MARYLAND HEALTH CONNECTION and MEDICAID EXPANSION

Transcription

1 MARYLAND HEALTH CONNECTION and MEDICAID EXPANSION Prince George s County Delegation October 17, 2013 Governor s Office of Health Care Reform Carolyn A. Quattrocki, Executive Director

2 Scope of Presentation QUICK REVIEW Four Pillars of Affordable Care Act Stronger, Non-Discriminatory Insurance Coverage More Affordable Insurance Coverage Expanded Access to Health Insurance and Health Care Cost Control and Improvement in Outcomes

3 Patients Bill of Rights Stronger, Non-Discriminatory Coverage Chapter Laws of Maryland Chapter Laws of Maryland Young adults can stay on parents insurance plan until age 26; 52,000 in MD; 2.5 million nationwide. No children denied coverage because of pre-existing condition. No lifetime limits on benefits and harder to rescind policies when people get sick; 2.25 million Marylanders benefiting, including over one half million children. In 2014, no exclusions for pre-existing conditions or annual limits on benefits. Women no longer paying higher premiums because they are women.

4 Preventive services: ACA requires coverage of many preventive services at no cost; Examples include mammograms and other cancer screenings, flu shots and other vaccines, tobacco cessation programs; Services designed for women, like well visits, contraception, breastfeeding equipment, and domestic violence and counseling; 1.2 million Marylanders covered with no cost-sharing; 554,000 on Medicare have received at no cost; 797,185 eligible. Carriers rating factors limited to: Age bands no greater than 3:1 Family size and geography Tobacco use no greater than 1.5:1 Maryland Health Progress Act directs State to study whether tobacco use rating should be eliminated or narrowed. Limits on out-of-pocket costs - $6,350 for individual; $12, 700 for family; lower on sliding scale for consumers below 400% of federal poverty level. New 80/20 Medical Loss Ratio 141,000 Marylanders received $28 million in rebates in 2012; Average of $340 per family.

5 ESSENTIAL HEALTH BENEFITS: SELECTION OF STATE S BENCHMARK FEDERAL GUIDANCE AFFORDABLE CARE ACT Beginning in January, 2014, all plans offered in small group and individual markets inside and outside exchanges must cover essential health benefits. Must cover 10 categories of mandated essential health benefits Ambulatory patient services; Emergency services; Hospitalization; Maternity and newborn care; Mental health & substance use disorder services; Prescription drugs; Rehabilitative and habilitative services; Laboratory services; Preventive/wellness services & chronic disease management; Pediatric services, including oral and vision care 5

6 ESSENTIAL HEALTH BENEFITS: SELECTION OF STATE S BENCHMARK HCRCC solicited stakeholder input and expert consultant s comparative analysis, and on December 17, 2012: Made selection of State s small group plan as benchmark; Retained all existing mandates in markets in which currently applicable; Substituted more comprehensive and parity compliant federal employee behavioral health benefit; Added adult component to existing child habilitative services benefit in parity with current rehabilitative services benefit. HCRCC decision preserves stability in small group market while offering robust, comprehensive benefit coverage and open drug formulary. 6

7 Pillars II and III Expanded Access to Care and More Affordable Coverage Medicaid Expansion MAGI - New eligibility rules based on modified adjusted gross income standard Uses income tax rules regarding household composition, income and deductions; Same standard in all states; Same standard used to determine eligibility for subsidies in Exchange. Expanded eligibility - All citizens at or below 138% of federal poverty level No longer specific categories, e.g. pregnant women, parents, for income-based eligibility; About $16,000 for individual; $33,000 for family of four Federal Poverty Level Guidelines

8 Pillars II and III Expanded Access to Care and More Affordable Coverage Medicaid Expansion Primary Adult Care (PAC) program will convert to full Medicaid benefits 1/1/14. 75,000 currently on PAC; outreach opportunity between now and January. Foster care Children who age out of foster care can retain Medicaid to age 26. Paradigm shift new assumption that all citizens qualify for health care; Issue no longer preventing erroneous eligibility; Instead, in which program does the person qualify? Federal support for , 100% federally funded; tapers to 90% by One-stop eligibility and enrollment through Health Benefit Exchange. Projections 2014: 110, : 135, : 190,000 (including current PAC population)

9 Pillars II and III Expanded Access to Care and More Affordable Coverage Health Benefit Exchange Transparent, competitive marketplace where consumers will compare private health benefit plans based on quality and price. Federal subsidies on sliding scale for low-income people between 133% - 400% FPL. Small business tax credits: 50% of employer s contribution to premium Single Person FPL Annual Income Maximum Premium (as % of income) Enrollee Monthly Share Projections 2014: 147, : 170, : 284, % $15, % $ % $17, % $ % $22, % $ % $28, % $ % $34, % $ % $45, % $363.85

10 Pillars II and III Expanded Access to Care and More Affordable Coverage Effect on Maryland s Rate of Uninsured 750,000 Marylanders currently uninsured (12.7%); 13 th among states; By 2020, uninsured rate cut in half; Medicaid expansion and Exchange enrollment will cover 350,000, or about 6.5%; Remaining uninsured will be undocumented immigrants, individuals with affordability exemption, those choosing penalty, etc. Maryland Health Insurance Program High risk pool - 20,000 Marylanders no longer medically uninsurable as of 1/1/2014. Members receiving subsidies will transition immediately to Exchange. Remaining two-thirds will transition gradually over next several years.

11 Pillar III More Affordable Coverage Closing the Donut Hole Prescription Drug Savings to Maryland Seniors 55,107 Maryland seniors received $250 rebate in ,000 saved $37.5 million in Overall savings to Maryland seniors to date: $84.1 million. Projected savings through 2020: $400 million. NO CHANGES TO MEDICARE BENEFITS

12 ECONOMIC BENEFITS OF EXCHANGE AND MEDICAID EXPANSION Economic Stimulus Independent analysis by Hilltop Institute at University of Maryland Baltimore County found that full implementation of the Affordable Care Act will: generate $3 billion in additional economic activity annually; create 26,000 new jobs by end of decade; have net positive impact on State s budget through 2020; protect safety net and other health care providers; and reduce hidden uncompensated care tax in insurance premiums. Source : Maryland Health Care Reform Simulation Model Hilltop Institute, University of Maryland Baltimore County (July 2012) 12

13 ECONOMIC BENEFIT OF EXCHANGE AND MEDICAID EXPANSION Economic Benefit Federal Subsidies $254 Million $607 Million $1.3 Billion Increase in Funds to Providers Increase in Health Expenditures Number of New Jobs Reduction in Uncompensated Care Additional State and Local Taxes $682 Million $1.2 Billion $2.3 Billion $1.06 Billion $2.08 Billion $3.9 Billion 9,000 16,000 26,000 $118 Million $306 Million $714 Million $61 Million $140 Million $237 Million 13

14 Maryland Health Benefit Exchange HEALTH BENEFIT EXCHANGE ACT OF 2011 Hybrid Model of Governance: Public Corporation Transparency, openness, and accountability of government Hiring and contracting flexibility of private sector BOARD OF DIRECTORS Joshua Sharfstein, Secretary, Maryland Dept. of Health & Mental Hygiene Therese Goldsmith, Commissioner, Maryland Insurance Administration Ben Steffen, Executive Director, Maryland Health Care Commission Kenneth Apfel, Professor, University of Maryland School of Public Policy Georges Benjamin, M.D., Executive Director of American Public Health Association Darrell Gaskin, Ph.D., Professor, Johns Hopkins Bloomberg School of Public Health Jennifer Goldberg, J.D., LL.M., Assistant Director, Maryland Legal Aid Bureau Enrique Martinez-Vidal, M.P.P., Vice President at AcademyHealth Thomas Saquella, M.A. retired President, Maryland Retailers Association

15 Name/Branding of Exchange: Maryland Health Connection Consumer Portal Welcome to Maryland Health Connection a new marketplace opening in October

16 Developments Leading up to October 1, 2013 Plans certified for offering on Maryland Health Connection: 45 medical plans offered by 4 carriers (CareFirst, Kaiser, Evergreen, and United HealthCare) and 20 stand-alone dental plans. 5 Star Quality Ratings, Summary of Benefits, and provider search: available to consumers for plan comparison; collaboration with CRISP (Health Information Exchange) Connector entity awards and navigator certification: MHBE began navigator and assister training and certification in September, Consumer Support Center: Began operations in August, 2013 Advertising campaign: Began early fall, Open enrollment: October 1, 2013 March 31,

17 Parent Company CareFirst Exchange Qualified Health Plans by Carrier Licensed Entity CareFirst Blue Choice # of Plans 11 Metal Levels 1 platinum, 3 gold, 3 silver, 3 bronze, 1 catastrophic CareFirst of Maryland Inc. 2 1 platinum, 1 bronze Group Hosp. and Medical Services Inc. 2 1 platinum, 1 bronze Evergreen Evergreen Health Cooperative 9 4 gold, 4 silver, 1 bronze Kaiser Permanente Kaiser Foundation Health Plan 9 2 gold, 3 silver, 3 bronze, 1 cat. UnitedHealthcare All Savers Insurance Co. 8 1 gold, 4 silver, 2 bronze, 1 cat. CareFirst (Multi-State Plan) CareFirst of Maryland Inc. Group Hosp. and Medical Services, Inc. 2 2 Total 45 1 gold, 1 silver 1 gold, 1 silver 17

18 36 include embedded pediatric dental 24 plans offer statewide coverage Product types PPO 8; POS 9; HMO 20; EPO 8 Metal levels correspond to the plan actuarial value: Bronze = 60% (+/- 2%) Silver = 70% (+/- 2%) Gold = 80% (+/- 2%) Platinum = 90% (+/- 2%) 18

19 Parent Company Delta Dental Stand-Alone Dental Plans by Carrier Licensed Entity Alpha Dental Programs # of Plans 4 Tier 2 low (pediatric and family), 2 high (pediatric and family) Delta Dental of PA 4 2 low (pediatric and family), 2 high (pediatric and family) DentaQuest DentaQuest Mid-Atlantic 4 2 low (pediatric and family), 2 high (pediatric and family) Dominion Dental Dominion Dental Services 4 2 low pediatric, 2 low family United Concordia United Concordia Life and Health 4 2 low (pediatric and family), 2 high (pediatric and family) Total 20 19

20 8 plans offer pediatric benefits only Metal levels do not apply to stand-alone dental plans; instead, new tiers that correspond to the plan actuarial value have been created. Low Tier = 70% (+/- 2%) High Tier = 85% (+/- 2%) 12 plans offer family coverage All plans are offered statewide 20

21 Components of Consumer Assistance Program Six Connector Entities Partner with community-based organizations, local health departments; Navigators provide full range of services from eligibility determination to enrollment in Medicaid or qualified health plan; certification required; Assisters provide education, outreach, and eligibility determinations; $24 million in grants; 330 navigators and assisters; 1,250 case workers. Application Counselors Provide assistance with eligibility determinations and enrollment into QHPs; Sponsoring entity required (e.g. hospital, community health center); Training required; no compensation from Exchange. Insurance Producers Training and authorization to sell in the Exchange required; Enrollment into QHPs only; 1,800 authorized for Individual Exchange. Consumer Support Center Contract awarded in June, 2013; opened August, 2013; 125 employees to provide full services to consumers; technical assistance to navigators and assisters. 21

22 Accessibility and Cultural Competency Section 508 compliant to make accessible for persons with disabilities; Spanish version website and materials; Cultural competency training for navigators, assisters, and call center employees; Cultural competency testing of website and all materials, outreach toolkits, etc. Connector Regions and Entities 22

23 Consumer Assistance in Prince George s County Capital Region: Montgomery County Dept. of Health and Human Services Partners: Prince George s County Health Department Prince George s County Department of Social Services Benefits Data Trust CASA de Maryland, Inc. Community Clinic, Inc. Family Services, Inc. Interfaith Works, Inc. Korean Community Services Center of Greater Washington Mary s Center for Maternal and Child Care, Inc. Primary Care Coalition of Montgomery County, Inc. Navigators/Assisters 12 navigators and 2 assisters dedicated to Prince George s County; Sample Outreach Events 9/ Latino Festival at Manor Park; 10/5 Laurel High School enrollment fair; 135 applications completed; Mayor Goodall s ACA town hall. 23

24 24 Intake Sites

25 Updates Since October 1, 2013 Launch Ongoing upgrades to IT System: IT team working around the clock to address website performance and software glitches. Website visits, consumer accounts and enrollments: As of 10/11/13, hundreds of thousands website hits; 217,000 unique visitors; over 26,000 accounts created; over 17,000 eligibility determinations; 1,120 enrollments. Consumer assistance: Over 19,000 calls answered by Consumer Support Center; DHR and DHMH caseworkers and navigators being provisioned for access to internal portal; paper applications available as back-up. Communications: Regular reports released by MHC with updates on numbers and consumer advisories regarding use of the website. Consumer resources page: Plan comparisons; links to provider search and sample rate scenarios; guide to consumer assistance services; enrollment checklist. 25

26 10/1 10/10 Geographic Breakdown 26

27 10/1 10/10 Age Distribution Figure 4: Age Distribution of First 25,000 Account Holders with Verified Identity in Maryland 27

28 Landing Page 28

29 Getting Started 29

30 Consumer Information Update Page 30

31 Prepare for Enrollment Before creating an account, visitors can view: Summaries of plan benefits and coverage Provider directories Plan quality reports Managed Care Organization comparison chart Sample rate scenarios Visitors can also find information on: Local events In-person assistance What documentation to have available before beginning an application 31

32 Provider Search 32

33 IT: Next Steps IT team working around the clock to improve the performance of MarylandHealthConnection.gov. System software will be updated and additional steps taken to improve website performance and consumer experience. Enrollment open until March 31, Enrollment by 12/18 for coverage to be effective 1/1/14. 33

34 QUESTIONS 34