Jackie Prokop, RN, MHA Director Program Policy Division Medical Services Administration Michigan Department of Health and Human Services

Transcription

1 Jackie Prokop, RN, MHA Director Program Policy Division Medical Services Administration Michigan Department of Health and Human Services March 23, 2016

2 Overview of the Healthy Michigan Plan (HMP) Federal and State Laws Eligibility Enrollment Demographics Covered Services Service Delivery System The MI Health Account Purpose Cost-Sharing Requirements and Exemptions The Health Risk Assessment and Healthy Behavior Incentives Second Waiver for HMP Informational Sources Questions 2

3 The Healthy Michigan Plan will celebrate its two year anniversary April 1, 2016 Over 600,000 Michigan residents are covered by the Healthy Michigan Plan Enrollment outreach continues 3

4 Positively and significantly impacts Michigan s underserved population by: Providing comprehensive health insurance coverage for Michigan s low income citizens Providing access to primary care services Improving health status Improving employability Drastically reducing Michigan s uninsured population 4

5 Affordable Care Act (ACA) authorization New eligibility category Funding must be appropriated by State Public Act 107 of 2013 was signed into law by Governor Snyder September 16, State law requires certain cost-sharing responsibility and health promotion activity Requirement of federal waivers (Section 1115) First Waiver approved December 30, 2013 Second Waiver approved December 17,

6 Michigan residents who: Are ages Are not receiving or eligible for Medicare benefits Are not eligible for other Medicaid programs Are not pregnant at the time of application Have income at or below 133% of the federal poverty level (5% disregard = 138%) Must meet other federal requirements 6

7 HMP Eligibility Fills the Gap HMP fills the gap between current Medicaid coverage and private health insurance coverage offered on the Exchange 400% 350% 300% 250% 200% 150% 100% 50% 0% Pregnant Women Children 0-6 Children 7-18 Parents Caretaker Relatives Pre-HMP Medicare year olds Elderly Disabled Childless Adults HMP Exchange 7

8 Eligibility Applying for HMP Three ways to apply for HMP: 1) Online (encouraged) using the electronic application through MiBridges: 2) Phone by calling ) In Person using the DCH 1426 paper application (available online and at local county MDHHS offices) Enrollment is open and continuous 8

9 Enrollment (4/2014 3/2016) 700, , , , , , , , ,000 April-14 April-15 March-16 9

10 % % % % % 10

11 Female 52% Male 48% 11

12 Percentage of HMP Beneficiaries Under 100% FPL Over 100% FPL 19% 81% 12

13 Benefit coverage must be based on federal benchmark coverage and include the 10 essential health care services Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric Services (19 & 20 year olds) including oral and vision care Other services including dental, Maternal Infant Health Program, hearing aids, and vision services 13

14 Most Healthy Michigan Plan beneficiaries will enroll into the one of the current Health Plans Current populations that are exempt or voluntary from managed care remain exempt or voluntary Dental is included in the health plan benefit Prepaid Inpatient Health Plan system of care for behavioral health services 14

15 Mechanism to facilitate beneficiary education and responsibility of health care service utilization Required by Public Act 107 of 2013 Begins six months after enrollment in a health plan Introductory Letter Mailed one month prior to receiving first statement Explains the MI Health Account and what to expect MI Health Account Quarterly Statement Itemization of health services received Cost of services for the beneficiary and the Health Plan Co-pays and/or contributions owed by the beneficiary Reductions in cost sharing Payment coupons 15

16 Two types of cost-sharing to be paid on a monthly basis Average monthly co-pays Contributions Limited to beneficiaries above 100% of the FPL Total annual amounts may be up to 2% of income Efforts to align cost-sharing requirements with high-value services Many factors determine cost-sharing responsibilities 16

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19 Alcohol Use Disorder Asthma Chronic Kidney Disease Chronic Obstructive Pulmonary Disease and Bronchiectasis DVT (while on anticoagulation)/pe (chronic anticoagulation) Depression Diabetes Heart Failure HIV Hyperlipidemia Hypertension Ischemic Heart Disease Obesity Schizophrenia Stroke/Transient Ischemic Attack Substance Use Disorder Tobacco Use Disorder 19

20 Health Risk Assessment Healthy Behavior Initiatives Captures patient self-reported data General health status rating Exercise frequency Nutrition Alcohol use Smoking/tobacco/drug and substance use Anxiety and depression Flu vaccinations 20

21 Beneficiaries who complete a Health Risk Assessment and agree to address or maintain a healthy behavior may be eligible to receive financial incentives: A 50% reduction in their required monthly copay amounts (after 2% of income has already been paid in copays) AND A 50% reduction in required contributions or a comparably valued gift card from their health plan if they are not required to pay contributions Primary Care Provider attestation is required 21

22 Goal is three-fold for beneficiaries: To have them more educated and involved in their health care decisions AND To promote early engagement with primary care providers and access to preventive care services AND To improve their health outcomes The public benefits in myriad ways: Better overall health status in Michigan Greater productivity amongst the Michigan population More appropriate utilization of health care services 22

23 Overview Affected Population Details Next Steps 23

24 Per State Law, MDHHS submitted a second waiver request to CMS on September 1, The waiver was approved on December 17, 2015 Approval of this Second Waiver allows the State of Michigan to maintain coverage for the approximately 600,000 individuals currently enrolled in the program 24

25 Beginning April 1, 2018, targets all beneficiaries who have incomes between % of the federal poverty level. Does not apply to people who are below 100% of the federal poverty level. Medically Frail are exempt. 25

26 Affected beneficiaries will choose between two delivery system options: The traditional Healthy Michigan Plan, available with the completion of a healthy behavior, OR The Marketplace Option, whereby beneficiaries receive coverage through a Qualified Health Plan. NOTE: Both programs will provide alternative benefit plan coverage. NOTE: Beneficiaries newly enrolled or come into the higher income level (>100% FPL) on or after April 1, 2018, may have one year enrollment in the traditional HMP to allow for completion of healthy behaviors. 26

27 Develop new operational protocols Establish Qualified Health Plans for the Marketplace option Revise demonstration evaluation Policy changes 27

28 Informational websites for beneficiary handbook, FAQ, 1115 Demonstration Waiver documents and MI Health Account and Health Risk Assessment information: address for Healthy Michigan Plan: MI Health Portal for beneficiaries: 28

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