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Presentation to Advisory Council Boston, MA August 25, 2011

Presentation to Advisory Council Boston, MA August 25, 2011. Meeting Purpose. Introduce Manatt/Mercer. Review research framework and provide updates on progress. Discuss next steps. States. $. $. Payers. Providers. Foundations and Other Stakeholders. Manatt Health Experience.

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Presentation to Advisory Council Boston, MA August 25, 2011

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  1. Presentation to Advisory CouncilBoston, MAAugust 25, 2011

  2. Meeting Purpose Introduce Manatt/Mercer Review research framework and provide updates on progress Discuss next steps

  3. States $ $ Payers Providers Foundations and Other Stakeholders Manatt Health Experience

  4. Health Exchange $ Uninsured Health Plan Reviews Actuarial Rate Setting Mercer Health Experience

  5. Transition Planning Massachusetts is operating major elements of federal health reform and today operates a mature and successful health benefit exchange (HBE). The Commonwealth seeks to evaluate the options for providing subsidized coverage, Exchange (i.e., Health Connector) structure, and operations in light of federal health reform. The Strategic Plan must: Leverage the Commonwealth’s strong foundation Ensure compliance with ACA requirements Facilitate integration between MassHealth and the Connector Strengthen the role of the Connector in the Insurance Market . . . to successfully support health care delivery system reform in the Commonwealth 4

  6. Transition Goals and Priorities • Comply with or, seek waiver from, specific ACA requirements related to coverage and eligibility • Maximize continuity of coverage from as-is to to-be • Minimize harm to transitioning populations • Maximize continuity of coverage among to-be coverage options • Leverage federal dollars to provide state fiscal relief • Leverage purchasing power of the Connector and MassHealth • Identify and optimizeadministrative simplification opportunities

  7. Jan2011 Feb2011 Mar 2011 Apr2011 May2011 Jun2011 Jul2011 Aug2011 Sept2011 Oct2011 Nov2011 Dec2011 2012 2013 2014 High Level Timeline State must spend grant funds -September 30 HHS Approval that Exchange will be operational by 1/1/14 – January 1 Exchange must be operational – January 1 Project Kick-Off – June 13 ACA Sec. 1321(e) provides that HHS will provide assistance to existing Exchanges for coming into compliance with the ACA and a presumption of compliance after this process State Milestones Exchange must be self-sustained – January 1, 2015 Exchange must be “soft-launched” – July 1 CMS to issue initial Exchange and Medicaid eligibility regulations – July, August CMS to issues second set of Exchange regulations – September Key Federal Dates Quarterly report – April Quarterly report – July Quarterly report – October Final report & Federal Financial Report due – 90 days within project end date Quarterly report – January Reporting Requirements HHS Exchange Establishment Grants RFP – February HHS Exchange Establishment Grants awarded – May 23 HHS Exchange Establishment Grants Level 1 and Level 2 deadline –September 30 HHS Exchange Establishment Grants Level 1 and Level 2 deadline –December 30 Early Innovator Grant period ends – February Funding Opportunities Early Innovator Grant Awards – February 15 (Applications due 12/22/10) HHS Exchange Establishment Grants Level 2 deadline – March 30 HHS Exchange Establishment Grants Level 2 deadline – June 29 HHS Exchange Establishment Grants Level 1 and Level 2 deadline – June 30

  8. Research Approach • Conduct additional federal and state statutory, regulatory, and administrative guidance research • Conduct modeling • Evaluate transition options • Conduct gap analysis • Assess coverage options balancing the interests of multiple stakeholders • Present findings and recommendations to Subsidized Insurance Workgroup, Advisory Council, Executive leadership, and stakeholders • Analyzed State statute, regulations, and administrative guidance: • Analyzed Federal statute, regulations, and guidance • Developed preliminary gap analysis • Conducted key informant interviews • Identified policy questions/issues for further research • Developing high-level transition roadmap and assessment • Developing modeling framework and assumptions June July August September

  9. Individual CoverageTransition Options

  10. Findings: As-Is Takeaways Coverage of 98% of Commonwealth residents has been achieved through a patchwork of programs. 98% Programs vary in: • Eligibility levels and requirements • Benefit packages • Cost-sharing • Funding sources • Responsible agencies/entities 1 2 3 4 5

  11. Findings: As-Is Takeaways Children’s Medical Security Plan Common wealth Choice 400% Medical Security Plan MassHealthCommonHealth Health Safety Net 300% Insurance Partnership Common wealth Care Bridge Common wealth Care Family Assistance FPL 200% Family Assistance MassHealthLimited 100% MassHealth Basic MassHealth Standard MassHealth Essential Population Children < 1 (35,185) Children 1 – 18 (449,687) Parents (191,060) Preg. Women (pending) BCCTP (351) HIV+ (1,262) Childless Adults MH (12,511) Childless Adults LTU (88,283) Indiv. Unempl. Comp (pending) Small Biz Empl. (5,226) Imm. 5 yr Bar (15,474) Imm. GF (pending) Indiv Inelig for MassHealth(195,984) Disabled Adults & Children (20,419) Non- qual Aliens (58,365) Non- qual Aliens Children (26)

  12. Findings: To-Be Takeaways • Transition offers the opportunity to dramatically simplify the patchwork, benefiting consumers and the Commonwealth. MassHealth Standard MassHealth Basic MassHealth Essential MassHealth Standard Family Assistance (CHIP) MassHealth Benchmark Medical Security Plan Family Assistance (CHIP) Basic Health Plan (option) Insurance Partnership Qualified Health Plan Commonwealth Care Commonwealth Care Bridge Commonwealth Choice Health Safety Net

  13. Transition from As-Is to To-Be:First Level Assessment To-Be As-Is First level assessment Federal Financial Participation 2014 Benefit Change Consumer Cost Sharing Change State Financing

  14. Transition from As-Is to To-Be:Second Level Assessment To-Be As-Is Second level assessment Efficient Administration of Subsidized and Non-subsidized Insurance Options Connector Financial Sustainability Robust Connector Marketplace Leveraging Payment and Delivery System Reform

  15. In Summary Final Transition Decisions will be Informed by: Cost - Benefit Analysis Delivery Model Basic Health Program Purchasing Leverage Connector Sustainability • Balancing scope of benefits, consumer cost-sharing, access to federal financing, and impact on state expenditures • Implications of the potentially divergent delivery models in MassHealth (MCO, PCC) and the Connector delivery model • (health plans) • Balancing the advantages, disadvantages and risks Optimizing to advance payment and delivery system reform • Implications for Connector scale and sustainability Effective administration of preferred options is the final question

  16. Next Steps • Conduct additional federal and state statutory, regulatory, and administrative guidance research • Conduct modeling • Evaluate transition options • Conduct gap analysis • Assess coverage options balancing the interests of multiple stakeholders • Present to Subsidized Insurance Workgroup, Advisory Council, Executive leadership, and stakeholders

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