Your Source for Health Reform

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Many questions about how health reform is affecting us have already been answered. Perhaps yours is one of them. If you do not find the answer you need below, please send us your own question.


YOUR QUESTIONS ANSWERED

 Q:   What does the ACA's grace period mean for me as a provider?

 A:   Marketplace consumers receiving advance premium tax credits can keep their insurance for a 90-day "grace period" if they fail to pay one month's premium. To qualify for the grace period, consumers must have also previously paid at least one premium during the coverage year. For the first month of the grace period, insurers must continue paying their share of costs for medical services. The insurer may hold off payments during the second and third months of the grace period. Consumers will lose coverage if they don't pay their premium at anytime during the 90 days. Providers can then seek payment directly from the consumer. This brief from Health Affairs explains more on the grace period.

 Q:   Does Medicaid Cover Dental?

 A:   Now, as of July 1, 2014 Medicaid covers restorative dental services like x-rays, crowns, and fillings for adults. Dental coverage is comprehensive for children on AllKids and includes services like twice-a-year exams. See a detailed description of dental services offered under Medicaid.

 Q:   When is the increase in Medicaid payments to primary care physicians?

 A:   On March 4, 2013, the Illinois Department of Health & Family Services (HFS)  published this notice about the increase in fees for primary care physicians. It says, "For dates of service January 1, 2013 through December 31, 2014, the department will apply an increased payment rate to enrolled practitioners for primary care services delivered by a primary care physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine. The increased payments will apply to services reimbursed by Medicaid fee-for-service, Voluntary Managed Care Organizations and Integrated Care Program Health Plans."  In order to receive the increased payments, physicians must self attest that they meet certain criteria. Interested primary care providers should read the notice for more information.

 Q:   Do physicians have to accept Medicaid patients?

 A:   There is no requirement in the Affordable Care Act that physicians or other medical providers must accept Medicaid patients in 2014. However, incentives in the ACA are designed to encourage providers to accept more Medicaid patients like a temporary payment rate increase for primary care in 2013 and 2014. Learn more about provider incentives here.

 Q:   Where do low income patients receive care?

 A:   Federally Qualified Health Centers and other safety net clinics play an important role in the delivery of health care in 2014. Patients will rely on their community providers for primary care and may choose a clinic as their medical home. Most Medicaid patients will be or are in some sort of coordinated care either managed care through an insurer, or an innovations project under a provider group. This means that clinics need to plan ahead to ensure that they are part of the delivery system choices for their patients. More low income patients are enrolled in Medicaid and in the new health care exchange, and clinics can serve as a medical home for these patients and receive reimbursement. See Get Covered Illinois' FAQs about using new coverage here.

 Q:   Are non-citizen victims of domestic violence eligible for Medicaid under the Affordable Care Act?

 A:   Yes. Under the Violence Against Women Act (VAWA), certain non-citizens are eligible for Medicaid (providing they meet income guidelines) and are not subject to the 5 year bar. See #10 in the following Illinois Department of Human Services eligibility chart. If VAWA applicants are eligible now, they should remain eligible under ACA. They typically have to provide a receipt that their application has been filed with US Citizenship and Immigration Services, not that the application has been approved.


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