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Health Reform in King County. Housing Development Consortium November 13, 2012. Jennifer DeYoung Health Reform Policy Analyst, Public Health - Seattle & King County Susan McLaughlin

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Health Reform in King County

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health reform in king county

Health Reform in King County

Housing Development Consortium

November 13, 2012

Jennifer DeYoung

Health Reform Policy Analyst, Public Health - Seattle & King County

Susan McLaughlin

Health and Human Services Integration Manager, Department of Community and Human Services

presentation overview
Presentation Overview
  • Health Reform in King County
    • Benefits to date
  • Access and Outreach Efforts
  • Delivery System Reforms
    • Managed Care
    • Health Homes
  • Health Reform and Housing
  • Questions
timeline of key health reform activities affecting seattle king county
Timeline of Key Health Reform Activities Affecting Seattle & King County

New Medicaid Managed Care contracts in effect

Open enrollment begins for Exchange & Medicaid Expansion (Oct 1)

Health Homes Initiative for high risk Medicaid (Nov 1)

ACA signed into law

June 2012











Medicaid beneficiaries with disabilities phased into mandatory Managed Care

Supreme Court ruling

Medicaid Expansion & Exchange Coverage Begins (Jan. 1)

Development of Health Benefit Exchange

benefits today health reform in king county
Benefits Today: Health Reform in King County
  • About 736,000 individuals no longer face lifetime caps on their health benefits
  • About 15,000 young adults up to age 26 are covered by their parents’health plans
  • About 368,000 individuals have coverage for preventive care with no co-pays or deductibles

Source: Public Health-Seattle & King County, 2012.

next 14 months a critical time for king county to shape health reform
Next 14 Months: A Critical Time for King County to Shape Health Reform
  • To gear up for enrollment
  • To shape Medicaid delivery system changes focused on high-risk, high-need enrollees
  • To influence Exchange policies and Medicaid program changes
king county health reform planning team
King County Health Reform Planning Team
  • Co-convened by Public Health and Department of Community & Human Services
  • Adoption of Framework for an Accountable, Integrated System of Care
  • Identification of priority areas of focus
key changes still to come how will we get to expanded coverage
Key Changes Still to ComeHow Will We Get to Expanded Coverage?

Employer-sponsored coverage

Exchange(Tax credits & cost sharing subsidies for those 100-400% FPL)

Medicaid ProgramCoverage (up to133% FPL)

Individual mandate

Federal Basic Health Option ? 133% - 200% FPL

FPL = Federal Poverty Level. 133% of FPL is about $15,000 for an individual.


access and outreach efforts
Access and Outreach Efforts
  • Providing input on development of Health Benefit Exchange
  • Influencing shape of Essential Health Benefits package
  • Developing community-wide enrollment strategy


Ensure residents obtain coverage

health home models of care
Health Home Models of Care
  • Comprehensive care management including
    • Intensive/chronic disease management
    • Transitions management/readmission reduction
    • Self-management support/patient education
    • Linkages to community/social support services
  • Health Assessment
  • Coordinated Health Action Plans
  • Use of Health Information Technology
health home structure
Health Home Structure
  • Network of organizations that provide health home services
  • Each network has an identified “lead entity” that is responsible for administrative functions
  • Bridges all service domains including medical, mental health, chemical dependency, long term services and supports
  • May include health plans, community based organizations, clinics, etc.
timeframe next steps
Timeframe/Next Steps
  • State will “qualify” health home networks
    • King County exploring creating a Health Home Network including PHSKC, DCHS, and AAA
  • Implementation being phased in regionally
  • King County implementation November 1, 2013
health reform and the housing system
Health Reform and the Housing System

Key areas of opportunity and planning for the Housing System and health reform:

  • Enhanced roles in helping people get enrolled in and retain health coverage.
  • Care coordination & care transition partnerships with Medicaid managed care organizations.
  • Potential for reimbursement of certain services under Medicaid
1 enhanced roles in helping individuals get enrolled in and retain health coverage
1. Enhanced roles in helping individuals get enrolled in and retain health coverage
  • Community-wide strategy to assure people get enrolled in Medicaid expansion & Exchange will be crafted.
  • Potential for longer-term payoff for housing providers→ greater access to earlier medical & behavioral health care.
2 care coordination care transition partnerships for those on medicaid
2. Care coordination & care transition partnerships for those on Medicaid
  • Significant numbers of formerly homeless clients will be on Medicaid and in a managed care plan.
  • Over time housing providers will need to cultivate working relationships with all 5 Managed Care Organizations (MCOs).
  • Many may be involved in a health home and receiving care coordination & care transition functions
    • Housing providers will play a critical role as essential partners in health home networks
3 potential for reimbursement
3. Potential for reimbursement
  • Medicaid Expansion provides a potential source of revenue for people in supportive housing who have clinical service needs
  • Health Home Networks provide an opportunity to serve people with the highest needs more efficiently
  • Opportunities for WA to propose new ways of approaching healthcare through different state “authorities” or “waivers”
corporation for supportive housing
Corporation For Supportive Housing
  • Develop a “cost case” for supportive housing that demonstrates that housing is healthcare
  • Develop a crosswalk of the services provided in supportive housing with one or two possible state waivers
  • Keep housing and other stakeholders involved
health reform challenges
Health Reform Challenges
  • Can’t underestimate the work needed to get and keep people covered
  • Some will remain uninsured (including undocumented); others will fall off and on
  • Lack of capacity in the safety net health system to serve increase in people
  • Historic challenges of managed care in providing quality services for individuals with significant behavioral health issues
staying engaged
Staying Engaged
  • WA State Health Benefit Exchange
  • WA Medicaid Expansion
  • WA State Health Care Authority listserv
  • King County Health Reform Planning Team