About MNSURE Minnesota s health insurance marketplace Presentation to Minnesota Department of Health Rural Health Advisory Committee/Flex Advisory Committee May 21, 2013 Mario Vargas, MNsure Outreach Manager Overview What is MNsure What s been done to date What s next 2 What is MNsure? 3
What is MNsure? A new marketplace where Minnesotans can find, compare, choose, and get quality health care coverage that best fits your needs and your budget. 4 Why MNsure? Subject of ongoing dialogue in Minnesota since 2006 Provision within the federal Affordable Care Act (ACA) enacted in March 2010 State-based marketplace signed into law by Governor Dayton in March 2013 5 Why MNsure? Simple One-Stop Shop One place to search, select and enroll. Less administration for small employers. More Choice Lower Costs Consumer has many plans to pick from and can pick a quality plan that best fits their needs. Financial assistance and greater market incentives for competition on quality & cost. Quality Ratings Consumers can find easy to use, comparable information on plans and providers 6
How will MNsure work? Insurers Individuals Commerce Commerce Employers / Employees Navigators, Agents, Brokers MNsure Marketplace Federal Hub DHS MDH Other 7 How will MNsure work? One process to determine eligibility for Qualified Health Plan Financial assistance/tax credits to lower premiums Medicaid Children s Health Insurance Program (CHIP) Reduced cost sharing Offers choice of plans and levels of coverage Insurance companies compete for your business 8 Who will MNsure serve? Over 1 million Minnesotans Individual Consumers 450,000 Small Businesses and Employees 155,000 Medical Assistance Enrollees 690,000 9
Who can use MNsure? Not be incarcerated Live in service area Be a U.S. citizen 10 When can you enroll? Initial open enrollment starts October 1, 2013 and ends March 31, 2014 Annual open enrollment periods after that run October 15 through December 7 Special enrollment periods available in certain circumstances during the year Members of federally-recognized tribes may enroll or change plan designations one time per month Small employers can enroll/renew throughout the year at one time of their choosing Individuals may apply and be eligible for Medicaid throughout the year 11 Consumer Assistance Network Website Toll-free call center In-Person Assistance Help when you need it 12
What s Been Done to Date 13 Grant Funding Federal Grant of $1 M February 2011 Federal Grant of $4.2 M August 2011 Federal Grant of $23 M February 2012 Federal Grant of $42.5 M August 2012 Federal Grant of $39.3 M January 2013 Planning Development Technical Infrastructure Stakeholder Consultations Market Research Technical Infrastructure Program Integration Operations Outreach Branding 14 Stakeholder Engagement Advisory Task Force 15 members Provides guidance on issues related to the development of a health insurance marketplace for Minnesota. Technical Work Groups 185 members Develop, discuss, and provide technical assistance on options to the Advisory Task Force Adverse Selection Finance Governance Individual Eligibility IT and Operations Measurement and Reporting Navigators and Agents/Brokers Outreach, Communications & Marketing Plan Certification Small Employers and Employees Tribal Consultation 15
System Development 16 MNsure Functionality and Interactions 17 The User Experience Helps to design a user experience that is responsive to people s different needs, desires and expectations. 18
How might MNsure look? 19 Federal Planning Landmarks Design Review May 2012 Assessed progress on IT and operational functions Blueprint Certification Application November 2012 Described readiness to perform exchange activities and functions for states seeking approval to operate a state-based exchange Conditional Approval Received December 20 Certification Documents and Approval Notification http://www.mn.gov/hix/planning-activity/certification/ 20 MNsure Legislation HF5 / SF1 introduced January 10, 2013 Heard and passed in 18 House and Senate committees More than 100 amendments offered Over 100 hours of debate Signed into law March 20, 2013 21
MNsure Governance State Board 7 members Appointed by the Governor Confirmation by the House and Senate 4 year staggered terms 2 term limit 22 MNsure Governance Board Members Commissioner of DHS 6 appointed to represent interests of consumers, small employers, uninsured, health care system Board appoints advisory committees of stakeholders 23 MNsure Oversight Legislative Oversight Committee 10 members from House and Senate 6 of the majority 4 of the minority Review the finances, operations and rules of the marketplace MNsure report to legislature each year by January 15 starting in 2015 24
MNsure Funding May withhold up to 1.5% of policy premiums No more than 25% of 2012 MCHA assessment Up to $20 million loan 2014 2015 May withhold up to 3.5% of policy May withhold up to premiums 3.5% of policy No more than 100% of premiums 2012 MCHA No more than 50% of assessment 2012 MCHA assessment 2016 25 Qualified Health Plans All plans meeting requirements allowed in 2014; Board may select best starting in 2015 Plans must meet minimum certification requirements Plan submissions by mid-may 26 Certification Criteria: http://mnsure.org/hix/your-benefits/plan-carriers.jsp Plan Levels of Coverage Levels of Coverage Plan Pays on Average Enrollees Pay on Average* (in addition to the monthly plan premium) Bronze 60 % 40 % Silver 70 % 30 % Gold 80 % 20 % Platinum 90 % 10 % 27
Consumer Assistance Services Qualifications 1 Demonstrate proven connections to the communities MNsure will serve, or demonstrate the ability to form relationships with consumers, including uninsured and underinsured consumer 2 Successfully complete MNsure's certification training program 3 Comply with any privacy and security standards applicable to MNsure 28 Consumer Assistance Services Eligible Organizations Have existing, or could readily establish, relationships with consumers in Minnesota, including uninsured and underinsured, likely to be eligible to enroll through MNsure Community and consumer non-profit focused groups Trade, industry and professional organizations Farming organizations Religious organizations Chamber of Commerce Agents/Brokers Coalitions and collaborative efforts Tribal organizations State and local human services 29 Consumer Assistance Services Duties/Responsibilities Maintain expertise in eligibility, enrollment & program specifications Conduct public education activities Provide information & services in fair, accurate and impartial manner Religious organizations Facilitate enrollment in QHPs offered in MNsure Provide referrals for grievance, complaint or question Provide information in culturally and linguistically appropriate manner to needs of the population 30
Consumer Assistance Services Certification Training Consumer Assistance Partners MNsure will develop a certification training program MNsure will administer web-based training Applicable staff (navigator, in-person assister, or certified application counselor) must complete training with minimum passing score Agents/Brokers Establish minimum certification training standards Training and proficiency assessment administered by MNsure Applicable staff must complete training with minimum passing score 31 Consumer Assistance Services Compensation In-Person Assister Infrastructure and outreach grants competitive solicitation process Payment per enrollment (until funds are depleted) Pay-for-performance payments Certified Application Counselors Do not receive payment from MNsure or health carriers Agent/Brokers Continued commission from carriers 32 What s Next 33
Next Steps Business Operations Customer Service/Call Center Navigators/In-Person Assisters/Brokers Plan Certification and Comparison Info Eligibility and Enrollment Premium Processing Technology Hardware/Software Federal Hub Privacy/Security System and Software Integration Testing Outreach Messaging Outreach grassroots within communities Public Awareness TV, radio, social media, etc. 34 Upcoming Key Dates April: Consumer Assistance Program finalized May: MNsure Board appointed and meeting May: Health insurance plans filed with DOC & MDH Summer: System testing; Consumer Assistance training; MNsure at State Fair September: Call Center opens October 1: Enrollment begins 35 Public Education Website 36
Questions? mnsure.org healthreform.mn.gov healthcare.gov Mario Vargas Outreach Manager mario.vargas@state.mn.us 651-539-1358 37 MNsure Milestones Oct 2011 Feb 2011 Initial $1 mil federal planning grant awarded June 2011 RFP released for technical infrastructure Aug 2011 $4.2 mil federal planning grant awarded Nov 2011 Technical Work Groups formed Dec 2011 Consumer Jan 2012 feedback on Legislation vendor based on sample Task Force modules recommendations collected for evaluation introduced Governor Dayton signs Executive Order 11- Sept 2011 30 State Stage II Advisory vendors Task Force for IT RFP assembled selected Feb 2012 $23 mil federal design/ development grant awarded July 2012 State enters into May 2012 $41 mil Design contract Review with with federal Maximus government for IT build Oct 2012 $42.5 mil development grant awarded Nov 2012 Federal Blueprint Certification application submitted Dec 2012 State received conditional approval to open statebased exchange Jan 2013 $39.3 mil federal development grant awarded Mar 2013 Statebased exchange authority signed into law MNsure name & logo unveiled Apr 2013 In-Person Assister & Navigator program finalized May 2013 Public education & outreach campaign begins Filing of health insurance plans with Commerce & MDH begins Summer 2013 System usability testing Assistance Network training MNsure at MN State Fair Sept 2013 Call Center opens Oct 1, 2013 Enrollment begins Jan 1, 2014 Plan coverage starts w w w. m n s u r e. o r g 38 Tribal Specific Topics Tribal Consultation Tribal Sponsorship Certification Requirements Indian Addendum Consumer Assistance / In-Person Assisters Eligibility 39
MNsure Tribal Process Registration Tribes will register as a Tribal third party payer Submit sponsored individual s membership data or information Select QHP the Tribe will subsidize Submit banking information for monthly payments 40 MNsure Tribal Process Premiums Tribes will be responsible for notifying members/sponsored individuals of their eligibility for Tribal subsidies and information on QHPs selected. Individual s portion of premium will be adjusted on individual invoice or on small employer employee share of invoice. Sponsored individuals and Tribal sponsors will be notified when premiums change for change in plan or other life event changes impacting plan selection and/or premium. 41 MNsure Tribal Process Payments MNsure will aggregate premiums for Tribes so one invoice/payment per month per Tribe will be sent. Tribes will be responsible for notifying MNsure and sponsored members when amending amount paying for members and/or members sponsoring. MNsure will send funding to appropriate carrier. All payments will be electronic 42