ACA State of Play: What’s at Stake for Indiana?

1. ACA State of Play: What’s at Stake for Indiana? Indiana ACA Symposium March 15, 2013 Tricia Brooks

2. The ACA is already at work in Indiana

3. More Coverage; Better Coverage • > 60k young adults gained coverage by staying on their parent’s plan • > 55k Indiana seniors saved nearly $36 million (an average of $646) on prescriptions • 1.66 million Hoosiers have received free preventive care • 2.3 million Hoosiers no longer have to worry about hitting lifetime insurance caps

4. Strengthening Public Health • $16.5 million in public health grants • $47.5 million to strengthen and expand community health centers • $1.7 million to support school-based health • $13 million for home visiting programs • $4 million to support pregnant and parenting teens and women who continue education

5. Digging into Access to Coverage • What are the implications of the Medicaid decision for Indiana? • How will the federally-facilitated insurance marketplace work? • How will new eligibility and enrollment systems drive efficiency and modernize the enrollment experience? • How can we best assist consumers in connecting to coverage?

6. The ACA’s Continuum of Coverage Pregnant Women Exchange Subsidies if no Expansion

7. A path or no path to coverage For almost 400,000 low-income parents and other adults

8. Compensation to Hospitals For services to people without insurance – uncompensated care reimbursement will substantially decline over time

9. Economic Boost Job Creation and State Revenue from Economic Activity

10. Lower Cost for Private Insurance Savings for individuals and businesses that purchase private insured by reducing cost-shifting for uninsured

11. Weighing the Key Issues in Expanding HIP Cost-sharing Lockout Program Recognition Provider reimbursement Benefits Political support Waiting list Lifetime and annual caps Block grant

12. Indiana’s Insurance Marketplace • Declined to create a state-based exchange • Opted against FFE Partnership • What about Marketplace Plan Management?

13. Exchanges Across the States WA NH VT MT ME ND OR MN MA ID WI SD NY WY MI RI CT IA PA NV NE NJ OH IL UT IN DE CO CA WV KS VA MD MO KY NC DC TN AZ OK NM AR SC MS AL GA TX LA AK FL HI Federally-facilitated Exchange (23) Marketplace Plan Management (4) State-based Exchange (17; DC) Partnership Exchange (7) Source: Kaiser State Health Facts; Politico Pro Report on Marketplace Plan Management 3/12/12)

14. What will the FFE do? • Develop and manage the IT infrastructure for eligibility, enrollment and plan management • Develop and implement the outreach and marketing strategy • Run the call center • Select, fund and manage navigators • Certify and manage qualified health plans • Develop QHP quality ratings and quality improvement strategies

15. Coordination with Medicaid is Critical • Families members will be split across programs • Families will transition between programs when their circumstances change • FFE and Medicaid agencies must transfer electronic case records to fulfill the promise of no-wrong- door, streamlined access to coverage

16. Transforming Medicaid Regardless of whether a state expands Medicaid; new federal regulations are intended to coordinate eligibility across programs and accelerate the use of technology

17. Unprecedented Opportunity to Improve Medicaid • Reduce paperwork burden • Reduce processing backlogs and delays • Reduce churning and increase retention • Reduce gaps between eligibility and enrollment • Improve client communications • Empower self-service • Increase administrative efficiency • Produce data to assess program performance

18. Streamlining Enrollment & Renewal • New basis for counting income and household size generally consistent with APTCs in the exchange • Single streamlined application for all insurance affordability programs • No wrong door – eligibility for all coverage options regardless of point of entry • Multiple paths to enrollment and renewal: online, phone, in person, mail, through navigators/assisters • Verification of eligibility through electronic sources including federal data hub • Real or near real-time determination of eligibility Web Portal

19. Harnessing Technology to Modernize Eligibility and Enrollment • Accelerating the use of technology to improve Medicaid with significant federal funding (90%) • Moving to data-driven, paperless, real-time verification of the eligibility • Making government more efficient and effective • Empowering consumer self- service through online account management

20. Consumers Will Still Need Assistance

21. Will Assistance Be Plentiful Enough? Federally Facilitated Exchange Medicaid Conduct outreach to vulnerable, underserved groups Provide program information in plain language Provide assistance in-person, over the phone, online May certify CACs • Conduct outreach and public education • Operate call center • Maintain a robust website • Create navigators; certify application counselors (CAC)

22. Tapping the Power of Community Organizations to Connect Consumers to Coverage

23. Georgetown Health Policy InstituteCenter for Children and Families Tricia Brooks Research Assistant Professor – GU Health Policy Institute Senior Fellow – GU Center for Children and Families pab62@georgetown.edu 202-365-9148 Our Website: http://ccf.georgetown.edu/ Our child health policy blog: Say Ahhh!http://www.theccfblog.org/