CUPA - RIO GRANDE CHAPTER ACA (PAST, PRESENT AND FUTURE)
Agenda 1. ACA Foundations 2. Past - The Early Days 3. Present - Current State 4. Future – What’s Next 5. Solutions – ACA Compliance Tools 6. Question and Answer Jeff Taylor Higher Education Specialist Equifax Workforce Solutions jeffrey.taylor@equifax.com 8432573.4147
ACA Foundations Four Key Stakeholders Individuals must Employers are State and federal The IRS will use forms have minimum required to offer exchanges will make 1094 and 1095 to essential coverage coverage to 95% subsidies available enforce the individual or pay a penalty. of their FTEs or pay a to individuals. and employer penalty. mandates. 3
The Early Days
Ancient History Is ACA going away? What exactly is the Affordable Care Act? Should we pay or play? Let’s just pull reports from our payroll system Do we have to comply with ACA? What is 6055 and 6056? 5
ACA Regulatory Timeline: Pre-2015 Supreme Court PPACA Employer Individual Final Employer grants judicial signed mandate mandate goes regulations mandate goes review of into law delayed into effect released into effect subsidy cases 3/10 7/13 1/14 2/14 11/14 1/15 6 6
Pre-2015 Focus: All About Eligibility Monthly Measurement Look-back Measurement • Full-time status is • Full-time status during a determined based on the future period (stability hours of service for each period) is determined based calendar month upon the hours of service in a prior period • Challenging in practice (measurement period) because you don’t know someone is eligible until it is too late 7 7
Look-back Transition Rules 2013 2014 2015 2016 J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D SMP 1 SMP 2 SMP 3 SSP 1 SSP 2 Eligible for Not Eligible for 31 hours per week Coverage Coverage Hired 3/15/14 A IMP ISP 5/1/16 12/31/16 4/1/14 5/1/15 3/31/15 4/30/16 Part-time employee with P SMP 2 10/15/14 10/14/15 fluctuating schedule 29 hours per week Not Eligible for Eligible for 28 hours per week Coverage Coverage Hired 3/15/14 A IMP SSP 2 5/1/15 12/31/15 3/31/15 4/1/14 1/1/16 3/31/15 12/31/16 Part-time employee with P SMP 2 10/15/14 10/14/15 fluctuating schedule 4/1/14 31 hours per week The final regulations contain numerous rules addressing the treatment of employees who have a change in employment status (e.g., part-time to full-time).
Who Must Be Measured? Part time: reasonably expected to Full-time: reasonably work less than 30 hour per week expected to work at least 30 hours per week Seasonal: hired to work Variable: unclear at time of hire for a period of less than whether the employee will work six months at least 30 hours per week 9
Current State
Subsidies Case: King vs. Burwell • Key phrase: “established by the states” • Plaintiffs argue that subsidies are only legitimate through state-based exchanges • Decision expected in late June • No ‘Plan B’ • Estimated 8 million subsidies at risk 11
Employer Mandate is in Effect! Managing offers of coverage Monitoring enrollment trends and premium costs Preparing for IRS reporting Preparing for employee inquiries Managing state subsidy notifications 12
Subsidies, Notifications & Appeals Employee applies for a subsidy through the exchanges Employee Federal Exchange notifies exchange is not yet employer of subsidies releasing awarded notifications Exchanges Employer has 90 days to appeal Employer 13
Appeals and Fine Disputes • CMS will likely begin notifying employers of employees that receive subsidies in 2015 – Standard appeals form – Receive determination in 90 days of appeal – To appeal or not to appeal? • The IRS will likely notify employers of 2015 penalties under 4980H(a) and 4980H(b) in late 2016 – Notification process has not yet been defined – Dispute process has not yet been defined Remember: the processes for appealing subsidies and appealing tax penalties are wholly separate. 14
State Exchanges • Autonomy to establish unique appeals processes • Not all states sending notifications yet • 13 states exchanges + State Exchanges: California, Colorado, Connecticut, Hawaii, DC Washington DC, Idaho, Washington, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, New York, Rhode Island, Vermont 15
CMS and IRS Responsibilities CMS IRS • • Income and employment Determine if individuals verification are subject to fines • • Employer sponsored coverage Determine if reconciliation of verification erroneous subsidies are necessary for individuals • Initial determinations • for employee subsidies Determine whether employers are subject to penalties • Notify employers of subsidies awarded 16
What’s Next
ACA Evolution 2016 Fine 2015 Disputes IRS Data/audit Reporting trail is key 2014 2016 is Appeals Management almost upon us ‘Coming 2016+ Eligibility Soon’ 2013 -CMS Benefits Modeling Counting to and Workforce 30 is Modeling difficult! 18
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