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Life After ACA Changing Landscape of Medical Assistance

This presentation discusses the implementation of the ACA in Maryland, the impact on Medicaid and financial assistance, and best practices for managing the self-pay population.

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Life After ACA Changing Landscape of Medical Assistance

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  1. Life After ACAChanging Landscape of Medical Assistance Presented By Godlee Davis, ADR Executive Vice President DECO Recovery Management, LLC. February 29, 2016

  2. Agenda • ACA implementation in MD • Marketplace & Medicaid Enrollment Statistics • Impact on Medicaid and Financial Assistance • Best Practices for Management of the Self Pay Population pre collection

  3. ACA Market Reforms include: Eliminates lifetime annual limits on benefits Requires coverage of preventive services and immunizations Extends dependent coverage up to age 26 Simplified summary of benefits Caps insurance company administrative expenditures Preexisting conditions exclusions eliminated. Rates cannot be based on health status, medical condition, claims experience or other health-related factors. Premiums may only vary by family structure, geography, actuarial value, tobacco use and age. Optional Reforms - Medicaid expansion and development of a state exchange if not participating in a federal exchange, or state/federal partnership exchange.

  4. Maryland did not have the flexibility to extend the end date as it was driven by ACA. HIX Development High-Level Timeline 2011 2012 2013 2014 2015 2016 2018 2019 2017 Phase 1A – Selected Exchange Functions and MAGI Medicaid Eligibility Determinations (Mandatory Task Order) Phase 1A – Selected Exchange Functions and MAGI Medicaid Eligibility Determinations (Mandatory Task Order) • Establish a Technology Platform (or “HIX”) that allows for enrollment in Exchange plans and SHOP; • Conducts eligibility determinations and supports case management services for Advance Premium Tax Credits, cost-sharing reductions, Modified Adjusted Gross Income (MAGI)-related Medicaid categories, and MCHP. Phase 1B – Operations, Hosting & Other Selected Services (Optional Task Order) Phase 1B – Maintenance Option (Optional Task Order) Phase 1B – Maintenance Option (Optional Task Order) Phase 1B – Maintenance Option (Optional Task Order) • Incorporate eligibility determinations and case management services for Non-MAGI Medicaid eligibility categories Phase 2 – Integrating Non-MAGI Medicaid Determinations • Incorporate eligibility determinations and case management services for human services programs such as SNAP and TANF. Phase 3 – Integrating Social Services Programs

  5. Funding ACA Implementation In MD • Maryland received 4 federal grants, totaling $157.5 million, to support the implementation of a state-based exchange through the ACA • Level Two Establishment grant for $123 million to continue implementation of the eligibility and enrollment system, consumer assistance, outreach and education, operations, and administration. • Grants totaling $34.4 million cover research, planning, information technology development, and implementation, including • $1 million Planning grant for initial research and planning, a $6.2 million Early Innovator grant to design and implement an information technology (IT) model that could also serve as a model for other states. • $27.7 million Level One Establishment grant allows for policy development, planning, technology and operational infrastructure, and the IT platform.

  6. MD Health Connection

  7. MD Health Connection Stats • Maryland achieved one of the fastest growth rates of any state in the country for 2016 enrollment compared to 2015, according to ACASignups.net.  • Enrollments in qualified health plans totaled 162,652 from Nov. 1, 2015 to Feb. 5, 2016.  • That was 33% more than the 122,778 enrolled during the 2015 open enrollment period from Nov. 15, 2014 to Feb. 28, 2015. Including Medicaid enrollments, since Nov. 1 more than a half-million Marylanders have enrolled through the state marketplace for 2016 coverage.

  8. MD Enrollment Highlights • Enrollments of young adults (18-34) tied for 5th in the country with 29% of the total private plan enrollments, according to the latest data from the U.S. Department of Health as of Dec. 26, 2015. • That was greater than the national average of 27% and greater than Maryland’s rate of 27% for young adults last year. • African-American enrollment was up 37% to more than 31,036. That compared to 22,632 a year ago. • Hispanic enrollment was up 244% to 18,878, compared to 5,481 a year ago. Since the ACA took effect, the uninsured rate for African Americans and Hispanics has decreased twice as quickly as for whites, according to a recent study by researchers at the University of Maryland School of Public Health.

  9. MD Enrollment Highlights • 30,313 individuals enrolled in 2016 dental plans, either standalone or as part of their medical coverage. This is the first year that dental coverage is offered on the state marketplace. • Of the total enrollments, 51,195, or 31%, were new customers and 111,457, or 69%, were returning enrollees. After open enrollment ends, people can enroll only if they have had a qualifying “life event,” such as marriage, birth of a child or loss of coverage.

  10. State Marketplace Statistics Health Insurance Marketplace 2016 open enrollment period statistics from November 1, 2015 to December 26, 2015.

  11. Distribution of Eligibility for ACA Health Coverage Among those Remaining Uninsured as of 2015

  12. Marketplace Plan Selections as a Share of the Potential Marketplace Population

  13. MD QHP Carrier Market Shift

  14. Total Monthly Medicaid and CHIP Enrollment

  15. MD Health Connection Stats • 9 out of 10 Marylanders who enrolled through MHC were determined to be eligible for federal subsidies or qualified for Medicaid. • Last year, more than 60,000 Maryland households received a total of $208 million in federal tax credits to lower their cost of health insurance. • An additional 362,415 enrolled in Medicaid through Maryland Health Connection since Nov. 1. • As of Jan. 31, a total of 1,220,460 Marylanders are enrolled in Medicaid and the Maryland Children’s Health Program (MCHP). • The total number of ACA Medicaid Expansion Adults is 239,072. Since Dec. 31, 2013, net change in Medicaid enrollment is +217,603 as of Jan. 31. (Considers loss of Medicaid coverage due to changes and redeterminations)

  16. Impact of ACA on Financial Assistance • Section 501(r) imposes new requirements on 501(c)(3) hospital organization to meet four general requirements on a facility-by-facility basis: • Establish written financial assistance and emergency medical care policies; • Limit amounts charged for emergency or other medically necessary care to individuals eligible for assistance under the hospital's financial assistance policy; • Make reasonable efforts to determine whether an individual is eligible for assistance under the hospital’s financial assistance policy before engaging in extraordinary collection actions against the individual; • Conduct a community health needs assessment (CHNA) and adopt an implementation strategy at least once every three years. • The ACA also added new section 4959, which imposes an excise tax for failure to meet the CHNA requirements, and added reporting requirements under section 6033(b) related to sections 501(r) and 4959

  17. Eligibility Criteria Meet MAGI category eligibility Maryland resident U.S. citizen or legal immigrant Social Security Number (preferred, not required) eMedicaid will automatically generate an approval letter for hospitals to print No cards issued Parents and Caretaker Relatives (through 133% FPL) Pregnant Women ( through 259% FPL) Medicaid Children (through 317% FPL) CHIP Children Newly Eligible Adults (through 133% FPL) Individuals (to age 26) formerly in Foster Care in Maryland (no FPL limit) Hospital Presumptive Eligibility All information is self-attested and there is no requirement that the applicant be admitted or be seeking hospital services at the time of an HPE determination.

  18. Best Practices • Patient Education • Make patients aware of Medical assistance and financial assistance programs available • Highly Visible Signage • Brochures & Flyers • Videos • Review All Patient Types • IP • OP • Observation • Clinic • Physician

  19. Outreach Tools - Videos • What’s New at MHC • https://www.youtube.com/watch?v=Vav2kp-pqjc&feature=player_embedded • What to Expect After You Enroll • https://www.youtube.com/watch?feature=player_embedded&v=Pkxnreu4BCU • MCH Overview (2015) • https://www.youtube.com/watch?feature=player_embedded&v=PyzHEjgGka8 • You Could Qualify for Financial Help • https://www.youtube.com/watch?feature=player_embedded&v=WOxvtNKDsBY • How to Apply for Health Coverage • https://www.youtube.com/watch?feature=player_embedded&v=WiTQUm7BeEA • Buying a QHP • https://www.youtube.com/watch?feature=player_embedded&v=UbNL-OVlL0s • Selecting a Plan • https://www.youtube.com/watch?v=bsJ6TwBWDrI&feature=player_embedded • Enrolling in Medicaid • https://www.youtube.com/watch?feature=player_embedded&v=7Pv-2EXYwlk MHC Videos are short and can be uploaded to websites, played on education channels in patient rooms and waiting rooms, and sent out via social media.

  20. Best Practices • Screen for ALL Eligible Coverage Options • Medicaid • Medicare • COBRA • QHP • Victims of Crime Other benefits include but are not limited to Breast & Cervical Cancer programs, Ryan White, KDP, QMB/SLMB, SSI & Disability.

  21. Best Practices • Patient Scoring • Utilize scoring to identify presumptive charity and predict propensity to pay • The presumptive eligibility model should • Rely on multiple data sources • Utilize provider’s financial assistance program policy • Utilize income and household size calculations Patient Scoring and presumptive eligibility is a valuable screening tool during registration, financial counseling, and back-end collections

  22. Best Practices • Know Your Population • Collect data to determine the profile of your uninsured population • Unemployed/Self Employed/Working Poor • Citizen/Documented Non-Citizen/Undocumented • Inner City/Rural/Out of State/International • Age/Language Spoken/Household Composition

  23. Questions ? ? ? ? ? ? ? ? ? PLEASE ASK

  24. Contact Us DECO Corporate Operations Headquarters • 8201 Corporate Drive, Suite 1020Landover, MD 20785 (301) 429-9316 • Godlee Davis, ADR • gdavis@decorm.com www.decorm.com * https://twitter.com/deco_rm/ * http://www.facebook.com/decorecoverymanagement/

  25. Thank you

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