepage if you were to go to ConnectForHealthCO.com you would click Shop Now and start by creating an account with the Marketplace, and you'll see a little picture on the side of our Shop Now button.

One of the first questions you'll be asked after creating your account is whether you want help paying for health insurance.

If the answer to that question is yes, then customers will be directed to the State's Medicaid application. So the application will open right there on the screen and you can proceed with filling that application out.

In the online Medicaid application, again a person needs to create another account and answer some questions, and then the State Medicaid application does have the ability to do a real-time eligibility.

So if you get a Medicaid denial then the customer is directed back into the Marketplace or back into Connect for Health Colorado.

In Connect for Health Colorado, you would answer a few more questions and see your eligibility results for the Advanced Premium Tax Credit and Cost Sharing Reduction.

At that point you could go shopping for a health plan. So assuming that you were not found eligible for Medicaid and you came back to the Marketplace then had Advanced Premium Tax Credit, or even if you didn't, you can then proceed to go ahead shop for a health plan.

You can use our provider search tool to narrow your plan choices by those plans that have your provider in network.

We have filters and sorting options that allow customers to sort and filter on cost, coverage level, and quality; and then do a side-by-side comparison which is shown here on the slide.

So let's also talk about some important deadlines. I think this has been mentioned already. We have until March 31st to get covered through the Marketplace.

So with private coverage through the Marketplaces, we have an open enrollment period, and our open enrollment period ends on March 31st.

One deadline that we're facing very soon is on February 15th in Colorado you need to sign up by February 15th if you want your coverage to start by March 3rd.

Similarly in the coming month in March if you want coverage for April 1st you need to sign up by March 15th.

If you do get signed up later in March, if you sign up by March 31st for example then your coverage would begin on May 5th—I'm sorry, May 1st.

So it is important to keep in mind that we have this open enrollment period and that that period does end on March 31st.

But also keep in mind that if you have a qualifying event, something like the birth of a new child or an adoption, or you moved from one State to the other, or you've lost coverage from your employer all of those types of things serve to trigger a special enrollment period for you.

So even if you haven't—if you didn't get enrolled in by March 31st you're—sometime this summer you have a life-changing event that could qualify you for an open enrollment period or special enrollment period, and you would have some time to enroll at that point.

Also just a reminder that Medicaid and the Children's Health Insurance Plan do not have enrollment periods and you can enroll in those programs at any time.

I just put a few resources from the Connect for Health Colorado Web site on the slide. One is again our Web site, our homepage address. But also there is a searchable Frequently Asked Questions link here so you can go in and type in some keywords and we can—we have a good FAQ on our Web site.

And then the Insurance Basics link is also provided for you here if you wanted to just get some background information on private insurance and what some of the terminology means.

And then here is my contact information. If you need help locating somebody in the State of Colorado to help you with the application process, you can certainly reach out to me and I can help put you in touch with somebody who can sit down and help you through the application process, or if you have general questions as well about Connect for Health Colorado, I'm happy to answer those. So thank you and I'll hand it off.

Jane Tobler: Thank you Adela for sharing the information on what's going on in Colorado as well as what we can expect when we pursue insurance coverage in a Medicaid expansion States with its own Marketplace.

As our third presenter we will hear from Mr. Nyi Myint who serves as the Navigator Project Manager with Project Jumpstart of the Alcohol/Drug Council of North Carolina.

Mr. Myint joined the staff of the ADCNC in 2013 becoming the Clinical Program Manager on a project that provides no-cost substance abuse assessment and brief intervention services to members of the North Carolina National Guard.

Mr. Myint served in the U.S. Army for 25 years retiring at the rank of major to pursue a career in the human services.

He's a veteran of Operation Desert Storm and Operation Iraqi Freedom and he did a tour of duty in Bosnia.

Today Mr. Myint will discuss the outreach strategies his organization is using to reach mental health and substance use service recipients and what you can expect if you're attempted to enroll in a State that is using the Federal Marketplace and has opted not to expand Medicaid. Thank you for joining us Myint.

Nyi Myint: Thank you. I appreciate the opportunity to speak on the Webinar and certainly that wonderful introduction.

And I'm going to apologize in advance. I've got a little bit of a cold that's on the tail end. But thank you very much and I'm also going to ask Dr. Manderscheid to advance our slides. We seem to be having a slight technical issue, so sir if you don't mind the next slide please?

Okay, just a little bit about the Alcohol and Drug Council of North Carolina. We are an information and referral service. We specifically address the needs individuals with substance use disorder.

And the Navigator, navigating and assisting people enrolling in affordable health care works very well with our existing mission of providing information referral, no-cost assessments, and also peer support services throughout our State.

Next slide. So, our hypothesis was that health insurance gives us access to treatment and access to treatment gives you a better chance of recovery.

This is a message that is specifically for individuals struggling with substance use disorder. But our goal was to provide this service, but we are in no way, shape, or form turning away anybody that needs access.

We do this to provide access to health care for those that are underinsured or those that are uninsured. And it's been a wonderful experience for us as we continue to reach out to these individuals throughout North Carolina.

Next slide. Because of the timeliness of the grant, we were able to work with our existing partners throughout the State.

And we found that because we wanted to reach a very difficult population to reach on—we used partners like the Burke Council on Alcoholism and Chemical Dependency that already had a very strong support network in the western side of the State.

Using our existing call center, we were able to field calls as they came in and then direct them to not only our Navigators and our partners, but other Navigators within the State as we've all consolidated and shared our resources, so, it's been a good opportunity to work our existing resources.

So our Field Navigators are Navigators that we've assigned to special events. And as we see events or we're requested we've been able to do fairs, schools, methadone clinics, community colleges, conferences—lots of locations where we would find individuals that were either uninsured or individuals that work with individuals that tend to be underinsured.

North Carolina has over 140 Oxford Houses. We partnered with Oxford House and we were able to use our outreach workers to target individuals in Oxford Houses to provide access to the Affordable Care Act to assist in enrollment along those lines.

And we included TASC, which works with the vendors to ensure that as they transition out of the correction system that they have access to health care and treatment should they need treatment as well.

There is also several fixed sites. We were fortunate that there were many partner agencies or treatment facilities that were willing to train either their own staff to become Navigators or provide us office support and office space where we can set navigators on schedules so that individuals could set up the appointments and receive assistance enrolling in the Affordable Care Act.

Next slide please. Because North Carolina did not have a single per se point of entry, we relied heavily on the Federal Web site as well as creating our own site which is HealthCareNCnow.

And we used our existing call center and expanded our hours within the call center so that we were able to have a single point of entry where we could actually take that information and then shoot it to the different Navigators.

We have a specific communication and messaging targeted to individuals in recovery in addition to just general messages.

We're also reaching out to those pockets where you tend to find people that are uninsured or underinsured. And again the importance is making sure that part of our hypothesis is out there as well.

And it helps us get our message out as well as part of recovery and health insurance and one strategy may feed the other.

We leverage social media by using both Facebook and Twitter. And both of those have provided significant dividends as we continue along the last 6 or so weeks.

Next slide. So, North Carolina was a non-expansion State which makes—which adds some challenges, but certainly some opportunities as well.

North Carolina not expanding Medicaid created a gap in coverage for certain North Carolinians. The State does not have a per se sanctioned officially State-run point of entry.

We do have a Web site. We do have a number, 1–800 number which is tied into resources where we can direct people towards those access points.

Like many States, North Carolina receives block grant funding for public substance abuse and mental health treatment. But, as always, those funds are limited.

So, those were the—specifically that was the population that we looked at to try and enroll into the Affordable Care Act because they tend to be uninsured or underinsured. And it facilitates our hypothesis again, where we would like to have access to treatment.

And finally we will talk a little bit more about subsidies on the next slide.

Next. So, a non-expansion State, the Federal poverty level is very important. So, you'll see from the slide the Marketplace subsidies. The Affordable Care Act assumed Medicaid expansion.

When Medicaid was not expanded in the States, it created this gap. So you'll see that there's subsidies built in above 100 percent of the Federal poverty level up to 400 percent. And those are and they take the form of Cost Sharing Reductions or Advanced Premium Tax Credits which the other speakers have addressed.

Below 100 percent of the Federal poverty level there is a gap—jobless parents, working parents, pregnant women. There are some options as well as CHIP above the Federal poverty level. And CHIP exists in some name in each of the States.

However there's a gap. And so the individuals in that gap are the ones that tend to be uninsured or underinsured.

We made a conscious effort to continue enrollment, regardless of whether an individual fell in this gap or not because the choice was really theirs on whether or not they elected health coverage.

There are some other very important reasons. As we enroll in health care and part of the application process, you report your income and it is projected.

So as you project your income it is important to kind of explain this and address this in a non-expansion State when you have individuals applying for health insurance.

Because if the Federal poverty level—and we are using the Federal poverty level numbers for 2013—at about $1,000 a month individuals will receive about the maximum number of subsidies. So, you always want to encourage people to report income accurately.

But there is an incentive to make sure—a lot of people are under the mistaken belief that if they low-bid their income that they will receive more subsidies. However, that can be punitive in this case.

So you will want to encourage everybody to report their income correctly. And everyone you really, really want to strive to try and then break the Federal poverty threshold to make sure that, you know, you are above that 100 percent. So, next slide.

And so here are some numbers that you are going to look at.

So for of family size one you see the Federal poverty level's $11,490.

So if you were below—if you were at $11,000 and you applied through the exchange what you would find is there was no subsidy.

So plan A on the Marketplace that would've cost $256 for the premium with no subsidies for an individual at $11,000 will cost $256.

When that individual actually crosses over that 100 percent the subsidies kick in and the plans become very affordable. So you are looking at very low-cost health insurance.

So again, what we found is that you encourage people, you explain this ahead of time as they fill out this information because people are reticent to change their income projections while sitting with a Navigator while they are filling out this information.

So, you want them to have that information ahead of time. And again, you are going to encourage people to report everything as accurately as possible.

Next slide. Okay, so, how do you enroll? Well, essentially there's four means of enrolling, the online site at HealthCare.gov. We have encouraged everyone to use HealthCare.gov.

Even during the more challenging times at the beginning of the enrollment campaign, we found that depending on the time that you got on the system you could go start to finish on a fairly simple application in about an hour.

Now, we found that it is working very well. Individuals are enrolling and we encourage people to do online applications first.

Now some individuals have chosen to do it by phone. There is a phone line that is operated by the Federal Marketplace.

Paper applications are always an option. When you have an individual, especially in open events that's hesitant, we always like to push the paper applications in any case, because if nothing else, it makes a good worksheet when you're actually talking to somebody online or filling out the—or talking to somebody over the phone or an online application. Regardless, it's kind of a trigger to do it.

And then of course we have in-person assistance. And we accept appointments. And we very often we can expand hours just as individuals contact us. We make it an effort to reach out and find as many of them as possible.

Next slide. So, what do we need to apply? A lot of this information was covered earlier in this presentation.

But you'll see that one thing I do want to say is the more information you provide, and that you have, and the more the system can validate those things against the Federal hub which is the database that checks this information, the quicker you get a decision. And that's—this really drives how quickly you get a decision back from the Marketplace.

So again encourage you to provide as much accurate information as possible and then certainly your Social Security number.

Next slide, just real briefly, about healthcare plans. We talked about a Bronze plan earlier.

The different metal levels depict what the plans are, the actuarial levels of the plans. The more expensive plans, the premium plans cover 90—pay 90 percent and the consumer pays 10 percent and then vice versa.

Obviously, the Platinum plans tend to be more expensive than Bronze plans. But this is kind of—this is consumer's choice and they really have to look at their health needs and what they think best suits their financial situation.

So next slide, okay, so if an individual does not qualify for Medicaid, they can certainly apply for insurance through the exchange. If the insurance through the exchange proves to be unaffordable then there's—there are some other options.

The first is to look at—what we have in North Carolina obviously we talked about Medicaid and CHIP. But we have block grants in North Carolina. It's called the Integrated Payment Reporting System, or IPRS.

This is block grant funding for mental health and substance abuse treatment. But, it is not all encompassing, which is something important when we address individuals within our specific population.

So when we talk to them and they say well I'm getting coverage through IPRS we want to reiterate things like well it's not going to cover an antibiotic. You know it's not going to, you know, treat all the other things that you need health insurance for.

So, it was one of the important things about our message is to make sure that we explain why you need health insurance.

In North Carolina, both the Division of Social Services and the Division of Public Health have public funds available for some types of treatment. And it is important to reach out in your individual State to see where those resources are available.

And Division of Social Services is generally the best starting place to reach.

North Carolina is also fortunate through the University of North Carolina Hospitals that they have a program called Charity Care. So those are available for individuals with chronic health conditions.

Next slide. A little more about the process: Essentially you establish the account. HealthCare.gov is by far the fastest means of getting coverage. After the online application of reviewing your results at Marketplace, they can select plans.

We have had for the most part as we go through the application process, we find that most individuals when they see the plans and they get to that, especially if you have just a one individual that just comes in the office and goes through the process and then sees the plans, a lot of times they need some time to think about their plans. And we won't typically see them again.

But periodically one individual will come in or something and ask for assistance in showing plans, et cetera.

And as Navigators we don't recommend plans. What we do is we show them, we kind of explain the terms and we let them make their own choice. And of course the key is making your first month's payment.

Next slide. We talked a little bit about the subsidies. I think it's important to know that if you are below the Federal poverty level, the individuals are below the Federal poverty level, we still encourage individuals to apply.

That information is still available to the Federal Government and State government. And it kind of gives them an idea of the cost of remaining uninsured and not expanding Medicaid. And it helps decisionmakers decide what the actual cost is of our policies within North Carolina.

Next slide, and this is certainly—this is outside the scope of the grant but this is important for individuals that work in the field that we've chosen to work in is provider panels in North Carolina there's—we have two insurance—two companies that signed on to the Federal exchange in North Carolina—Coventry and Blue Cross. And then you'll see that Blue Cross has 26 plans in 100 counties and Coventry has 25 plans in 39 counties.

So there's a lot of counties where only Blue Cross and Blue Shield were—Blue Cross/Blue Shield provided coverage.

So, you know, in the future it's something to consider that you want specific providers. You want more—as many providers to enroll in the provider panel as possible to give the consumers the most possible choice of clinicians, especially as you get to some of the more remote areas.

And a small component down at the bottom is outreach as case management. As we went through and selected Navigators, one of the goals as we looked at Navigators is to hire individuals that were already working with special populations or populations that tended to be uninsured, underinsured.

And in doing so we hired a lot of clinicians or clinical social workers, counselors, peer support specialists.

And by doing this we provided a skill set, which is navigation, to them that they can integrate with some of the things that they were already doing.

This grant when it ends and open season ends this is also a time for—that skill set remains so that when open season starts next year we would like health care to be the standard of care that we expect with our clinicians when they engage people that are uninsured or underinsured.

Next slide. So defining parity, parity was one of the true triumphs of the Affordable Care Act. Parity would allow us to receive the greatest degree of treatment for our consumers that very often couldn't—wouldn't necessarily—would hit lifetime caps on inpatient treatment for substance abuse or mental health issues.

So, that being the case, when parity was added to the Affordable Care Act, it really changed the landscape on how we provide services and how services are going to be delivered and how treatment's going to look, not just in a non-expansion State, but across the country.

So this is a true triumph. But this is just the first step.

Right now if you look at the slide, there is—this is a process that's ongoing. And it's important from an advocacy standpoint and also from a consumer standpoint to understand that there is—there's a new standard of care as far as receiving treatment for substance use disorder or mental health treatment.

So this is something that will evolve over time and we look—we're anxious to be part of it.

Next slide. I've included a couple resources. One of the things that we did do on outreach is we partnered with a local nonprofit as they're doing promotions for a movie called The Anonymous People. And it deals with addiction and bringing addiction out of the shadows.

I encourage you to look at the trailer. It's a very good movie and it carries a very important message.

Our Web site is listed and there is also a link for local help on the Federal Web site that will help you find Navigators in your area that can help you through the process if you require assistance. So, next slide.

Again my contact information is below. Feel free to email or call if you have questions or if there's anything I can assist on. I want to thank everybody for their time and effort in listening in on this snowy Wednesday. And I will turn it back over to you.

Jane Tobler: Thanks Myint and thanks for sharing about the work that your organization is doing and giving us an idea of what we would need to do to consider if we are in a State like North Carolina that has opted not to expand Medicaid.

We will take questions soon so press Star 1 to get into the queue. But first, our speakers provided some great resources at the end of their presentation. And also on Slide 52 to 63 there are additional resources for you to learn more about the topics that have been discussed today.

The resources are subdivided by audience on each slide, including resources for service recipients.

We're going through them now. Resources for assisters, resources for communities, and general resources.

We will now take questions from callers. To ask a question please dial Star 1 on your telephone to be placed into the queue. Be sure and tell the operator it your name. If you do not wish your full name to be announced then please only state your first name.

Questions can also be asked using the online question feature at the top of the screen.

Because our time is limited we ask that you only ask one question and after the conference operator announces your name, you may ask your question.

First question we're going to go to has already come in. And it is this.

I currently have health insurance, BlueCross/BlueShield. However, I expect to leave my job, resign, once the sale of my home finalizes and move to another State. What would my options be at those—at that time?

Dr. Ron Manderscheid: So Jane let me began and let my colleagues join in. So, we need to know some more information about this person. We need to know when this person goes to the second State are they going to have a job and what is the size of the employer that they're going to be working with?

Is this a small business? Is this a medium-sized business? Is this a large business that is offering its own insurance?

If it is one of the former, it is a small business without insurance or it is a medium-size business that doesn't offer insurance, then I would say the person needs to investigate the State Health Insurance Marketplace. If the person is employed, and their income is in the appropriate range, and if the person's income is between 100 percent and 400 percent of poverty, they then would be qualified for the subsidies of the type we've talked about.

If their income is above 400 percent of poverty they would not be entitled to subsidies, but they would be entitled to purchase insurance through the State Health Insurance Marketplace. And they could investigate the different levels of insurance that have been discussed on the presentation today all the way from Bronze to Silver to Gold to Platinum—60 percent, 70 percent, 80 percent, 90 percent paid for through the insurance and 10 percent, 20 percent, 30 percent, 40 percent paid for through the person basically as copays and deductibles.

So let me stop and let my colleagues join in here.

Adela Flores-Brennan: I think the only thing that I would add—this is Adela in Colorado—is that the move to another State or the loss of coverage through the employer are both those opportunities that open up a special enrollment period outside of the current open enrollment period.

So if this person were to lose her coverage sometime this summer or make a move sometime this summer those would both be triggering events that could allow her to go into the State's Marketplace, Health Insurance Marketplace to find coverage.

Jane Tobler: Excellent, thank you.

Our second question was also sent to us. What happens if someone loses insurance and needs to apply after March 31st, 2014, which is the deadline for open enrollment?

Dr. Ron Manderscheid: Adela do you want to start with that one?

Adela Flores-Brennan: Sure. So if I heard correctly what happens if a person loses insurance after the deadline? Again if you've lost your coverage, so if you've lost your minimum of essential coverage outside of that March 31st deadline then it is something that we call life change event or a qualifying event that would allow a special enrollment period to open. And that person would have a set amount of time to go into a Marketplace and be able to find coverage.

Similarly, if they are in an expansion State or otherwise qualify for Medicaid there is no timeframe on accessing the Medicaid program.

Jane Tobler: Great, thank you Adela. Operator do we have any questions in the queue?

Coordinator: Yes ma'am. Our first question comes from Beth Ann. Your line is now open.

Beth Ann: Good afternoon. Is the open enrollment period through March 31st, the deadline, regardless of whether you're seeking subsidies or not?

And if you miss the March 31st deadline and there is not an exception to that deadline, such as some life altering event, then must you wait until next year to enroll?

Dr. Ron Manderscheid: So let me begin and my colleagues again can join in.

So yes, if you are enrolling through a State Health Insurance Marketplace the deadline is in fact March 31st.

If you have not enrolled by that time then other things come into play here.

One thing that might come into play depends upon what kind of business you are employed in. If you are employed by a small business or a business between 50 and 100 people you might be exempted from the health insurance mandate at the present time, but not in the future.

If you are required, and you don't have a special circumstance as Adela was talking about previously then you would have to wait, I believe until November 15th, when the Marketplace opens up again to enroll in insurance.

If your income is such that your—after you have lost your insurance—then you could enroll in the Medicaid expansion if that is operating in your State. As Adela had said several times, that Medicaid expansion process will operate continuously and you could enroll in the Medicaid expansion component of the insurance at any time during the year.

Jane Tobler: Thanks Ron. Our next question is how do we know if someone is 133 percent above poverty level? Is there a scale we can access to compare someone's income?

Dr. Ron Manderscheid: There's actually a number that defines what 133 percent above the Federal Poverty Level is. And I showed that in my overheads.

And the number that we showed in the overheads, not only in mine but also in Adela's and Myint's were the—at 133 percent of the Federal poverty level for the year 2013. So those numbers will be valid through 2014.

When it comes to 2015 and enrollment insurance in 2015 we will need to adjust those numbers to reflect the changes in the definition of the Federal poverty level. Those adjustments are done by the U.S. Department of Health and Human Services.

And the new numbers for 2014 are already available. So yes, it is a defined number and it is in the overheads.

Nyi Myint: And let me add just a little bit on that. I would encourage everybody to enroll or just to go through the Federal application process. It is a very sophisticated system and allow the system to calculate based on your income that you input what subsidies you qualify for.

So, I wouldn't want anybody to screen themselves out of the process very early based on something they've calculated. Allow the Federal system to do it.

Jane Tobler: Great, great point.

Operator is there another question on the phone?

Coordinator: Yes, our next question comes from Amanda. Your line is open.

Amanda: Hi. Good afternoon. I'm wondering about my fiancé and I are due with our first child in mid-March. And if we can't get her Social Security number processed before the deadline, should we enroll him in a plan and then see if we can modify it, or should we just wait and then enroll them together after the deadline?

Dr. Ron Manderscheid: Adela?

Adela Flores-Brennan: Yes, I can take that. So, you should have no problem enrolling now and then adding the baby when the baby is born.

Amanda: Okay thank you.

Dr. Ron Manderscheid: And Adela isn't the birth of a baby a special circumstance here that allows you to extend the opportunity to enroll?

Adela Flores-Brennan: Yes. It would open up a special enrollment period for the family. But also there's, you know, there's no reason to delay getting you and your husband covered now and then adding the baby when you have the appropriate information.

You can—the baby can be added even without the Social Security number. You can provide that later with a lot of plans.

Amanda: Okay thank you.

Jane Tobler: Thank you. Operator next caller please.

Coordinator: Thank you. Our next question comes from Peter. Your line is open.

Peter: Yes, hi. My question is my wife has been unemployed for a number of years now and she has no coverage. So we just want to find out if we shouldn't go and apply through the Medicaid expansion because we are in the State of New York. And we just want to find out if she will be qualified for that with the Medicaid expansion.

Adela Flores-Brennan: I think the best way to find out if you qualify is to go ahead and put in an application.

There's a lot of organizations in the State of New York that can help with that process.

Jane Tobler: Okay thank you. Operator next caller please.

Coordinator: Thank you. The next question comes from Angela Taylor. Your line is open.

Angela Taylor: Hello everybody. I'm from Kentucky and I'm having problems when I go to the gateway login and it goes with the user name or email address.

I work at a mental health clinic. And a lot of our folks have no income. And so I've been using the phone and sending them to a Federal building. But it would be so much easier if I could get on the Internet on your login and log in. But I'm having problems with user name and password. How do I get past that?

Adela Flores-Brennan: Well, if I'm not mistaken, Kentucky has a State-based Marketplace. And have you tried calling the service center?

Coordinator: I do apologize. Her line is now muted.

Adela Flores-Brennan: Okay sorry. So I would try calling the Kentucky exchange's service center for support with the user name and password issue.

I don't know that I can speak to it directly, since I'm in Colorado. I know Kentucky has its own system, so they are not using the Federal Marketplace.

Nyi Myint: And I'd like to add something else to this. Especially if you're at an agency, I would reach out to some of the Navigator organizations. In North Carolina we're more than happy to send Navigators out too, even on a regular basis, if we can assist in enrolling consumers.

And that's—I'm sure Kentucky has a very similar Navigation agency that's willing to do that.

Jane Tobler: Okay thank you.

Jane Tobler: Our next question came online. I work for nonprofit substance abuse and mental health facility. Some of our consumers qualify for food stamp assistance but not medical or cash assistance. Can they receive assistance through the Affordable Care Act?

Dr. Ron Manderscheid: So let me start again. So, if you are in a State that is doing Medicaid expansion, anybody from wherever the current State Medicaid program leaves off up to 133 percent of the Federal poverty level would be eligible to enroll in health insurance through the Medicaid expansion if they don't currently have health insurance. And they would be entitled to the payments that would be made by the Federal Government to pay the premiums for that health insurance as part of the Medicaid expansion.

And it sounds to me as if we're talking about people whose income would be within the range that the Medicaid expansion would be applicable.

If they are in the State where the Medicaid expansion is not currently being done then, if they're between 100 percent and 133 percent of the Federal poverty level they would be eligible to enroll in the State Health Insurance Marketplace and to receive a Federal tax subsidy because of their income level to help them pay the premiums for the insurance in the State Health Insurance Marketplace.

So it depends on the State and what the State is doing about the Medicaid expansion, what action should be taken.

One further comment on the latter situation, if a person is also in the State that's not doing the Medicaid expansion and their income is below 100 percent of the Federal poverty level they can still enroll in the health insurance through the Marketplace but they can't get the Federal tax subsidy. So that makes the insurance much more expensive for them.

Jane Tobler: Okay, here's another question that we received online. Myth or fact, people who get a policy through Medicaid expansion are voluntarily giving up their ownership of some assets and are not being made aware of it in the enrollment process.

This is a rumor I had heard that is swaying people's willingness to register for healthcare coverage.

Dr. Ron Manderscheid: So let me start, and let my colleagues join in here again.

So, the only requirement for enrolling in health insurance through the Medicaid expansion is the person's level of income.

No assets that the person holds are considered as part of that process other than their level of income.

And as I said just a few minutes ago if their income is between wherever the current State Medicaid program leaves off and 133 percent of poverty they are eligible to enroll in insurance.

We believe that the particular provision that's been talked about here is a provision that is used in the Medicaid program for people who are—for elderly people who are receiving residential support through Medicaid and is probably not directly applicable to the circumstance that we are talking about today.

Jane Tobler: Thanks Ron. Operator, could you go to the next question please?

Coordinator: Thank you. Our next question comes from Wendy. Your line is open.

Wendy: Thank you. I was wondering of these—can you hear me?

Dr. Ron Manderscheid: Yes.

Jane Tobler: Yes we can Wendy.

Wendy: Okay great. Are these subsidies above the poverty level available in all States and applicable to all coverage plans?

Dr. Ron Manderscheid: So let me start off again. So the Federal tax subsidies that are available through the State Health Insurance Marketplaces are available across the United States and in every State.

And maybe have Adela and Myint talk a little bit about that on how that operates in each place there. So Adela do you want to comment on that?

Adela Flores-Brennan: Sure—as Ron said, the subsidies are available across the country. It's the same poverty levels or same income levels.

But they apply to the plans that are sold only within the Marketplaces.

So in Colorado we have certified a certain number of plans as you saw. I think in my slide, 150 plans for the individual market were certified to be sold in Connect for Health Colorado.

And those are the plans that you have to purchase in order to get the Premium Tax Credit and Cost Sharing Reduction.

So similarly and other States it would be the plans that are sold in the Marketplace or in the—or in the Marketplace in the respective State. And I don't know if Myint has anything else to add to that.

Nyi Myint: No you covered it. Thanks.

Jane Tobler: Thank you. Operator next question please?

Coordinator: Thank you. Our next question comes from Jean. Your line is open.

Jean: Yes, thank you. When is the open enrollment for Michigan for the Medicaid expansion? I was told that I could not apply until after April 1 . . .

Dr. Ron Manderscheid: Yes.

Jean: . . . and will it be retroactive?

Dr. Ron Manderscheid: I'm a little knowledgeable of that. I believe you are correct, the open enrollment period for the Medicaid expansion in Michigan begins on April 1. And I do not believe that it will be retroactive.

And for the rest of the audience listening here why is it April 1st versus last October 1st. It's April 1st of 2014 versus October 1st of 2013 because Michigan decided at a later date to do the Medicaid expansion. Hence there was not time to set up the system so it could be implemented on October 1st of 2013.

We're just very glad that Michigan is doing the Medicaid expansion.

Jane Tobler: Thank you. Operator, could we have the next question please?

Coordinator: Yes. Our next question comes from Milly. Your line is open.

Milly: Yes hi. My mother is an 83-year-old immigrant. She's never worked in the United States. She has a green card. And she has never had insurance. She's been here for 6 years. And she's elderly. She does not work.

My question is, is she eligible for any type of insurance? And if she is eligible for Medicaid, would that put her at risk of losing her legal residency in the United States or if she was eligible for a cost sharing or something like that?

Dr. Ron Manderscheid: So . . .

Adela Flores-Brennan: I can . . .

Dr. Ron Manderscheid: Yes Adela go ahead, please.

Adela Flores-Brennan: Yes, if you—I can try and take that. So this one's a little bit more complicated and you may need to look for an assister or Navigator in your State.

But we the—if she were able to access Medicaid she might not be able to because she's a fairly recent immigrant and there is still a 5-year waiting period for Medicaid.

So she may not be able to get into Medicaid. But even if she did, it would not affect her immigration.

She could, since she was not eligible for Medicare, and not eligible—if she were not eligible for Medicaid she could potentially get subsidized coverage through a Marketplace.

So I want to caveat that, you know, a great deal because, you know, there's probably a lot of other factors that need to be considered. But that is it's, you know, absolutely the type of case that you want to seek some specialized assistance with to navigate the process.

Jane Tobler: Okay, we have another question that came in online. I live in California want to know if I can claim my 21-year-old son on my tax return as a dependent for 2013 without jeopardizing his eligibility for Medicaid? He's considered greatly disabled and has not worked since 2010.

So she lives in California and wants to know if she would be jeopardizing his eligibility?

Dr. Ron Manderscheid: Let me start and Adela can add in here.

So I guess my assumption would be that simply by claiming him on her tax form does not interfere with his right because of his own income or lack of income to enroll in the Medicaid expansion in California.

Once he's enrolled in the Medicaid expansion in California and I think another thing comes into play in this particular instance. There's such a concept as a person who is medically needy.

So if he were enrolled in the Medicaid expansion in California and were found to be medically needy than he might be eligible for a broader Medicaid program in California based upon the fact that he is also a medically needy person and not just a person seeking to enroll in health insurance.

Jane Tobler: Okay. I think we have time for one more question.

My income is well above the Federal poverty level. Will the cost of my health insurance go up if I register for coverage with the new Marketplace?

Some people I know are paying a higher cost for coverage in the new Marketplace than they were paying before registering in the Marketplace.

Dr. Ron Manderscheid: So . . .

Adela Flores-Brennan: Go . . .

Dr. Ron Manderscheid: Adela go ahead and then I'll add something here.

Adela Flores-Brennan: Yes, the cost of coverage itself is not affected by income level. This thing that is affected by the income level is the amount of subsidy that a person could be eligible for and therefore applied to the premium and it would have the effect of bringing down the cost of the premium.

So the plan sold outside of a Marketplace versus plans sold inside of a Marketplace could be a lot of differences there that would account for the premium costs.

Also when the new plans were issued for 2014, there was a set minimum requirement for what the benefit packages needed to look like. And that also could have affected premium level.

But let's just be clear that the premium itself is not affected by your income, but rather the other way around, the premium assistance that you might get is affected by your income level.

And so depending on your income level you could receive more or less premium assistance to help bring down that monthly cost.

Dr. Ron Manderscheid: I want to add that this answer on the benefit.

So I think it isn't simply true that the insurance you had previously cost less and now the insurance would cost you more. You have to also look at the benefit structure.

The benefit structure through the State Health Insurance Marketplace and through the Medicaid expansion typically are a better configuration of benefits than most people had previously.

So it isn't simply a question of cost. It is question of what benefits you are eligible for versus what the cost is.

For example we did talk earlier in this presentation about mental health and substance use benefits being in parity. In most policies previously, they were not at parity.

So that makes a difference in the cost but there's also a huge benefit to the individual of actually having the better insurance should they need to use that insurance for their own care.

So there are two factors as Adela said and both of them need to be considered here.

Nyi Myint: And if I could, I'd just like to add one last thing specifically. I think both presenters actually answered that very well.

But in North Carolina, one thing as this question comes up to Navigators, what I say is the plan, if you look at our plans there are plans that were—they are what we called ACA compliant.

The North Carolina Division of Insurance would go through and screening plans and say they are ACA compliant which means it meets minimum essential coverage.

There are healthcare plans out there that are called micro-plans that don't meet that requirement. And there's some different rules that are associated with that.

So it is important when you look at plans that you're really comparing apples to apples. So it's hard to just gauge that fully off the premiums. Thank you.

Jane Tobler: Thank you.

And I want to thank everyone for your questions and also for the answers and discussion.

If we were unable to take your question today you can reach out to the speakers directly or contact the ADS Center at promoteacceptance@esi-dc.com.

Contact information for each speaker is available at the end of their individual presentation and is also available on Slide 65.

You can read more about each speaker on Slide 66, 67, and 68.

We value your feedback. Within the next 24 hours you will receive an email request to participate in a short anonymous online survey about today's training.

It will take about 5 minutes to complete. Please take the survey and share your feedback with us. Survey information will be used to help determine what resources and topic areas need to be addressed by future training events.

This teleconference has been recorded and the video archive including closed-captioning and transcript will be available by mid-March on the SAMHSA ADS Center Web site.

If you enjoyed this training teleconference we encourage you to join the ADS Center listserv to receive further information on recovery and social inclusion activities and resources including information about future teleconferences.

To learn more about SAMHSA's wellness efforts go to www.behavioral.net.

We've come to the end of our time today. If you have more questions or would like to follow up, please contact the SAMHSA ADS Center by phone, fax, or email. Again, the Web site is www.promoteacceptance.samhsa.gov.

And on behalf of all of us at the SAMHSA ADS Center I want to extend our sincere appreciation to Dr. Ron Manderscheid, Ms. Adela Flores-Brennan, and Mr. Nyi Myint who have reviewed an incredible amount of information and given us a greater understanding of the ACA insurance expansion program and what we can do to get ourselves, clients, community members, and loved ones enrolled before March 31st.

We encourage all of you to do your part to encourage those in their life to explore their options and obtain insurance.

And finally, thanks to you all of our listeners for taking time out of your day to join us. And thank you in advance for completing our survey. Goodbye.

Coordinator: This concludes today's conference call. All participants may disconnect at this time.