The Affordable Care Act (Obamacare): If You Do Not Have Health insurance (Uninsu

New Medicaid Eligibility:

• Health Reform 2010 expands Medicaid to all individuals under age 65 with incomes up to 133% of the federal poverty level (FPL) Income for these purposes is based on modified adjusted gross income. At the latest, newly eligible Medicaid beneficiaries must be enrolled into the Medicaid program no later than January 2014.
• All newly eligible adults will be guaranteed a benefit package that meets the essential health benefits available through the Exchanges.
• States have the option to expand enrollment to childless adults beginning in 2011.
• The Act encourages Medicaid programs to include preventive services.

NOTE: A state will be exempt from the requirement for non-disabled adults with incomes above 133% FPL for any year from January 2011 through December 31, 2013 if the state certifies that it is experiencing a budget deficit or will experience a deficit in the following year.

Tobacco Cessation: Effective October 1, 2010, Medicaid is required to offer coverage for tobacco cessation services for pregnant women. Also, the Act encourages Medicaid programs to include preventive services.

Minimum Medicaid Benefits: States must maintain current Medicaid eligibility levels for children until 2019 and maintain current Medicaid eligibility levels for adults until the Exchanges are fully operational.

Payments to doctors:

• Medicaid payments in fee-for service and managed care for primary care services provided by primary care doctors (family medicine, general internal medicine or pediatric medicine) are required to be 100% of the Medicare payment rates for 2013 and 2014. The intent of this provision is to encourage more doctors to accept Medicaid.
• The Act also provides a 10% bonus payment to primary care physicians in Medicare from 2011 through 2015.

States are permitted to obtain a five year waiver of certain new health insurance requirements if the state can demonstrate that it provides health coverage to all residents that is at least as comprehensive as the coverage required under an Exchange plan and that the state plan does not increase the federal budget deficit. (Effective January 1, 2017).

Nursing Homes: The Act requires skilled nursing facilities under Medicare and nursing facilities under Medicaid to disclose information regarding ownership, accountability requirements and expenditures. (Standardized Information about nursing homes will be available on a Medicare website so Medicare enrollees can compare facilities.)

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