Washington Coalition of Medicaid Organizations Navigator Program Update MARCH 31, 2017

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1 Washington Coalition of Medicaid Organizations Navigator Program Update MARCH 31,

2 Agenda Federal and State Exchange News OE 4 Enrollment Highlights Exchange/Navigator Updates and Activities 2

3 Exchange Updates 3

4 ACA Repeal Efforts Executive Order U.S. House of Reps propose Repeal & Replace Bill X Pass the House of Representatives X Pass the Senate X Signed by President Trump 4

5 Americans speak out for health care 5

6 HHS Proposed Market Stabilization Rules Intent of regulations is to stabilize the individual and small group markets to retain carriers Increase proportion of younger, healthier enrollees Reduce incidence of people enrolling only when sick Keep carriers in the market Keep rate increases down HHS aim was to get a final rule out in March (Comments were due March 7)

7 Open Enrollment Dec. 15 Encourages year-around enrollment Eliminates open enrollment crossing over two plan years 7

8 Plan value Allows carriers to reduce the value of plans May reduce premiums Higher out of pocket costs Exacerbates affordability issue Could lower tax credits for all 8

9 Tightens eligibility for special enrollment periods Restricts eligibility in some cases to those who were covered prior to a qualifying life event Restricts mid-year metal level changes Requires verification of eligibility prior to transmitting enrollment files to the carrier 9

10 Unpaid premium balances Permits carriers more options to collect unpaid premium balances Can delay/deny new coverage if outstanding balance is due 10

11 House of Representatives v. Price U.S. House of Reps filed a lawsuit in 2014 Lawsuit claims cost sharing reductions are not legal Court originally agreed with the House Obama administration appealed Trump administration asked for a continuance Estimated payments to carriers in 2017 is $9 billion 11

12 Governor s Exchange Budget Summary Strong state support Requests modest expenditure authority, no additional GF-State Healthplanfinder improvements, marketing, printing and postage So far, budget proposals are favorable 12

13 2017 State Legislative Bills of Interest Health care coverage (premium and cost sharing assistance) for COFA islanders residing in WA (SHB 1291/SB5683) (Marshal Islanders, Palau, Micronesia) Protecting consumers from charges for out-of-network health services (ESHB 12114, OIC bill) Requiring health plans to cover, with no cost sharing, all preventive services required to be covered under federal law as of December 31, 2016 (HB 1523) Addressing prescription drug cost transparency by issuers and manufacturers (2SHB 1541) 13

14 2017 Open Enrollment Results 14

15 Open Enrollment Results Total Plans Selected Over 225,000 13% increase over last year 62% Subsidized and 38% Non-subsidized opercentage non-subsidized has doubled since year one New to Exchange: 80,000 Over 60,000 QHP family dental plan selectees Almost double our family dental target Over 1 million page views Jan. 31 highest volume ever

16 HBE OE4 Goals Area Benchmark OE3 Result OE4 Goal Actual Result IT Planned System Uptime Plus Partners (11/2015-2/2016) 97.58% 100% 99.25% Enrollment Number of plans (QHP) selected by the end of OE 200, , ,000 Enrollment Family Dental Enrollees N/A 37,200 60,000 plans selected Enrollment Comms Percentage of <250% FPL population which selected a silver plan Percent of applicants who have defaulted communications to 72% 80% 77% (Navigators 82%!!) 27.6% 35% 50% 16

17 Lead Organization QHP results Total Target and Total Enrolled/Selected Total QHP 22,670 (113% of 20,000 target) BHT CHOICE Confluence KPHD KWA PHSKC SEA MAR CLARK SEA MAR MULTI TCCH SEA MAR TACOMA Achieved Percent of Goal 117% 66% 97% 71% 106% 188% 125% 155% 74% 98% 54% 115% Target Achieved Target Percent of Goal WAHA YNHS 17

18 HBE Updates 18

19 Exchange Updates Conditional Eligibility New webinar, updated resources on corporate site Conditional eligibility verification is not new verifying eligibility is a requirement under the ACA (through federal hub) If eligibility cannot be electronically verified, the applicant must provide additional documentation within 95 days (SSN, citizenship, lawful presence, income, tribal membership, incarceration) Healthplanfinder displays conditional eligibility status OE conditional eligibilities are now past due or becoming past due New CEV team reviews and re-determining eligibility. 19

20 Conditional Eligibility Verification Impact on customer depends on which conditional category could not be verified. Enrollment terminated for SSN, citizenship, lawful presence, incarceration Tax credit terminated for income, or other federal coverage (i.e., Tri- Care, Medicare) Tribal benefits terminated for AI/AN membership The deadline is the deadline. Incorrect documents and/or documents received after the due date do not restore the enrollment CEV team will review and notify the consumer if documents do not verify eligibility if the documents are uploaded early enough to do so Enrollment cancelled at end of month re-determined 20

21 Healthplanfinder release April 17 Navigator-Broker partnering improvements Accept or decline partnership Ability to terminate partnerships Ability to terminate existing partnership with a different navigator Partner with one navigator and one broker Primary applicant can be changed to non-seeking Document center improvements Document Center My Profile tab with easier change reporting for address, , etc. 21

22 Healthplanfinder Release Enrollment cut-off date switched to the 15 th 22

23 Mobile App April 17 Mobile App v1.0 for iphone and Android Display household enrollment Upload documentation View messages in Message Center v2.0 coming this Fall Including search for a Navigator or Broker near me! 23

24 Tax Season 24

25 To correct a 1095-A Error 25

26 Other Updates Nothing has changed for 2017 keep paying your premiums! Lead Organization RFP HBE Technical and Advisory Committees In-service training this fall 26

27 Navigator Survey and activities under way Partnership functionality Real time help In-person training Streamline training modules Improve income reporting More marketing of the navigator program Community enrollment sites Navigators! 27