1 / 20

Health Exchange Briefing

Health Exchange Briefing. Wisconsin Access Coalition Meeting, July 23, 2012. David Riemer , Senior Fellow Michael Bare, Research and Program Coordinator. Project for Health Insurance Exchange Education (PHIXE). Overview. We’ll answer three main questions: Where do exchanges fit?

blair-cain
Download Presentation

Health Exchange Briefing

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Health Exchange Briefing Wisconsin Access Coalition Meeting, July 23, 2012 David Riemer, Senior Fellow Michael Bare, Research and Program Coordinator Project for Health Insurance Exchange Education (PHIXE)

  2. Overview We’ll answer three main questions: Where do exchanges fit? What are the exchanges? What is Wisconsin’s path?

  3. I. Where do exchanges fit?

  4. States Now Have the Option to Expand/Contract Medicaid

  5. Basic Health Plan for 134% to 200%

  6. Individual Exchange

  7. Small Group Exchange

  8. States Can Merge the Two

  9. States Can Include Large Groups in 2017

  10. Essential Health Benefits Package

  11. Expanded Coverage • Essential Health Benefits Package: •  Ambulatory patient services • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance use disorder services, including • behavioral health treatment • 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 • States can also add to the package.

  12. II. What are the exchanges?

  13. Three Types of ACA Exchanges • State-Based • States can choose to create their own exchanges with a • state law or “rule,” and seek funding from the federal • government. • Federally-Facilitated • If a state chooses not create exchanges, the federal • government will facilitate them (Details TBD). • Partnerships • States can enter into partnerships with the federal • government to operate the exchange.

  14. Authority Options: • State-Based • States can designate a governmental agency to facilitate • the exchange, or establish a non-profit entity; and • The authority must have a governing board with strict • conflict of interest protections. • Law is specific, as are final rules from HHS, DOL and IRS. • Federally-Facilitated • The federal government can designate a non-profit or • operate the exchange itself • Details TBD by federal rules, general guidance exists (15 • pages) • Partnerships • General guidance only (2 pages).

  15. Exchange Authority Must: Consult during the design, implementation, and operational phases of the exchange with six types of stakeholders; Certify, re-certify, and de-certify qualified health plans; Designate navigators in compliance with ACA; Establish enrollment procedures (online portal, phone help line, and a path for agents and brokers)

  16. Subsidies within Exchanges Generally, individuals with incomes between 100% and 400% of the FPL will be eligible for subsidies within the exchange. Calculator: http://healthreform.kff.org/SubsidyCalculator.aspx

  17. 3. What is Wisconsin’s path?

  18. Establishment Options State Law? Executive Order? Federal “Takeover”?

  19. Timeline March 23, 2010: ACA signed by President Obama June 28, 2012: Supreme Court decision upholding ACA November 6, 2012: Presidential election November 16, 2012: Exchange blueprints due to HHS January 1, 2013: HHS determines if state will be ready January 20, 2013: Inauguration Day October-December, 2013: Exchanges begin operations January 1, 2014: Exchange must be fully operational 10 days!

  20. Thank you! Please feel free to contact us: Community Advocates Public Policy Institute 728 North James Lovell Street, Milwaukee, WI 53233 David Riemer, Senior Fellow driemermil@yahoo.com, 414.270.2943 Michael Bare, Research and Program Coordinator mbare@communityadvocates.net, 414.270.2976

More Related