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Using the Affordable Care Act to Close Workers Compensation Cases

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Teddy Snyder
Teddy Snyder

The Affordable Care Act provides new safety nets to assure injured workers ongoing medical care: private health insurance regardless of pre-existing condition, expanded Medi-Cal/Medicaid, Medicare prescription help, and new programs for those who are enrolled in both Medicare and Medi-Cal/Medicaid. When choosing a mediator, make sure the mediator can help fashion settlement solutions using all available resources, including the Affordable Care Act.

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USING?THE?AFFORDABLE?CARE?ACT? TO?CLOSE? WORKERS?COMPENSATION? CASES (c)?Teddy?Snyder?2013
Teddy?Snyder?mediates?Workers?Compensation? cases?throughout?California.? An?attorney?since?1977,?she?has?concentrated? on?claim?settlement?for?over?19?years. Teddy?was?in?the?first?group?LEXIS\NEXIS?named?as?notable? persons?in?Workers?Compensation?in?2008. She?is?a?nationally?recognized?expert?on?Medicare? Secondary?Payer?and?Affordable?Care?Act?issues?affecting? settlement,?having?written?and?spoken?extensively?on?these? subjects.
WHAT¨S?THE?BIGGEST?OBSTACLE?TO?CLOSING? WORKERS?COMPENSATION?CLAIMS?? THE?ISSUE?OF?ONGOING?MEDICAL?CARE
3?FEDERAL?STATUTORY?PROGRAMS HEALTH?INSURANCE?EXCHANGES MEDI\CAL??aka?MEDICAID MEDICARE
NEGOTIATING?TIP?#1 AFFORDABLE?CARE?ACT or OBAMACARE
Using the Affordable Care Act to Close Workers Compensation Cases
WHY?WOULD?AN?APPLICANT?CLOSE?A?CLAIM? ? ? ? ? ? UNCERTAINTY?OF?OUTCOME CONTROL?OF?MEDICAL?TREATMENT NEED?FOR?CASH LEAVE?AN?ESTATE? GET?ON?WITH?LIFE
WHY?WOULD?AN?EMPLOYER?CLOSE?CLAIMS? ? ? ? ? ? ? ? UNCERTAINTY?OF?OUTCOME ＾STOP?THE?BLEED￣ INFLATION?RISK MORTALITY?RISK CLOSE?RESERVE RECOVER?BONDING?EXPENSE COST?OF?ADMINISTRATION
CASE?EVALUATION 2?WAYS?TO?CALCULATE?FUTURE?MEDICAL?EXPENSE: 1) PROJECT?PAST?MEDICAL?EXPENSE?OVER?ANTICIPATED? LIFETIME?ADJUSTING?FOR?CHANGED?USAGE?AND? INFLATION.?? 2)???DETERMINE?THE?COST?OF?A?PRIVATE?INSURANCE? PLAN?OBTAINED?THROUGH?THE?AFFORDABLE?CARE? ACT?STATE?EXCHANGE,?COVEREDCA.COM.
ACA¨s?VIRTUAL?SHOPPING?MALL? FOR?PRIVATE?HEALTH?INSURANCE ACA?IS?THE?MALLC NOT?THE?STORE
HOW?MUCH?WILL?IT?COST? ACA??GUARANTEES? INJURED?WORKER?WILL?BE?ABLE?TO?BUY? HEALTH?INSURANCEC BUT?DOES?NOT?REGULATE?WHAT?INSURERS?CAN?CHARGE CALIFORNIA?DOES?REGULATE?THAT
4?LEVELS?OF?COVERAGE: Least?expensive Bronze Silver Gold Most?expensive Platinum 60%?coverage 70% 80% 90% BUT?WHAT?ABOUT?ALL?THE?NON\INDUSTRIAL? STUFF?BEING?COVERED?
WHAT?ABOUT?THOSE?SUBSIDIES? SUBSIDIES?ARE?CALCULATED?BASED?ON? ＾MODIFIED?ADJUSTED?GROSS?INCOME￣ NOT?ASSETS 2?KINDS?OF?SUBSIDIES UP\FRONT?COST?ASSISTANCE TAX?CREDITS
PREMIUM?REDUCTION Types?of?Cost? Assistance: Health? Insurance Financing Individual?Annual? Income Help?to?pay?your? premium,?if?you?buy? in?your?state's?online? marketplace Between?$11,505\ $46,021 Family?of?Four?Annual? Income Between?$23,425\ $93,700 Source:??obamacarefacts.com/obamacare\subsidies.php
TAX?CREDIT Types?of?Cost? Assistance: Health? Insurance Financing Subsidies?for?out\of\ pocket?costs,?if?you? buy?in?your?state's? online?marketplace Individual?Annual? Income Up?to?$28,763 Family?of?Four?Annual? Income Up?to?$58,564 Source:??obamacarefacts.com/obamacare\subsidies.php
NEGOTIATING?TIP?#2 APPLICANTS¨?COUNSEL: SHOPPER?MUST?COMPLETE?THE?APPLICATION? TO?SEE?ACTUAL?COST.?? TRAIN?STAFF?TO?HELP?THE?INJURED?WORKER?NAVIGATE? COVEREDCA.COM INCOME?INFORMATION?IS?REQUIRED?TO?DETERMINE? SUBSIDY?AVAILABILITY HAVE?CLIENT?BRING?IN?COPY? OF?MOST?RECENT?TAX?RETURN.
HOW?CAN?I?RELY?ON?THESE?NUMBERS? ISN¨T?IT?ALL?GOING?TO?CHANGE? MEDIATOR?CAN?HELP
Expanded?Medicaid Workers?Compensation?Settlement? Game\Changer
MEDI\CAL MAY?BE?A?SOURCE OF?ONGOING?MEDICAL?CARE WHICH?WILL?ALLOW?YOU?TO?SETTLE?THE?CASE
TO?RETAIN?TRADITIONAL?MEDICAL,? THE?INDIVIDUAL?MUST?MEET?STRICT?RESOURCE?AND? INCOME?RULES THIS?INCLUDES,?FOR?AN?INDIVIDUAL,? NOT?MORE?THAN?$2,000?CASH
BEST?WAY?TO?FUND?A?SETTLEMENT?AND?STILL?RETAIN? MEDI\CAL?HAS?BEEN?THROUGH?A? SPECIAL?NEEDS?TRUST
ACA?CREATES?A?SECOND?FORM?OF?MEDI\CAL: EXPANDED?MEDICAL THERE?ARE?NO?RESOURCE?LIMITS?FOR? EXPANDED?MEDI\CAL
MODIFIED?ADJUSTED?GROSS?INCOME??(＾MAGI￣) CANNOT?EXCEED?138%?OF? FEDERAL?POVERTY?LEVEL FOR?SINGLE?PERSON,?THAT¨S?CURRENTLY?$15,856
OTHER?QUALIFIERS MUST?BE?AGED?19\64 NOT?PREGNANT NOT?INCARCERATED MEET?MEDI\CAL?CITIZENSHIP?RULES NOT?BE?MEDICARE\ELIGIBLE
Using the Affordable Care Act to Close Workers Compensation Cases
SHOULD?THE?INJURED?WORKER? SKIP?THE?SPECIAL?NEEDS?TRUST? EXPANDED?MEDI\CAL?COVERAGE?IS?NARROWER THAN?TRADITIONAL?MEDI\CAL NO?HOME?HEALTH?CARE INJURED?WORKER?MAY?NOT?BE?ABLE?TO? MANAGE?THE?MONEY?ON?HIS/HER?OWN
A?MATTRESS?IS?A?LOUSY?INVESTMENT
NEGOTIATING?TIP?#3 TO?ADVISE?WHETHER?TO?ACCEPT? SETTLEMENT?DIRECTLY?OR?SET?UP?AN?SNT, APPLICANT¨S?COUNSEL?MUST?DETERMINE?IF? INJURED?WORKER?QUALIFIES?FOR? MEDI\CAL?AND?WHICH?TYPE
MEDICARE PER?ACA,?NO?MORE?DONUT?HOLE?AFTER?2020
THE?DONUT?HOLE? IS??NOT?AN?ISSUE?IN?WORKERS?COMPENSATION? SETTLEMENTS?
DUAL\ELIGIBLES aka?MEDI\MEDI ACA?CREATED?2?NEW?CMS?OFFICES?TO?IMPROVE?HEALTH? CARE?DELIVERY?TO?DUAL\ELIGIBLES 15?STATES,?INCLUDING?CALIFORNIA,?ARE?PART?OF?A? DEMONSTRATION?PROJECT?
CAL?MEDICONNECT AN?OPTIONAL?HMO?PROGRAM?FOR?ENROLLEES?IN?8?COUNTIES ALAMEDA,?SAN?MATEO,?SANTA?CLARA,?LOS?ANGELES,?ORANGE,? SAN?DIEGO,?RIVERSIDE?AND?SAN?BERNARDINO TO?START?NO?SOONER?THAN?APRIL?2014
＾Medicare?and?Medicaid?were?not?designed?to?work? together,?and?their?separation?leads?to?significant? fragmentation?of?services.? *** The?proposal?emphasizes?continuity?of?care?so? beneficiaries?don¨t?experience?interruptions?in?their? needed?services.￣ WWW.CALDUALS.ORG
HOW?DOES?THIS?HELP? EASIER?ACCESS?TO?HEALTHCARE? MAY?ENCOURAGE?INJURED?WORKERS?TO?C&R EASIER?SELF\ADMINISTRATION?OF?HEALTH?CARE? MAY?HELP?IN?THE?DECISION? WHETHER?TO?ESTABLISH?AN?SNT BUT?FOR?NOW?THE?PROGRAM?IS?TEMPORARY
CONCLUSIONS
YOU?CAN?REACH?TEDDY?SNYDER?AT TSnyder@WCMediator.com Phone?310/889\8165

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Using the Affordable Care Act to Close Workers Compensation Cases