An online marketplace where Minnesotans can find, compare, choose, and get quality health care coverage that best fits your needs and your budget.

Transcription

1 December 6,

2 An online marketplace where Minnesotans can find, compare, choose, and get quality health care coverage that best fits your needs and your budget.

3 Uninsured Medicaid/CHIP Eligible Enrollee Individual Consumers (subsidized and unsubsidized) Small Business Owner/Employees

4 Enroll UX Demo

5 Affordable Care Act (ACA) The collection of bills that encompass federal health care reform. Exchange An online marketplace where Minnesotans can find, compare, choose and get quality health care coverage that best fits their needs and budget. Qualified Health Plan (QHP) A health plan that is certified to be issued through the Exchange. Advance Premium Tax Credits (APTCs) Payments of a tax credit which provide premium assistance on an advance basis to help individuals enroll in a qualified health plan through the Exchange. APTCs are available to individuals with incomes between 100% 400% FPG. They will reduce monthly premiums to between 2% 9.5% of monthly income. Cost-Sharing Reductions (CSRs) Out of pocket costs (copays, deductibles) will be reduced by up to 2/3 for individuals with incomes between 100% 250% FPG who are enrolled in certain QHPs through the Exchange. 5

6 Insurance Affordability Programs (IAPs) All assistance programs available through the Exchange. Includes Medicaid & Children s Health Insurance Program (CHIP) A basic health plan (if available in the state) Coverage in a QHP with APTC or CSRs Modified Adjusted Gross Income (MAGI) An income calculation method from the tax system that will used to determine eligibility for Medicaid (certain populations) and for tax credits available to people buying insurance in the Exchange. Grandfathered Plan Health plans that existed on March 23, Grandfathered plans are exempt from several of the reform provisions of the ACA as long as the plan terms do not change significantly. Essential Health Benefits (EHB) The minimum set of benefits that a non-grandfathered plan offered inside or outside the Exchange must provide. 6

7 Individual mandate On January 1, 2014, everyone must have insurance, with some exceptions: Religious objections Those not lawfully present Incarcerated individuals Financial hardship Or pay a fine per person equal to the greater of the flat fee or percentage of income above the tax filing threshold. 2014: $95 or 1% of income 2015: $325 or 2% of income 2016: $695 or 2.5% of income 7

8 The new adult group would include: Childless Adults (0% to 133% FPG) Parents (100% to 133% FPG) 19 and 20 year olds (100% to 133% FPG) Minnesota is currently covering each of these populations in either MA or MinnesotaCare and receiving 50% federal match. 8

9 Up to 100% FMAP for newly enrolled individuals that: o Are over age 18 o Not eligible under the State Plan or Federal Waiver as of December 1, 2009 o Enhanced FMAP at 100% for o phases down to 95% in 2017 o phases down to 94% in 2018 o phases down to 93% in 2019 o phases down to 90% in 2020 and thereafter 9

10 In 2014, certain Medicaid populations will be subject to the MAGI methodology to determine eligibility. Pregnant Women and Infants Children Parents Adult Expansion ( Adult Group ) to 133% FPL Modified Adjusted Gross Income (MAGI) is adjusted gross income (following IRS rules) plus tax-exempt interest and certain foreign earned income. No asset test. 10

11 Medicaid income and asset eligibility remains the same for: Elderly (age 65 and older) Certain people with a disabled basis of eligibility People in need of certain Long Term Care (LTC) services not available under MAGI-based Medicaid People who have a spenddown Dual eligibles in the Medicare Savings Programs People whose eligibility is based on receipt of other aid (such as foster care assistance) or are automatically eligible (such as certain newborns) 11

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13 Individuals seeking coverage should have the same experience regardless of the insurance affordability program they apply for. The Consumer Experience is Key: For most people, eligibility and enrollment should happen in real time. 13

14 Exchange website: Informs, screens and enrolls individuals in Medicaid if eligible. Renews Medicaid eligibility via the website. People ineligible for Medicaid must be screened for eligibility for plans under the Exchange, and premium and cost-sharing assistance. Exchange and Medicaid agency must have secure electronic interfaces. Hospitals participating in Medicaid may make presumptive eligibility determinations for all populations. 14

15 Minnesota Medicaid enrollment estimated to increase by 16% or 95,000 in 2014 under the ACA. Current Medicaid coverage goes above 133% FPG through our MinnesotaCare program. How do we continue those MinnesotaCare coverage groups? Basic Health Plan? Move people to the Exchange? Move some, not all? Wraparound? 15

16 ACA mandates the MAGI populations be enrolled in a streamlined process through the Exchange. How will this occur? How will the streamlined process address issues like churning for low-income populations (e.g., frequent changes in income)? How will the administration of Minnesota Health Care Programs change? Is spenddown eligibility and other specialty programs still needed? Policymakers will need to decide 16

17 Health Reform Minnesota Minnesota Health Insurance Exchange U.S. Department of Health and Human Services 17