Opportunities on the Horizon Florida Healthy Kids Corporation & the Affordable Care Act

Transcription

1 Opportunities on the Horizon Florida Healthy Kids Corporation & the Affordable Care Act

2 Discussion Topic Affordable Care Act Background: Board directed that HK explore opportunities resulting from the Affordable Care Act. Board directed that HK staff provide tools for Board to advocate on behalf of HK.

3 Nuts & Bolts of the Affordable Care Act Expansion of Medicaid for families up to 133% of the FPL Created Interim High Risk Pool Mandated Health Insurance Guaranteed Policy Issue Rate Protection No Policy Maximums Individual and Small Business Exchanges established States can opt in, partner with Feds or opt out

4 Affordable Care Act Events to Date Florida led challenges against the Act s constitutionality went to the U.S. Supreme Court for a final decision Florida opted out of State High Risk Pool All Health Plans left Florida s Commercial Individual Child Policy Market Healthy Kids re-procures TPA services for 8/13 Implementation DCF directed to develop eligibility determination capability for Medicaid, CHIP and or any other state or federal exchange that offers cost-sharing benefits for the purchase of health insurance. DCF issues ITN for KidCare eligibility services Feasibility study of build vs. remediate by 9/12 System development by 1/14

5 Affordable Care Act Events to Date (Continued) Supreme Court Decision Mandate is constitutional Tax not Penalty Provides for Guaranteed Issue Supports Exchanges Medicaid Expansion is Optional Governor declares no Florida participation Medicaid expansion State Exchanges Legislature studying ACA options

6 HK Impact Affordable Care Act Program Extension to 2019 Funding Extension to 10/2015 Medicaid Expansion to 133% FPL Basic Health Plan for families up to 200% FPL Individual Health Care Exchange

7 Affordable Care Act Assumptions/Known Information States required to continue Medicaid and CHIP funding for children New federal funding for new populations only

8 Affordable Care Act Unknown Information Will Florida expand Medicaid? Will Florida develop state Exchanges? Will Florida develop Basic Health Plan? Can Federal Funds be used for BHP Administrative Expenses? Will Florida fund new DCF eligibility system? Without Medicaid Expansion, are FHKC enrollees 100% - 133% moved to Medicaid? HHS letter to governor states children expansion is not optional

9 No Medicaid Expansion Children 0% - 200% eligible for Medicaid or CHIP Possible transfer of children from HK to Medicaid Adults 100% - 400% and children 200% - 400% eligible for subsidy in exchange Adults 133% - 200% eligible for optional Basic Health Plan Short Term Immigrants (STI) 0-100% eligible for subsidy in Exchange No option for any other adults below 100% and not presently eligible for Medicaid

10 Medicaid Expansion Families 0-133% FPL in Medicaid Children funded at current match Other family members federally funded at 100% initially Children < 200% FPL in CHIP Funded at current match Adults >133% FPL and children >200% FPL eligible for subsidy in Exchange Adults133% - 200% FPL eligible for optional Basic Health Plan

11 Nuts & Bolts of the BHP Eligibility % FPL; can t substitute BHP coverage for the Medicaid expansion Benefits The coverage must be equal to the standard health plan offering in the Exchange Financial Responsibility Families in the BHP cannot pay more for their premiums and cost-sharing than what they would pay in the Exchange Health Plan Choice Coverage must be through a competitive contracting process HHS pays state 95% of what it would have otherwise spent to subsidize premiums and cost sharing in the Exchange HHS is still finalizing the financial component administrative cost funding source

12 BHP & the Medicaid Expansion If Florida opts out of the Medicaid expansion, the BHP option is still available Creates a hole in the Exchange coverage Only 4 types of coverage available for all Floridians 0-100% FPL: no subsidized coverage (except STI) % FPL: subsidized coverage in the exchange %: BHP % FPL: subsidized coverage in the exchange

13 FHKC Key Messages If Florida decides to operate a BHP: The existing KidCare system can easily be modified to incorporate adults The BHP could operate like a CHIP for families, Creating an option that allows the families to keep their coverage together FHKC has experience with unified branding efforts statutorily charged with marketing FKC FHKC s contract & scope of work with its TPA can be expanded to incorporate the BHP population

14 Nuts & Bolts of the Individual Exchange Subsidy Eligibility % FPL; Functions: Customer Assistance Outreach and Education Call Center and Customer Communications Website Marketing and Branding Plan Management Health Plan Qualifications Collection of rate and Benefit Info Quality and Compliance Monitoring

15 Nuts & Bolts of the Individual Exchange Functions: Eligibility Application Receipt Subsidy Determination Coordination with Medicaid and CHIP Enrollment Transactions with Health Plans Tax Credit and Cost Sharing Transactions Financial Management User fees

16 State Responsibilities in Exchanges State Exchange Partnership Exchange Federal Exchange Customer Assistance Plan Management Marketing and Branding Customer Assistance* Plan Management* Marketing and Branding? Eligibility Enrollment Financial Management * Feds have authority over certification of health plans, navigator selection, etc.

17 Where FHKC Stands The next few slides will focus on where FHKC stands regarding federal requirements to be considered the Individual Exchange. Here are some of the pros and cons:

18 Pros for FHKC FHKC meets the required organization structure FHKC is a state operated non-profit FHKC is only Entity that collects premiums FHKC contracts with health plans to provide service FHKC operates on a statewide basis and has experience in the individual market FHKC has experience operating as a partner with state agencies and other stakeholders FHKC has experience and community partners that assist with outreach and educational activities related to an individual exchange (i.e., Florida KidCare)

19 Pros for FHKC FHKC contracts with a TPA that provides: Premium collection Eligibility determination Customer service Income, citizenship, immigration status and residency verification Cross reference with CHIP agency (Healthy Kids, MediKids and CMSN) and the Medicaid office to determine appropriate program for applicants Annual renewal processing Ability to adapt to significant fluctuations in application and health plan selection volume

20 Cons for FHKC FHKC would need a self sustaining financial model for administrative costs. FHKC does not offer direct enrollee payment to health plans FHKC and KidCare websites do not offer health plan shopping/comparison and premium calculation

21 FHKC Key Messages If Florida decides to operate an exchange, or one is federally implemented: FHKC was the state s 1 st exchange style health insurance for children. FHKC is the state s best organization to run an exchange. Given the short time frame, Florida could move quickly to implement an exchange by taking advantage of what FHKC has in place. FHKC has 22 years of experience in running a program similar to an individual exchange.