SoonerCare. Insured (2.2M) and. Uninsured (500K) $54, % FPL 250% FPL $45, % FPL $36, % FPL $33,874 $24, % FPL 100% FPL $18,310
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1 Oklahoma SoonerCare (Medicaid) and the Affordable Care Act (ACA) Cindy Roberts, CPA OHCA Deputy CEO Buffy Heater, MPH Director of Planning & Development
2 SoonerCare Today
3 SoonerCare Landscape Today Annual Insured (2.2M) and income Family of 3 300% FPL Uninsured (500K) $54, % FPL $45, % FPL $36, % FPL $33, % FPL Long Term Care 16K $24, % FPL $18,310 Children 491K Pregnant Women 34K Oklahoma Cares 2100 Sooner Plan 28K Aged, Blind, Disabled 127K Insure Oklahoma 32K SoonerCare 37% FPL Parents 48K (Members as of September 2010 Fast Facts)
4 Federal Poverty Level (FPL) Guidelines Persons in family/hh 100% 133% 185% 200% 250% 300% 1 $10,830 $14,404 $20,036 $21,660 $27,075 $32,490 (6.93) 2 $14,570 $19,378 (9.32) $26,955 $29,140 $36,425 $43,710 3 $18,310 $24,352 $33,874 $36, $45,775 $54,930 (11.71) 4 $22,050 $29,327 (14.10) 5 $25,790 $34,301 (16.49) 6 $29,530 $39,275 (18.88) 88) $40,793 $44,100 $55,125 $66,150 $47,712 $51,580 $64,475 $77,370 $54,631 $59,060 $73,825 $88,590
5 Challenge: Oklahoma s Uninsured Oklahoma Uninsured 2009 Total 18% (658,862 persons) Children (0-18) 13% (130,605 children) Adults (19+) 20% (528,257 adults) Distribution of Oklahoma s Uninsured Children and Adults by FPL (2009) US 21.8% 13.2% Children < 300% FPL Children 300% + FPL 18.4% 15.7% Adults < 300% FPL OK Adults 300% + FPL 61.9% 35% 30% 25% Children and Adults Uninsurance Rates by FPL in Oklahoma (2009) 32% 62.0% 20% 15% 10% 8% 16% 9% 300%+ FPL <300% FPL 5% 0% children adults Source: US Census Bureau, CPS Table Creator. html
6 Generation Five Medicaid and the ACA
7 Health Care Coverage % FPL Insured and Uninsured Annual income Family of 3 $54, % FPL 200% FPL 185% FPL 133% FPL Long Term Care 16K $45,775 $36,620 $33,874 $24,352 Children 491K 50K New SoonerCare 200K Aged, Blind, Disabled 127K $18,310 SoonerCare (Members as of September 2010 Fast Facts)
8 Participation Scenarios 2014 Low 57% Medium 75% High 100% Newly Qualified 110, , ,000 Woodwork 30,000 35,000 50,000 Total Enrolled 140, , ,000 State Share $23.8 M $31.2 M $41.6 M Source: Presentation by Kaiser Family Foundation on 5/26/10 reported an estimated 57% standard participation rate for all populations affected by reform. This was calculated from the base CBO participation rates used to cost the federal reform legislation. In addition, when presenters considered outreach efforts and other methods states might employ to seek out coverage for previously uninsured individuals, the participation rate is estimated to be as high as 75%, which is referred to as an enhanced participation rate.
9 Oklahoma FMAP Outlook: Newly Qualified Percent Federal Dollars Regular ARRA Future Years Time Period Source: CMS, Regular reflects FY 2010 FMAP Estimates
10 State Dollar Offsets Pregnant Women Insure Oklahoma Oklahoma Cares (Breast & Cervical Cancer Services) SoonerPlan (Family Planning Services) Other State Agencies
11 Impact Analysis for Planningning New Members: 200, newly qualified 50,000 woodwork effect Years $42.3 Million Avg Avg Avg Annual Annual Avg Annual State Federal Jobs Annual OK Tax Dollars Dollars Earnings Rev $600 Million 22,500 $530 Million $71.7 Million $73 $600 Million 23,900 $570 Million $76 Million Million 2020 $95 Million $607 Million 24,800 $574 Million $79 Million
12 Eligibility Rule Changes MAGI (Modified Adjusted Gross Income) Intended to simplify Consistency between states New data matches
13 Information System Changes
14 New CMS IT Guidance Service Oriented Architecture Reusable Interoperable Scalable Ease of Use
15 CMS IT Funding Enhanced funding available Medicaid Eligibility Systems (thru ) 90% match design, development and implementation 75% match ongoing operations Must meet or exceed new CMS IT guidance In the past only 50% match for development and operations
16 Federal / State Decisions and Concluding Steps
17 ACA Requirements Decisions still needed Benefit Packages Other Issues
18 Other Authority and Approvals State Plan Amendments Waivers Promulgated Policy Tribal Consultation Medical Advisory Committee OHCA Board Legislature Oklahoma Governor
19 Accountable Care Organizations
20 Accountable Care Organizations (ACO) Defined: Medicare Shared Savings Program or Pioneer ACO Model. ACO s are networks of physicians and other providers working together. Improve the quality of health care services and reduce costs for a defined patient population. Eligible Providers: Group practices Independent practice associations Networks of individual practitioners Partnerships of fhospitals and professionals Hospitals that employ professionals Other groups
21 ACO Basic Features ACO must agree to at least a three year contract Must serve an assigned Medicare patient population of at least 5,000 Invisible Member Enrollment Performance Measurement Shared Savings Stronger Incentives (Future) Source: Health Affairs, Health Policy Brief, Accountable Care Organizations,
22 ACO Challenges Volume based incentives for providers Slow growth / uptake Significant upfront investment No early incentives & financial rewards Long range savings dependent upon culture change
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