Jackie Prokop; HMP Director Christina Severin; Policy Specialist Monica Kwasnik; Quality Improvement & Program Development Manager

Transcription

1 MI Health Account

2 Jackie Prokop; HMP Director Christina Severin; Policy Specialist Monica Kwasnik; Quality Improvement & Program Development Manager

3 The Healthy Michigan Plan went live on April 1 st, 2014: More than 380,000 Michigan residents are covered in the Healthy Michigan Plan at this time Most Healthy Michigan Plan participants must join a Health Plan. 3

4 Affordable Care Act (ACA) authorization New eligibility category Funding must be appropriated by State Public Act 107 of 2013 was signed into law by Governor Snyder September 16, State law requires certain cost-sharing requirements (co-pays and contributions) Some of these requirements are not stated in federal regulation so need a waiver amendment to implement what is in state law Approved December 30,

5 Michigan residents who: Are ages Are not qualified or enrolled in Medicare Are not qualified or enrolled in other Medicaid programs Are not pregnant at the time of application Have income at or below 133% of the federal poverty level Must meet other federal requirements 5

6 Benefit coverage must be based on federal benchmark coverage and include the 10 essential health care services. Ambulatory Patient Services Emergency Services Hospitalization Maternity Care Mental Health and Substance Use Prescription Drugs Rehabilitative and Habilitative Services Laboratory Services Preventive and Wellness Services Pediatric Care (includes oral and vision) Dental Services are also covered in the Healthy Michigan Plan 6

7 Most Healthy Michigan Plan beneficiaries will enroll into the one of the current Health Plans Current populations that are exempt or voluntary from managed care will remain exempt or voluntary PIHP system of care 7

8 Required by Public Act 107 of 2013 Two types of cost-sharing, to be paid on a monthly basis Co-pays Contributions Limited to beneficiaries above 100% of the FPL Total annual amounts may be up to 2% of income A number of factors will determine cost-sharing responsibilities Beneficiary cost sharing information is available on 8

9 9

10 Certain individuals and services will be exempt from co-pays Co-pays for certain chronic conditions and related medications will be waived Existing exemption frameworks are in place for both services (e.g. family planning, emergency services) and populations (e.g. under 21, individuals in hospice) Contribution exemptions also apply More information is available at: 10

11 Implementation begins October 1 st, 2014 Welcome Letter o Explains the MI Health Account and what to expect o First batch of welcome letters mailed this week MI Health Account Statement o Quarterly Statements will provide information on the services received and amounts due o First statement will be sent approximately 6 months after health plan enrollment o Will also include payment coupons (with the first payment due approximately one month after the statement was received)

12 Beneficiaries can pay all at once or one month at a time. Payment options include: By Mail: Payment coupons will be included with the statement. Each coupon shows the amount owed for one month, the due date, how to pay, and where to send a check or money order. Cash is not accepted. Online: An online option will be available at healthymichiganplan.org Payments can be made using bank account information (no credit cards). Please direct beneficiaries with questions about their MI Health Account statement or payments to call the Beneficiary Help Line at (TTY: )

13 Changes to co-pay collections Once a beneficiary is enrolled in a health plan, copays for Health Plan covered services will be collected via the MI Health Account Copays for these services should not be collected at the point of service Per the waiver approval, beneficiaries must receive notice of potential copays at the point of service Providers will have a role in ensuring that beneficiaries receive this information More information on this requirement will be available soon 13

14 Healthy Behaviors is an important feature of the Healthy Michigan Plan Two key components to the Healthy Behaviors Program include: Engagement with primary care provider and preventive care Opportunity to earn meaningful incentives More information about Healthy Behaviors can be found at

15 Successful entry into any health care system includes an annual visit to a Primary Care Provider Particularly true for individuals with unmet health needs. Under the Health Michigan Plan beneficiaries will be encouraged to: Schedule a visit with their Primary Care Provider within 60 days of joining a Health Plan Discuss health risks and behaviors and complete a Health Risk Assessment with their Primary Care Provider 15

16 Beneficiaries will be rewarded for addressing or maintaining behaviors necessary for improving health. Beneficiaries who complete a Health Risk Assessment with a Primary Care Provider attestation and agree to address or maintain healthy behaviors will receive: A 50% reduction in required copays (after 2% of income has already been paid in copays) and one of the following A 50% reduction in required contributions or A comparably valued gift card from their health plan (for members who are not required to make contributions)

17

18 18

19 Health Risk Assessment Online Training Healthy Michigan Plan Provider Outreach Toolkit 19

20 Thank you for your assistance with the Healthy Michigan Plan! Please direct beneficiaries with questions about their MI Health Account statement or payments to call the Beneficiary Help Line at (TTY: )