The Road Forward: Simple Seamless Path to Affordable Coverage

1. The Road Forward: Simple Seamless Path to Affordable Coverage Vikki Wachino Director, Children and Adults Health Programs Group Center for Medicaid and CHIP Services October 19, 2011

2. Qualified Health Plans without Financial Assistance Qualified Health Plan with Premium Tax Credits-138%-400% FPL Medicaid, CHIP and Exchange Coverage: Income Eligibility Levels 400% FPL Medicaid/CHIP Children Cost-sharing reductions between 138% - 250% FPL 250% FPL CHIP/Medicaid for Children FPL Varies by State Medicaid Adults 138% FPL

3. Scope of the Three Proposed Rules

4. Covering the Low-Income Uninsured is a Key To Success 52% of Uninsured Have Income < 138% FPL 50 million Americans are Uninsured Children 19% Adults 66% 42% 81% 33% Uninsured <138% FPL Insured 139-399% FPL 400%+ FPL Source: KCMU/Urban Institute analysis of 2010 ASEC Supplement to CPS.

5. Seamless, Streamlined Eligibility and Enrollment

6. Our Goal: Better Care, Better Health, Lower Costs Population Health Per Capita Cost Experience Of Care

7. Simple, Seamless and Affordable Coverage Medicaid Eligibility NPRM • Expanding access to affordable coverage with significant federal support • Simplifying Medicaid & CHIP • Establishes a seamless system of coverage across insurance affordability programs

8. Building on State Success • Wisconsin: The ACCESS system allows people to apply for and enroll • in coverage online and set up a personal account to report changes • and renew coverage • Cuts the time it takes to apply for coverage in half • Louisiana: Renews without a paper form in most instances and uses existing data from other databases to determine eligibility • Reduced the percentage of children losing coverage at renewal to less than 1% • Utah: E-Find system streamlines the verification process by using • existing information about applicants from a “data warehouse” of • multiple databases to determine eligibility

9. Simplifying Medicaid & CHIP • Simpler Income Rules (MAGI) • Consolidates eligibility categories into four main groups • Following State lead, modernizes eligibility verification rules to rely primarily on electronic data • Federal government will perform some of the data matches for States, relieving administrative burden • Renewals every 12 months • If eligibility can be renewed based on available data, no return form is needed

10. Medicaid Eligibility Groups Affected by Proposed Simplification Number of Medicaid Eligibility Groups Number of Eligibility Groups pre-ACA Number of Eligibility Groups Proposed after Simplification ±Certain optional eligibility groups for certain children currently covered by some States are not affected by the proposed simplification.

11. Coordination: A Seamless System of Coverage • Coordinated policies and processes across Medicaid, CHIP and the Exchanges • Income rules • State residency • Verifications • Exchanges would conduct eligibility determinations for premium tax credits, Medicaid, and CHIP following the State Medicaid agency rules

12. Challenges to Continuity of Care Continuous Health Coverage

13. Concentration of Medicaid Spending 54% 50% 25% 5% 5% 1% Percentile of Medicaid Population (ranked by spending) Percent of Total Medicaid Spending Source: Medicaid Statistical Information System Claims Data for FY 2008

14. New Tools: Delivery System and Payment Reform • Primary care provider increase (2013) • Accountable Care Organizations • Medical and health homes • Bundled payments to integrate care • Global payment demonstrations • No payment for HACs • Center for Medicare and Medicaid Innovation Center • Office of Medicare and Medicaid Coordination

15. Achieving a High Performing Medicaid Program • Simplified, accurate, customer-friendly, data driven • eligibility/renewal processes that are coordinated with the • Exchange • Access to person-centered, high quality, integrated care with • options for continuity of coverage with plans on the Exchange • Continuing improvements in quality and cost throughout the • health care system • Based on consumer experience, stakeholder input, data, and • collaboration