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Affordable Care Act

Affordable Care Act

Progress and plans continue to unfold for the Affordable Care Act (ACA) which will be fully implemented January 1, 2014.  The following outlines information relevant to insured and non-insured individuals.

 

Connect

Stay up-to-date with news and updates about health reform through social media!

YouTube

Click the YouTube channel to watch videos highlighting important information about the Marketplace and featuring people like you who are looking forward to getting covered.

Facebook

Click “Like” on Facebook at facebook.com/Healthcare.gov and share your thoughts.

Twitter

Follow @HealthCareGov on Twitter for up-to-date Marketplace news.

Google+

Use Google+ to follow HealthCare.gov.

 

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" which include the statute, must include items and services within at least the following 10 categories:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care

 

Implementation

Overview

For an overview of benefits, new services and programs, learn how the ACA  is helping states across the U.S. , visit HealthCare.gov For Spanish speaking consumers, CuidadoDeSalud.gov.

Substance Abuse and Mental Health Services Administration’s health reform website has information about health reform basics, prevention under health reform and SAMHSA’s health reform efforts. To access, click here.

 

New Benefits
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. Click here to view.

 

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.

 

Brochures & Educational Materials
Below you'll find brochures and materials related to the implementation of the Affordable Care Act. For other brochures and resources, click here.

ACA Educational PowerPoints

Families with Children (PDF - English 7.27 MB, Spanish 1.23 MB)

Health Care Providers (PDF - English 2.71 MB, Spanish 517 KB)

People with Disabilities (PDF - English 2.56 MB, Spanish 930 KB)

Seniors (PDF - English 11.3 MB, Spanish 1.54 MB)

Small Business Owners (PDF - English 4.22 MB, Spanish 646 KB)

Young Adults (PDF - English 6.56 MB, Spanish 919 KB)

 

Information for Consumers and Small Businesses

The Health Care Law & You (PDF - 8.99 MB)

Information for Small Businesses (PDF - 763 KB)

 

Exchanges

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.

 

Insurance Options
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

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

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

Joint Comission