UW MEDICINE HEALTH INSURANCE EXCHANGE AND MEDICAID EXPANSION

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1 UW MEDICINE HEALTH INSURANCE EXCHANGE AND MEDICAID EXPANSION TASK FORCE COMMUNICATION UPDATE NOVEMBER 2013

2 The Affordable Care Act (ACA) is the federal health care law passed in The objective is to increase access to health care across the country, improve quality and affordability in the health care system. The Affordable Care Act will offer more options through Medicaid Expansion and the Exchange for WA residents. By assessing one portal through Washington Healthplanfinder their eligibility path for either Medicaid or the Exchange can be determined. Washington Healthplanfinder will be a new online marketplace for individuals, families and small businesses to compare and enroll in health insurance. For the Exchange, you can determine if you are eligible for financial assistance through cost sharing (silver plan only) and/or premium reductions. Enrollment kicked off on October 1, 2013 with coverage effective on January 1, 2014 for the Exchange, however some Medicaid groups can be effective as early as 10/1/13. 2

3 Washington Healthplanfinder announced more than 55,000 residents have enrolled in health coverage during the first month of enrollment (Oct st ). Since launch, more than 100,000 people in Washington State have either fully enrolled in new health coverage options or completed an application that is awaiting payment due in December. This was a historical opening month for Washington Healthplanfinder, said Richard Onizuka, CEO for the Washington Health Benefit Exchange. We are proud of our success to-date, but continue to be laser-focused on fine-tuning our site to ensure all of our customers are having a positive enrollment experience. Washington Healthplanfinder IT staff continue to perform weekend maintenance to further improve the online customer experience. The addition of 145 new representatives at the Customer Support Center over the next several weeks are expected to gradually decrease call center wait times. We continue to be pleased with Washington State residents response to the Health Benefit Exchange, said Dorothy Teeter, director of the Health Care Authority. We appreciate the commitment of our community partners to get people connected to insurance coverage. Enrollment numbers were impacted slightly this week by outages of the Federal Data Services Hub, which is managed by the federal government and allows Washington Healthplanfinder and other state-based marketplaces to verify identity and determine eligibility for financial help. Should this occur again, a message will be posted to and in-depth information will be posted to our Status Center. 3

4 The most popular channel through which 80% of enrollees are expected to purchase insurance is on the online marketplace at Washington HealthPlanFinder. Key stats for the state of Washington Oct 1-31st: Web and Call Center Data Unique Visitors 498,006 Total Site Visits 2,710,921 Page Views 11,527,730 Unique Page Views 8,180,172 Accounts Created 118,531 Call Center Volume 94,495 Average Call Center Wait Times 19:55 min Enrollments Completed Qualified Health Plans 7,341 Medicaid Newly Eligible/Coverage Jan. 1 29,622 Medicaid/Immediate coverage 18,702 Total 55,367 Total Completed Applications Total Applications 58,140 Total Applicants Included on Applications Completed* Qualified Health Plan Applicants QHP Only 34,861 Qualified Health Plan/Medicaid Mixed** 15,426 Medicaid Applicants Only 54,648 Total Applicants** 104,631 *Note: These numbers reflect enrollments and applications through Oct. 31. Applications completed includes individuals who have completed applications but have not yet submitted payment. Payment is due on Dec. 23, 2013 for coverage that begins on Jan. 1, *Note: These numbers have been updated to more clearly identify which applicants are applying for Qualified Health Plans and which are applying for Medicaid. Qualified Health Plan/Medicaid Mixed indicates applications in which at least one individual on the application is purchasing a Qualified Health Plan while others may be eligible for Medicaid. 4

5 Medicaid categories: new adult, children, CHIP, family medical and pregnancy. New Adults represents the highest enrollment category at 60%. This category opened Medicaid coverage to many childless adults aged with an annual income of <=$15,856 that were previously not eligible. "New Adults" Enrollment by WA Counties 35% 30% 25% 20% 15% 10% 5% 0% 32% 26% 11% 11% 8% 4% 4% 4% 5

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7 The ACA's health care exchanges the largest expansion of health insurance availability since the advent of Medicare and Medicaid in 1965 are expected to cover 7 million by 2014 then up to 24 million Americans by As of Oct. 2013, 16 states will operate their own exchanges, 7 will partner with the federal government, and 27 will default to federal exchanges. WA state represents one of more successfully managed state-based exchange programs. 7

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9 Washington State (Exchange) Qualified Health Plans by County 9

10 WA Membership Growth: New Members PROJECTED EXCHANGE MEMBER ENROLLMENT ( ) 10

11 Washington is a Leading State in the Process of Securing $178 Million for Exchange Establishment & Medicaid Eligibility Systems 11

12 The Supreme Court's ruling on the Affordable Care Act (ACA) allowed states to opt out of the law's Medicaid Expansion, leaving each state's decision to participate in the hands of the nation's governors and state. States could still change their minds about expansion either for 2014 or for later years. 12

13 Capturing New Revenue Opportunities By 2016, health insurance exchanges are expected to cover 24 million Americans, many of whom would otherwise not have had coverage; this will reduce the burden of bad debt and charity care for self-pay patients. Although exchange-based health plans are likely to reimburse at lower rates than existing commercial plans, exchange-based plans are required to cover a wider range of services (mostly outpatient) than most commercial plans do, which could provide a volume boost in outpatient screenings, diagnostics, and preventive treatment. Because exchange-based plans are required to cover many wellness and preventive services, with little or no patient obligation, health systems can be reimbursed for a broader array of services around maintaining population health. Widespread coverage expansion is likely to cause significant increases in wait times for primary care access; providers hoping to capture additional outpatient volume will need to heavily invest in expanded and alternative primary care access points for all patients. 13

14 Potential Risk Areas New regulations governing reimbursement may increase the risk of non-payment from plans to providers. Consumers maintain valid health insurance coverage for a 90-day grace period without premium payment, but health insurance companies are only required to reimburse providers for services rendered in the first 30 days of non-payment. While the intention of this rule was to ensure care continuity for patients, any services provided to a patient in the last 60 days of the 90-day period may not be reimbursed by the plan and must be collected directly from patients. CMS encourages issuers to notify providers of patients at-risk of defaulting on their premiums after the initial 30-day period, but no requirements for that communication currently exist. The penalty assessed when someone doesn t have health insurance is often less expensive than purchasing coverage. The penalty is expected to increase each year. A recent poll found that 25% of uninsured Americans are more likely to pay the fine than obtain health insurance. If young, healthy people choose to pay penalties rather than purchase insurance, then risk pools may be overwhelmed by older, less-healthy consumers. The Obama administration recently granted a sixweek extension until March 31 for Americans to sign up for coverage next year and avoid new tax penalties under the health-care overhaul law. In addition to non-compliance penalties, which will be far below the estimated premium cost of eligible plans for most individuals, restrictions on enforcement mechanisms will limit the government s ability to compel the purchase of insurance. Traditional mechanisms for collecting taxes, such as tax liens, wage garnishment, and jail time, are prohibited when enforcing the health insurance mandate. Withholding refunds is the only substantive mechanism available to the IRS for penalty enforcement. 14

15 Enrollment Guidelines Medicaid & Exchange For Medicaid Expansion & Classic enrollment is continuous throughout the year. For the Exchange after the initial open enrollment period ends on 3/31/14, eligible individuals may only enroll or switch plans due to triggering events. These events include: change in family status losing minimum coverage change in citizenship income fluctuation affecting cost-sharing/premium assistance permanent relocation that offers access to new QHPs People may only switch plans within the same metallic level (bronze, silver, gold, or platinum) they originally purchased. A precaution in place to prevent switching to a plan with a higher actuarial value before a significant medical procedure or purchasing a lower value plan after such an event. For benefit years beginning on or after January 1, 2015, the annual open enrollment period begins October 15 and extends through December 7 of the preceding calendar year. 15

16 PATIENT ACCESS ~ ENROLLMENT ACTIVITY While staff are waiting to complete their certification they has been proactive in scheduling future appointments, compiling patient waitlists for follow-up, referring patients to the Exchange call center or website, using paper enrollment applications, or sitting with the them as they complete their application. There are opportunities outside UW Medicine for our patients to enroll from going on-line at Washington Healthplanfinder, completing a paper application, calling the Spokane Call Center and attending an event sponsored by King County or a IPA Network Organization. UW Medicine Stats 10/1/13-11/1/13 Activity HMC FC/RCA HMC SW UWMC UWNC NWH VMC TOTAL # appts scheduled for enrollment assistance n/a # enrolled in ME # enrolled in HIX # HIX pending enrollment # paper applications # refused to enroll # of patient questions 429 n/a 277 n/a n/a n/a 706 HMC/UWMC: Focused on call center or elbow-to-elbow enrollments, Social Work enrollments in Madison clinic mostly, Financial Counseling enrollment in Mental Health have taken about 30 min each UWNC: Compiling a waiting-list of patients who they will call back and screen once they are certified NWH: Using paper applications when the system is down, referring patients to the call center or website VMC: Focused on elbow-to-elbow enrollments 16

17 Patient Access Subgroup Update We are partnering directly with Public Health to improve the timeline to complete the process of becoming an In-person Assister (IPA). There are several milestones that must be reached by UW Medicine staff from training, receiving the exam link, obtaining certification and gaining system access. UW Medicine In Person Assister status as of November 4 th : Certification Milestones Achieved UW Medicine In Training Waiting on Exam Link Completing Exam Obtaining Certification / System Access Total Enterprise Wide HMC Financial Counseling/RCA HMC Social Work UWMC PA PFS UWNC NWH ** 10 VMC ** 19 Note: **Currently a Certified Application Counselor (CAC), NWH is moving forward with IPA certification. CAC offers 30 days limited system access while IPA access is more long term. 17

18 Patient Access Subgroup Update As an organization we are partnering together to roll out the new coverage options driven by healthcare reform, however there have been a few challenges. Whenever possible, we are proactively identifying interim solutions until resolution can occur. In terms of Washington Healthplanfinder system some issues have been fixed, however these are still being managed: System is down periodically sometimes for long periods All entities are utilizing the paper application process if the system bounces them out during an enrollment process. The paper application once completed is either faxed to the Web Site (Exchange) or to Washington Connections (Medicaid). If the info entered does not match the federal hub the patient must submit documentation-- SSN card, birth certificate; many have to order the documentation which delays the enrollment process. We are improving the process to better prepare patients on what to expect when they come for their enrollment appointment. Based on having more experience with the IPA process, Social Work is finding that staff need to complete about 5 applications before feeling comfortable with the process. Long wait times are still being experienced when calling the Spokane call center. Call center staffing will increase over the next couple of months to reduce call times. HMC/UWMC are partnering with HCA (Medicaid) to be on-site for questions. In addition, an IPA Network Organization Within Reach (Medicaid & HIX) will be on-site to assist with enrollment. UW Medicine is embracing healthcare reform by assisting Washington residents with questions, resources and the enrollment process. 18

19 RESOURCES UW Medicine HIX & Medicaid Expansion SharePoint site had 574 unique visitors an increase of 300 from the prior month. Overall, the main page has been viewed a total of 1,956 times (531 in the last 30 days). SharePoint Enterprise-wide Communication Site for Health Insurance Exchange (HIX) & Medicaid Expansion Specific Questions Contact: UW Medicine HIX & Medicaid Expansion Task Force clsulliv@uw.edu 19