Coverage Expansion

1. Coverage Expansion Laura Appel

2. Political setting 2013 • Term limits – more than 90 state lawmakers with ≤ 4 yrs. exp. • Medicare and Medicaid account for half of avg. hospital revenue • More than 1.1 million people uninsured in Michigan • More than 1.8 million people in Medicaid, 167,000 eligible but not enrolled and 400,000 people projected to be added in 2013

3. Medicaid Expansion • Why do it? • Why not do it? resistance to Obamacare, $17 trillion in debt What’s in the expansion legislation? • $1.5 billion appropriation • Waiver requirements • Personal responsibility requirements • Health plan requirements • Reduced general fund expenditure • No immediate effect

4. Medicaid Expansion—next steps • Spending appropriated funds contingent on waiver approval • Federal waiver for new Medicaid design including health savings account • Initiate Medicaid beneficiary enrollment program • Expand Medicaidcoalition to assist with enrollment process • Effective date of HB 4714: end of first quarter 2014 • Enrollment/eligibility for new Medicaid population is dependent on waiver approval

5. The Insurance Mall (online) • Health Insurance Marketplace opened October 1 for enrollment • 12 insurers offering products online • Variety of plans—162 in Michigan • Variety of premiums—depends on plan selected • Variety of subsidies—depends on income • Coverage begins January 1, 2014

6. Coverage • Single application for all • No denial for pre-existing conditions • Insurers must cover a minimum set of services called essential health benefits • Must organize their plan offerings into five levels of patient cost-sharing from least to most protective • Catastrophic for those 30 and under • Bronze • Silver • Gold • Platinum

7. Example Most enrollees will pay a lower monthly premium than the unsubsidized rates presented above. For example, a 40-year-old with an income of 250 percent of the federal poverty level (roughly $29,000 per year) would pay about 8 percent of his or her income or $193 per month to enroll in the second-lowest-cost silver plan, regardless of the rating area.

8. Who can receive a subsidy? • Anyone with income between 100 and 400 percent of the federal poverty level • People with incomes between 100 and 133 percent of the FPL may choose between a product on the exchange (insurance mall) or a Medicaid managed care plan • Plans available through Medicaid are likely to be lower cost—co-pays, deductibles and premiums will apply to some Medicaid enrollees

9. Michigan Qualified Plans Filed for Health Insurance Exchange

10. Premium information available at DIFS http://www.michigan.gov/difs/0,5269,7-303-12902_35510_66707-313356--,00.html#noprint

11. Outreach and Enrollment • Medicaid expansion + Subsidy-eligible population = More than 1 million people • Health literacy among public is low • Many are lower income workers who need assistance applying for coverage • Exchange opened Oct. 1, continues through March 31, 2014 • Coverage begins at different times

12. Who is Helping People Apply? • Insurance agents • Navigators • DHS • Certified Application Counselors (CACs): voluntary, 5+ hours training (all online) • Who can be CACs? Hospitals, health centers, community-based organizations, physician offices, volunteers • http://www.getcoveredamerica.org/page/event/search_simple • www.enrollmichigan.com • www.michigan.gov/hicap

13. Available Role for Providers • Opportunity to significantly decrease the number of uninsured people • Fewer uncompensated ER visits • Greater ability to connect people with preventive care • Maintain healthy population/productive workforce • Hospitals are an obvious place to go for help; recommend preparing hospital staff to educate and assist • Physician offices, FQHCs, free clinics—all trusted voices of care for those seeking coverage

14. How health systems are engaging in enrollment • Certified Application Counselors • Patient financial services staff, volunteer leadership, patient advocates • Engaging trustees, volunteers and staff regarding the basics of coverage expansion • Educating patients • May conduct local outreach using detailed databases available from Enroll America—Michigan chapter

15. What MHA is Doing • MHA tools for hospitals • FAQs • Outreach methods • CAC guidance • Sample news release, flyer • Flowchart of uninsured person’s options • Website links • www.mha.org

16. Presumptive Eligibility • ACA allows hospitals to determine presumptive eligibility for all Medicaid-eligible populations (including the expansion population) starting Jan. 1, 2014 • Hospitals must move forward with these expanded determinations in compliance with state-issued policies and procedures • A proposed policy issued by the state late this summer did not reflect these expanded privileges for hospitals • This weekthe Department of Community Health provided informal notice to the MHA that this expansion of presumptive eligibility privilege for hospitals will not take effect until June 2014