Progress and plans continue to unfold for the Affordable Care Act (ACA) which will be fully implemented in less than a year. The following outlines information relevant to insured and non-insured individuals that emphasize:
- The decision-making and implementation process of health care reform in Texas and other states,
- Forthcoming information on the new private health insurance marketplace and what benefits will be offered to newly-eligible individuals,
- Protocols to assist people with enrolling in insurance; and
- New programs to help “special populations,” including people with chronic health issues and serious mental illness and providers taking advantage of these opportunities.
Essential Health Benefits
The Affordable Care Act ensures Americans have access to quality, affordable health insurance. To achieve this goal, the law ensures that health plans offered in the individual and small group markets, both inside and outside of Health Insurance Marketplaces, offer a core package of items and services, known as “essential health benefits.” Under the statute, EHB must include items and services within at least the following 10 categories:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
For an overview of benefits, new services and programs, learn how the ACA is helping states across the U.S. , visit HealthCare.gov.
To learn about the health care law that aims to improve our current health care system by increasing access to health coverage for Americans and introducing new protections for people who have health insurance, visit http://www.healthcareandyou.org.
Individual Mandate to Buy Coverage
The ACA includes a requirement that many people be insured or pay a penalty. This simple flowchart illustrates how that requirement, sometimes known as an "individual mandate," works. To view the presentation, click here.
Provisions and Coverage Costs
A Texas Health and Human Services Commission’s recent ACA presentation highlights ACA provisions implemented to date, page 5, and a forecast of health care coverage post ACA implementation, page 8. Click here to view.
The Health Care Law and You Presentation Tool in Chinese, Korean, Vietnamese, Tagalog, Hindi, Bengali, Hmong, Khmer, Laotian, Samoan and Tongan
The Health Care Law and You is a presentation tool developed by the U.S. Department of Health and Human Services to educate community members about the benefits of the Affordable Care Act. This resource has been translated by the Office of Public Engagement at the Centers for Medicare & Medicaid Services into the following languages: Chinese, Korean, Vietnamese, Tagalog, Hindi, Bengali, Hmong, Khmer, Laotian, Samoan and Tongan.
Brochures & Educational Materials
Below you'll find brochures and materials related to the implementation of the Affordable Care Act. For other brochures and resources visit: http://www.healthcare.gov/news/brochures/index.html.
The Top Five Things You Need to Know
Information for Consumers and Small Businesses
- The Health Care Law & You (PDF - 8.99 MB)
- Information for Small Businesses (PDF - 763 KB)
Essential Health Benefits
Kaiser Family Foundation outlines what states have decided for Essential Health Benefits (EHB’s). Beginning on January 1, 2014, the ACA requires that all non-grandfathered individual and small group health insurance plans sold in a state, including those offered through an Exchange, cover certain EHB’s. Click here to view national map.
HHS Issues Final Essential Health Benefits Rule (February 2013)
The Department of Health and Human Services has finalized its regulations on a key element of health reform, the essential health benefits package. Beginning in 2014, the essential benefits package will become the minimum standard of coverage that most insurance plans must meet, including plans sold on the exchanges, individual and small group plans, and Medicaid expansion plans. The National Council for Community Behavioral Healthcare's fact sheet outlines major elements of essential benefits and their impact on people with mental health and substance use conditions. Click here to access report.
The U.S. Health and Human Services Department internet portal helps individuals and small businesses identify insurance options in their state. To access portal, visit HHS.gov.
Marketplace Exchange Information
Enroll America provides resources for ACA state marketplace operations for new insurance enrollment.
Medicaid Eligibility and Benefits
Kaiser Family Foundation’s issue paper provides a short summary of Medicaid eligibility and benefits for people with disabilities today and explains how these issues affect health reform in light of the Centers for Medicare and Medicaid Services’ new regulations. Click here to view report.
Medicaid Expansion in Texas
The Center for Public Policy Priorities summarizes the latest estimates from state Medicaid officials of the numbers of newly insured, the state costs and the federal funding gains if Texas extends the new Medicaid coverage for parents and other adults. The following documents push Medicaid Expansion in Texas.
- Texas Public Policy Foundation
- Center for Public Policy Priorities
- Projected federal dollars and enrollment gains
- Potential savings on county jail hospital care under expansion
- Resource Guide for Medicaid Expansion
- ACA Impact in Travis County
Advocacy Tools for Your State
Knowing that states are evaluating the economic arguments in favor of and against the expansion, the National Council for Community Behavioral Healthcare has issued a set of talking points for advocates to use in states that may be hesitating to expand Medicaid. Click here to view.
Centers for Medicare and Medicaid Services
For technical information about Medicare and Medicaid, visit CMS.gov. Visit CMS’s Innovation Center which supports the development and testing of innovative health care payment and service delivery models. CMS’s Center for Consumer Information and Insurance Oversight helps consumers appeal health plan decisions, understand the Consumer Assistance Program and other health insurance choices.
MENTAL HEALTH PARITY AND ACA
Federal Research Brief
THE U.S. Office of Assistant Secretary for Planning and Evaluation’s recent brief on parity highlights mental health and substance use disorder benefits and parity protections for 62 million Americans. Click here to view.
News and Reports
The Center for Public Policy Priorities' new report provides an overview of the ACA and Mental Health. Click here to view. 3/20
Questions or comments? Let us know your thoughts on what’s going on with ACA implementation at firstname.lastname@example.org.