The Arkansas Health Connector and Arkansas's Approach to Implementing the Health Insurance Marketplace ***** Developme

1. The Arkansas Health Connector and Arkansas's Approach to Implementing the Health Insurance Marketplace ***** Developmental Disabilities Provider Association September 10, 2013 ***** Cindy Crone, Deputy Commissioner Bruce Donaldson, Accounts Specialist Arkansas Insurance Department, Arkansas Health Connector Division DDPA

2. What is a Health Insurance Marketplace (Exchange)? • Competitive marketplace where individuals, families and small employers can shop for, select and enroll in high quality, affordable private health plans that meet their specific needs at competitive prices. • Marketplaces will also help eligible individuals receive premium tax credits and cost sharing reductions or help them enroll in other state or federal public health programs. DDPA

3. Enrollment Options How? Who can help? Agents and Brokers Guides Navigators Certified Application Counselors • Internet • Phone • In-Person • Mail DDPA

4. Status of Marketplaces State-Based Marketplace State-Based Marketplace (SHOP only) Partnership Marketplace Federal Marketplace DDPA

5. State Partnership Marketplace Plan Management • Certify/Decertify QHPs for Marketplace • Monitor Plans – Prices, Benefits, Networks, Non-Discriminatory Design, etc. Consumer Assistance/Stakeholder Engagement • Outreach Education • In-Person Assister Program • Consumer Complaint Resolution DDPA

6. Uninsured Those without insurance coverage in Arkansas number 550,000. DDPA

7. Health Care Independence Act of 2013“Private Option” A concept embraced and supported by Governor Beebe and the Republican Leadership as a way to cover more low-income Arkansans with insurance but not grow the Medicaid Program LEADAR

8. Arkansas’s “Private Option” • Private Option eligible Arkansans will enroll in private insurance plans doing business on the Marketplace. • Allows Medicaid dollars to pay 100% of premiums; some Medicaid “wraps” for services (Federal dollars pay 100% for first three years; 90% by 2020). • No deductibles; no other cost-sharing for those under 100% FPL in the first year. After the first year, those between 50% - 100% of FPL will likely have some cost-sharing. LEADAR

9. Federal Approval • Arkansas needs to obtain a waiver from the federal government to operate the Private Option. • The Arkansas Department of Human Services has submitted the waiver. • Approval is expected soon. LEADAR

10. Money infusion • More than $1 billion a year in federal money will come into Arkansas a result of the Private Option. • Money comes from increased Medicaid expenditures paid toward private plan premiums. • Businesses, especially health care providers, will benefit greatly. LEADAR

11. Private Option Eligible Individuals in 2014 • Childless adults between 19-64 with incomes below 138% FPL • Parents between 19-64 with incomes between 17% and 138% FPL • Those not on Medicare and not disabled • Those determined to not be more effectively covered under the standard Medicaid program, such as persons with complex medical conditions requiring a high level of care coordination. LEADAR

12. Arkansas Health Insurance Marketplace • Expected enrollment in 2014 about 460,000, including Private Option population. • An estimated 211,000 >138% FPL will enroll. • An estimated 250,000 <138% FPL will enroll. DDPA

13. Stakeholder Engagement The AID has long sought to build relationships with those affected by the ACA, specifically through the Arkansas Health Connector Division. We have representatives from the insurance industry, health care providers, community activists, and the Legislature, among others on our advisory committees. DDPA

14. Cooperation • AID has worked diligently with numerous agencies to prepare for open enrollment and to implement the Private Option, a first-ever program of its kind. • Those agencies include Human Services, Health, Arkansas Center for Health Improvement, and the Department of Higher Education. DDPA

15. Committees • Steering Committee • Plan Management Advisory Committee • Consumer Assistance Advisory Committee DDPA

16. Stakeholder Input • The advisory committees have offered valuable assistance, helping Arkansas tailor the Marketplace to best serve your constituents. • The benchmark plan, habilitative services, regional rates, service areas, and tobacco upcharges were all shaped locally with stakeholder input. DDPA

17. Qualified Health Plan (QHP) Benefits • Must meet at least 60% Actuarial Value • Must provide Essential Health Benefits • Outpatient Services • Hospitalization • Emergency Services • Maternity and Newborn Care • Mental Health and Substance Use Disorder Treatment • Prescription Drugs • Rehabilitative and Habilitative Services/Devices • Laboratory Services • Preventive, Wellness, and Chronic Disease Management • Pediatric Services, Including Oral and Vision Care DDPA

18. Habilitative Services • The Steering Committee approved the definition and coverage scope of Habilitative Services in January, 2013, affirming the recommendation of the Plan Management Advisory Committee in December 2012. • Commissioner Bradford adopted the recommendations. DDPA

19. Coming together • An ad hoc committee of healthcare providers and insurers worked together in spirited meetings to propose acceptable definitions. • Consumers weighed in. • Staff worked closely with David Iversand other advocates and healthcare professionals to craft language acceptable to the provider and consumer communities. DDPA

20. Definition “HabilitativeServices are services provided in order for a person to attain and maintain a skill or function that was never learned or acquired and is due to a disabling condition.” DDPA

21. Scope of Coverage “Subject to permissible terms, conditions, exclusions and limitations, health benefit plans, when required to provide essential health benefits, shall provide coverage for physical, occupational and speech therapies, developmental services and durable medical equipment for developmental delay, developmental disability, developmental speech or language disorder, developmental coordination disorder and mixed developmental disorder.” DDPA

22. Collaboration • The debate regarding Habilitative Services is a prime example of how Arkansas stakeholders of various interests worked together to conceive a policy best for Arkansans. • Demonstrates the wisdom of keeping the Partnership model as opposed to defaulting to the Federal model. DDPA

23. Certification The habilitative services definitions were applied during the plan certification process. DDPA

24. Where are we Now? • Qualified Health Plans and Stand-Alone Dental plans were reviewed for compliance with QHP criteria and submitted on the July 31 deadline to the federal government for approval. • We expect to hear back on our recommendations and know more about rates this month. DDPA

25. Guide Organizations • 26 organizations have contracts with AID to serve as Guide Organizations. • Approximately 300 Guides have completed Phase I Training by AATYC. DDPA

26. Guide Assisters • We anticipate having 537 across the state for open enrollment, which starts October 1. • Will serve each county in the state. • 22 two-year colleges and one-four year college across the state are helping train the IPAs. • This activity is occurring in many of your counties and helping local economies. DDPA

27. Other Types of Assisters • Agents and brokers • Navigators • Outreach and Education Workers • Certified Application Counselors DDPA

28. Outreach and Education Broad multi-media campaign across Arkansas DDPA

29. Video DDPA

30. Statewide Campaign • Working hard to make sure people in each county learn about their insurance options. • Marketing campaign reaches across the state. • Goal is to visit each county seat. DDPA

31. Touching Arkansas • From July 1 to August 20, there have been 179,000 total visits to the website (www.ARHealthConnector.org) including 156,000 unique visitors. • During July more than 64 million media impressions were made across the state using television, radio, billboards, Internet, local newspaper and other media. DDPA

32. Other outreach Arkansas Health Connector Resource Center, 855-283-3483 Speakers Bureau, in partnership with the Arkansas Department of Health and the University of Arkansas Enrollment events across Arkansas DDPA

33. Act 1500 Arkansas Health Insurance Marketplace Act DDPA

34. Creates the pathway for Arkansas to set up a State-BasedMarketplace. • Structure would be a “non-profit legal entity”that is also a “political subdivision, instrumentality, and body politic of the State of Arkansas.” • Would NOT be a state agency. DDPA

35. July 1, 2015, is theearliest date the Partnership’s functions would transfer to the State Marketplace. • The decision is up to the Board whether or not to pursue the changeover. • The Board may extend that deadline if it chooses. DDPA

36. Starting July 1, 2015, the Board may apply for and spend any grant to assist with the implementation of the Marketplace. • Before July 1, 2015, the Insurance Department may applyfor such grants to help with development of the Marketplace. DDPA

37. October 1, 2013 is Very Soon!Full Coverage January 1, 2014 DDPA

38. Who Can Shop in the Marketplace? • Individuals and Families • Businesses with 50 or fewer full time equivalent (FTE) employees. • Businesses with 100 or fewer FTE employees will be Marketplace eligible as soon as 2016. • Businesses with more than 100 employees will be Marketplace eligible at State option beginning in 2017. DDPA

39. Premium Tax Credit Eligibility • Household income 139% - 399% FPL • Enrolled in a QHP through the Exchange • Lawfully present • Not incarcerated post conviction • Not eligible for other coverage such as Medicare, Medicaid, or affordable employer-sponsored insurance. DDPA

40. Premium Limits Based on Income DDPA

41. 2013 Federal Poverty Guidelines DDPA

42. What Are Employer Requirements? • No coverage requirement for employers with fewer than 50 full time equivalent (FTE) employees (>30 hours a week). • If >50 FTE employees, employers must provide affordable insurance options for full‐time employees beginning in 2015. • Grandfathered plans are continuing plans that covered employees on or before March 23, 2010. DDPA

43. Few Businesses Affected According to an analysis by CNN, Fortune and Money magazines, of the 6.5 million workplaces in the United States, only about 71,000 must take action and provide insurance. DDPA

44. Why? • Only businesses with at least 50 or more employees must provide insurance under the ACA. • There are about 200,000 such businesses nationally and many of those already provide insurance. DDPA

45. What are Employer Penalties? • If fewer than 50 FTEs, no penalty. • If >50 FTEs, must offer affordable coverage (< 9.5% of wages for individual premium portion) of at least 60% actuarial value beginning in 2015. • Penalties beginning in Plan Year 2015 if employee(s) get subsidy on Marketplace • $2,000 per employee (after first 30) if not offering coverage • If offering coverage, $3,000 per each employee that has unaffordable option or coverage at <60% actuarial value. DDPA

46. Small Business Tax Credit The Small Business Health Care Tax Credit significantly helps small businesses comply with the ACA by offsetting some of the cost increases that may come with providing quality and affordable health insurance to employees. DDPA

47. How does it work? To be eligible for the credit, businesses must: • Have fewer than 25 full-time equivalent employees • Cover at least 50 percent of the premium cost of an individual plan for employees • Pay average wages of less than $50,000 a year. DDPA

48. The Small Business Health Care Tax Credit equals a maximum of 35 percent of the costs incurred by small business employers (25 percent for small tax-exempt employers) toward premiums for their employees. • Tax exempt employers receive credit through a payroll refund. • On top of that, employers may continue to claim tax deductions for the insurance costs not covered by the credit. • The credit took effect for tax year 2010 and continues through tax year 2013. DDPA

49. In 2014, the credit increases to 50 percent. • The credit increases to 35 percent for small tax-exempt employers. • Employers receive the credit only if they provide insurance to employees through SHOP. DDPA

50. Contact Cynthia.Crone@arkansas.gov 501-683-3634 Bruce.Donaldson@arkansas.gov 501-683-7077 www.ARHealthConnector.org 855-283-3483 DDPA