Maryland Medicaid Expansion and Safety Net Providers

Transcription

1 Maryland Medicaid Expansin and Safety Net Prviders Charles J. Milligan, JD, MPH Deputy Secretary, Health Care Financing April 24, 2013

2 Outline Cntinuity f care Capacity building fr safety net prviders Delivery system refrms Remaining uninsured ppulatins 2

3 Cntinuity f Care

4 Cntinuity f Care Fur majr issues with cntinuity f care when individuals will mve between Medicaid and the Exchange: Cntinuity at the health plan level Cntinuity at the prvider level Cntinuity fr benefits cvered in bth benefit packages that might invlve utilizatin/authrizatin Cntinuity acrss prgrams when the benefit packages might vary Maryland has fcused n all fur 4

5 Cntinuity f Care Legislatin passed in 2012 requiring the study f cntinuity f care prtectins and engagement f a stakehlder advisry cmmittee The final reprt presented ptins, including prvisins t ensure cntinuity f care in specific situatins: Transitin in the curse f treatment Mving t a new managed care rganizatin (MCO) carrier where the current prvider is nt in-netwrk The cst f adding these prtectins was estimated by an actuary t be: $0.07 per member per mnth mre fr qualified health plans (QHPs) $0.05 per member per mnth fr Medicaid MCOs 5

6 Cntinuity f Care Beginning in 2015, Maryland law requires that receiving cmmercial carriers and MCOs must: Abide by earlier prir authrizatins fr treatment (f cvered benefits) Allw ut-f-netwrk care t cmplete a curse f treatment Hnr bth f these requirements the lesser f 90 days r the cmpletin f the curse f treatment Why shuld Federally Qualified Health Centers (FQHCs) be cncerned with this? Churn between Medicaid and QHPs will be high There are certain health cnditins that churning peple are likely t experience that FQHCs deal with frequently After 90 days, n assurance that FQHCs will be allwed t cntinue treating if they are nt in-netwrk 6

7 Churn Rate, 12-Mnth Medicaid Ppulatin, FY 2011 Cntinuus (%) Gained Eligibility (%) Lst Eligibility (%) Gained/Lst (%) Ttal All Medicaid 779,870 (69.0%) 203,733 (18.0%) 131,436 (11.6%) 15,824 (1.4%) 1,130,863 Family and Children 290,078 (68.6%) 79,664 (18.9%) 47,509 (11.2%) 5,307 (1.3%) 422,558 Fster Children 15,394 (85.3%) 1,359 (7.5%) 1,268 (7.0%) 32 (0.2%) 18,053 Maryland Children s Health Prgram (MCHP) 71,916 (73.6%) 13,890 (14.2%) 11,323 (11.6%) 591 (0.6%) 97,720 MCHP Premium 15,216 (71.9%) 2,920 (13.8%) 2,703 (12.8%) 323 (1.5%) 21,162 Family Planning 7,487 (39.0%) 6,678 (34.8%) 4,914 (25.6%) 137 (0.7%) 19,216 Medicaid Expansin 160,464 (70.3%) 43,894 (19.2%) 21,160 (9.3%) 2,656 (1.2%) 228,174 Primary Adult Care (PAC) 31,818 (43.3%) 26,591 (36.2%) 14,696 (20.0%) 428 (0.6%) 73,533 Sum f Grups Likely t Transitin t/frm MHBE 592,373 (67.3%) 174,996 (19.9%) 103,573 (11.8%) 9,474 (1.1%) 880,416 7

8 Distributin f Selected Cnditins amng the 12-Mnth Ppulatin Lsing Medicaid Eligibility Substance Abuse Nne f the Measured Cnditins Ttal Peple in Categry Eligibility Categry Pregnancy Prescriptins Mental Health All Medicaid (including grups nt listed) 2.5% 39.3% 13.5% 4.3% 69.6% 131,436 Family Planning 6.5% 20.1% 1.5% 0.4% 81.6% 4,914 Family and Children 1.5% 40.0% 9.1% 2.2% 62.6% 47,509 Fster Children 0.6% 42.1% 28.8% 1.2% 56.1% 1,268 MCHP 0.2% 36.0% 8.6% 0.6% 63.1% 11,323 MCHP Premium 0.0% 46.0% 11.0% 0.6% 55.1% 2,703 Medicaid Expansin 1.6% 41.8% 9.0% 1.9% 61.0% 21,160 PAC 0.1% 51.2% 17.1% 14.6% 47.0% 14,696 Sum f Grups Likely t Transitin t/frm MHBE 1.4% 40.8% 10.1% 3.6% 60.8% 103,573 8

9 Distributin f Selected Cnditins amng the 12-Mnth Ppulatin Gaining Medicaid Eligibility Substance Abuse Nne f the Measured Cnditins Ttal Peple in Categry Eligibility Categry Pregnancy Prescriptins Mental Health All Medicaid (including grups nt listed) 6.7% 43.7% 10.9% 4.3% 70.2% 203,733 Family Planning 80.7% 56.8% 4.5% 1.8% 49.2% 6,678 Family and Children 5.1% 46.5% 7.9% 2.4% 73.7% 79,664 Fster Children 0.0% 46.7% 30.8% 3.5% 65.7% 1,359 MCHP 0.6% 40.5% 6.3% 0.4% 71.7% 13,890 MCHP Premium 0.0% 44.9% 7.4% 0.4% 65.3% 2,920 Medicaid Expansin 5.3% 46.5% 7.7% 1.8% 68.4% 43,894 PAC 0.4% 46.1% 19.8% 15.3% 49.2% 26,591 Sum f Grups Likely t Transitin t/frm MHBE 6.8% 46.3% 9.6% 4.0% 67.4% 174,996 9

10 Capacity Building fr Safety Net Prviders

11 Building Capacity in Maryland s Safety Net Cmmunity Respnding t the recmmendatins f the Health Care Refrm Crdinating Cuncil (HCRCC), the Cmmunity Health Resurces Cmmissin (CHRC) develped a business plan in February 2012 that prvided recmmendatins fr hw the state culd prmte the readiness f safety net prviders as Maryland implements the Affrdable Care Act. 1. What shuld be expected f traditinal safety net prviders in an envirnment in which mre peple have insurance cverage? 2. Hw can the capacity f these prviders be leveraged and fstered? 11

12 Key Findings f CHRC Business Plan Mre than 65% f safety net prviders indicated they are fairly ready fr health care refrm with nly 8% extremely ready. Apprximately 15% f safety net prviders and 22% f health departments reprted fully implementing electrnic medical recrd (EMR) systems. Needs/requests fr technical assistance were diverse and varied. The favred methdlgies fr prviding assistance including custmized/individualized training, learning cllabratives, and peer-t-peer initiatives. 12

13 Key Recmmendatins f Business Plan Prvide technical assistance and supprt related t mechanics f health refrm legislatin. Catalyze innvative public-private partnerships that will leverage additinal private resurces. Wrk with Maryland s Health Department (which includes Medicaid), the Gvernr s Wrkfrce Investment Bard, and ther agencies t supprt statewide plans fr wrkfrce develpment. Assist cmmunity health resurces by facilitating access t data and interpreting r translating this data t meet custmized needs. Supprt effrts t develp expanded systems fr eligibility and enrllment f uninsured and underinsured patients. 13

14 Safety Net Prviders and Ptential Areas f Technical Assistance Grant-Funded Prviders Examples: free clinics and schl-based health centers Ptential Areas f Assistance Credentialing Submitting Claims IT/EMR supprt Strategic Business Planning & develping Value prpsitins fr ptential payrs Prviders with Medicaid Experience Examples: FQHCs, public behaviral health prviders, lcal health departments Ptential Areas f Assistance Pricing and MCO/QHP cntracting Imprving efficiencies in practice mdels Prducing utcmes data Utilizing EHR netwrks 14

15 Facilitating Safety Net and Health Plan Relatinship Building Meet and Greet Sessins ( Mixers ) will be held later this Spring, spnsred by the CHRC Reginal sessins will allw participating MCOs and QHPs, and safety net prviders, t begin discussins n cntracting Infrmatin n expected enrllment Infrmatin n Medicaid and cmmercial carrier requirements Technical assistance verview Carriers will be encuraged t attend these sessins in rder t identify cmmunity prviders wh are available t cntract within their service area. 15

16 Cmplementary Cncept: Health Access Impact Fund CHRC and private fundatins share similar grantees and cnstituencies, i.e., FQHCs, free clinics, behaviral health prviders, and schl-based health centers. Create a Health Access Impact Fund by pling public funding frm the CHRC with private funding (lcal philanthrpic partners) t create a public-private partnership t supprt specific prjects t build capacity f the safety net infrastructure. The Fund culd be used t award grants and/r supprt cntracts t prvide technical assistance in specific areas such as credentialing, cntracting, and billing/emr/practice management. 16

17 Delivery System Refrms

18 Delivery System Refrm Multi-payer Patient Centered Medical Hme (PCMH) Launched April 2011 with 53 separate practices, including 339 prviders Cvers 300,000 lives Medicaid and cmmercial payers Variety f practice types (FQHCs; private practices; hspitalemplyed) State plans t add Medicare under State Innvatin Mdel Health Hme (ACA Sectin 2703) Fcus n specialty behaviral health mental illness and substance abuse Build ut PCMH mdel frm behaviral health medical hme Linkage t scial supprts (emplyment, husing, criminal justice, educatin) FQHCs can participate 18

19 Remaining Hles in the Safety Net

20 Remaining Hles in the Safety Net Despite the expansin f Medicaid and insurance refrms, sme peple under age 65 will remain uninsured. Undcumented aliens Peple wh chse the tax penalty rather than btaining health insurance In additin, sme Medicaid-cvered benefits will fall utside the benefits in QHPs in the Exchange These grups and benefits will still need t be served, and safety net prviders, like FQHCs, will likely be the pint f access int care. 20

21 Charles J. Milligan, JD, MPH Deputy Secretary, Health Care Financing 21