Maryland Health Connection An Update on Maryland s Implementation of the State-Based Exchange

Transcription

1 Maryland Health Connection An Update on Maryland s Implementation of the State-Based Exchange Tequila Terry Director, Plan & Partner Management Maryland Health Benefit Exchange October 4, 2013

2 Today s Agenda Maryland Health Connection Individuals & Families Small Business Health Options Program (SHOP) Authorized Insurance Companies Outreach & Assistance Program Implementation Where is Maryland Today? Ways to Get More Information

3 Critical Need for Health Reform 48.6 million uninsured Americans $3 trillion spent annually on healthcare 17.9 % of our economic output tied up in the health care system Without reform, by 2040, 1/3 of economic output tied up in health care

4 Affordable Care Act Overview Prevent denials of coverage, including for pre-existing conditions Make health insurance affordable for middle class families Make health insurance affordable for small businesses with tax credits Improve the quality of health care

5 Affordable Care Act Overview Medicaid Expansion The Patient Protection and Affordable Care Act enables states to expand Medicaid eligibility rules so that more individuals can get coverage starting in Uniform rules for determining eligibility across the nation based on Modified Adjusted Gross Income (MAGI) Federal Government will fund 100% of expansion 2014 through %/10% formula thereafter Maryland Medicaid is going forward with the expansion to include all adults under 138% of the Federal Poverty Level (FPL). 4

6 Affordable Care Act Overview Exchanges The Patient Protection and Affordable Care Act requires each state to establish a health insurance exchange by 2014 A marketplace where individuals and small businesses explore, compare, and enroll in private health insurance and public assistance programs as well as access federal tax credits and cost-sharing subsidies States had a choice on how to establish their exchange marketplaces Maryland s exchange is called Maryland Health Connection 5 5

7 Why It s Important to Maryland Expands access to health insurance for 730,000 Marylanders (13% of Maryland) currently without health insurance Medicaid expansion Exchanges Provides federal subsidies for individuals up to 400% of FPL to pay for health insurance premiums Infuses $600 million in federal subsidies into the State of Maryland by 2015 NEW funds in health care system Gives individuals access to primary care physicians, preventive services Lowers uncompensated care costs in the healthcare system

8 Stakeholder Engagement Transparency: A Key Tenet of the Exchange Open, transparent process to create an exchange that represents all Marylanders and meets the needs of all individuals and small businesses in the state Advisory Committee Meetings Legislative Amendment Process Maryland will continue to have an open, transparent process to create a marketplace meets the needs of all individuals and small businesses in the state.

9 Maryland Health Connection a service of the Maryland Health Benefit Exchange

10 Individuals & Families

11 Maryland Health Connection Marketplace for Individuals & Families Individuals and families have access to Medicaid and private insurance plans Offers tax subsidies and cost sharing reductions to individuals and families to make commercial plans affordable Only place individuals can access subsidies Federal government will pay a portion of costs for health insurance for people who earn up to 400% of FPL Cost sharing reductions are available to individuals under 250% of FPL Individual Open Enrollment: October 1, March 31, 2014 Coverage Effective: January 1, 2014 Annual open enrollment occurs starting in October of each year

12 Individual & Family Subsidies Single Person FPL % Annual Income Maximum Premium (as % of Income) Enrollee Monthly Share 133% FPL $ 14, % $ % FPL $ 16, % $ % FPL $ 22, % $ % FPL $ 27, % $ % FPL $ 33, % $ % FPL $ 39, % $ % FPL $ 44, % $

13 Individual Enrollment Flow Application Eligibility Determination Tax Credit Eligibility Plan Shopping Initial Payment Collection Confirmed Coverage Notify Carriers Consumer completes online application for insurance coverage If not eligible for Medicaid, Consumer is evaluated for eligibility for tax credits Consumer is able to select from available plans based on personal preferences Consumer is able to make the initial premium payment directly through Maryland Health Connection Maryland Health Connection will display a message to the consumer for coverage start date Notify carriers of enrollment information and of premiums collected 12

14 Small Business Health Options Program (SHOP)

15 Maryland Health Connection SHOP Marketplace Maryland Health Connection will have a Small Business Health Options Program (SHOP) dedicated portal for small businesses and their employees Small businesses with up to 50 employees may participate SHOP Open Enrollment: January 1, 2014 Coverage Effective: March 1, 2014 Annual open enrollment is based on the renewal date of the small business 14

16 Maryland Health Connection SHOP Marketplace Employer Benefits Simple, streamlined administration Online Adds & Drops Online Billing & Payment Phone & Online Support Online tools available to help employers predict costs The ability to continue to work with brokers and TPAs Many small employers will qualify for tax credits Employee Benefits A wider range of plans to choose from Comparison tools to help select plans Online plan enrollment and account management 15 15

17 SHOP Marketplace: Enrollment Flow Eligibility Determination Employer Plan Set-up Estimated Quote Employee Enrollment Validate Group Notify Carriers Employer is evaluated for eligibility to purchase from SHOP based on demographic information. Employer selects a metal level (Employee Choice) or a carrier (Employer Choice) and sets defined contribution amount. SHOP provides an estimated quote based on employer choices and employee census (age, income, etc.) Employees make plan selections with information on employer contribution and their expected cost Validate that all requirements for the employer (e.g. minimum participation, creditable coverage for employees) have been met Notify carriers to contract with employer and start coverage for employees 16

18 Authorized Insurance Companies

19 Authorized Insurance Companies Maryland has adopted a strategy for that allows any willing carrier to offer qualified health plans on Maryland Health Connection. Medical CareFirst Evergreen (CO-OP) Kaiser United HealthCare Stand-Alone Dental BEST Life CareFirst Delta Dental DentaQuest Dominion Dental Guardian Metropolitan Life United Concordia List reflects names of carriers by parent company name. 18

20 Product Summary Plans offered on Maryland Health Connection will include: Medical Only Plans Medical Plans with Embedded Dental Stand-Alone Dental Plans Insurance companies will offer PPO, HMO, EPO, POS products. Essential Health Benefits Ambulatory Services Emergency Services Hospitalization Maternity and newborn care Mental health and substance use disorder services Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services including oral and vision care

21 Decision Support Tools As newly eligible consumers enter the health insurance market, the Maryland Health Connection portal will include several decision support tools to assist consumers in understanding insurance choices Provider search Ranking by premium Estimated annual cost Metal level search Carrier search Summary of Benefit Coverage Plan Quality Star Rating System & Quality Report

22 Outreach & Assistance Program

23 Projected New Enrollment 500, , , , , , , , ,000 50, , , , ,291 New Medicaid 409,715 Individuals/Families on Maryland Health Connection 439, ,

24 Consumer Assistance Program Multiple resources will be available for consumers who need assistance with understanding insurance options. Access to Coverage In-person Assistance: Connector Program Navigators Assisters Application Counselors Insurance Producers (Brokers/Agents) Captive Producers Consolidated Services Center (call center) Customer service Application and enrollment assistance Language line/ translation services TTY for the hearing impaired

25

26 Consumer Assistance Roles Navigators will: Conduct public education and outreach as required by the Affordable Care Act Distribute fair and impartial information Facilitate enrollment in health plans Provide referrals for grievances, complaints and questions Provide information in a culturally and linguistically appropriate manner Maintain expertise in eligibility, enrollment and program specifications Refer insured small groups and individuals back to producers Assisters will: Conduct public education and outreach; Facilitate eligibility determination for subsidies, Medicaid, and MCHP; Facilitate and provide ongoing support

27 Consumer Assistance Roles Application Counselors: New role introduced by U.S. HHS to allow for additional resources to assist Facilitate enrollment in health plans Act in the best interest of the enrollee Disclose any potential conflicts Receive no funding from the MHBE Insurance Producers (Agents/Brokers): Serve an important role in the Exchange Continue to work directly with small group customers Register to become authorized to sell QHP inside the Exchange Be compensated directly by the carriers (as they currently are) Receive training from the Exchange

28 Consumer Assistance Roles Captive producers: may transition carrier s existing enrollees into Maryland Health Connection qualified plan must act in best interests of consumer Consolidate Service Center: Inbound Call Center (Toll-Free Hotline) Language Line/Translation Services TTY (Hearing Impaired) Extended Hours During Open Enrollment

29 Ways to Get More Information!

30 Online Resources MarylandHealthConnection.gov Sign Up for Updates Sign Up for Text Updates: Text Connected to Get information on insurance resources available to help now Plans Available Individuals October 1, 2013 SHOP January 1,

31 Online Resources MarylandHBE.com Outreach Toolkits Meeting Information RFP Announcements Job Information 30

32 Social Networking Resources Twitter: MarylandConnect

33 Social Networking Resources Facebook: MarylandConnect

34 MARYLAND HEALTH CONNECTION OPEN ENROLLMENT Individual Open Enrollment: October 1, March 31, 2014 SHOP Open Enrollment: Begins January 1, 2014 for March 1, 2014 effective date

35 Thank you!