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The Affordable Care Act & Access to Health Care Along the Gulf: A Symposium“State-Specific ACA Rollout”Alliance Institute ~ PanAmerican Life Conference Center November 15, 2013 Robert M. Pugh, MPH Executive Director Mississippi Primary Health Care Association (MPHCA)6400 Lakeover Road, Suite AJackson, MS 39213

presentation topics
Presentation Topics
  • About MPHCA and member organizations
  • MS CHCs (Patients and Utilization)
  • BP Deep Water Horizon MS counties (Coastal Community Health Center patients and utilization)
  • Overview of ACA/MS Rollout and Insurance Market Place
  • MS Outreach & Enrollment, funding, staffing and impact/activities
  • Health Insurance Marketplace websites and other information
about mphca and member organizations
About MPHCA and Member Organizations
  • MPHCA’s MISSION is to support its members in a collaborative effort to advocate for the provision of equal access to quality, comprehensive primary health care services and the elimination of health disparities in Mississippi.
  • 501(c)(6) Nonprofit, Membership Organization (chartered in 1986)
  • Organizational Members: Community Health Centers (CHCs)
    • Typically referred to as Federally Qualified Health Centers (FQHCs)
  • Other memberships include: Associate Members, Business Members & Individual Members
about mphca and member organizations cont
About MPHCA and Member Organizations (cont.)

CHC Historical Overview

  • Proud History
  • Largest National Network
  • Record of Achievement
  • Bipartisan Support

Federal Law Requirements

  • Non-Profit/Public
  • Volunteer Board
  • Comprehensive Services
  • Sliding Fee Scale
  • MUA/HPSA
  • Federal Reporting Requirements
  • Programmatic (Clinical and Financial Performance)
chcs in mississippi
CHCs in Mississippi
  • 21 Organizations
  • Over 1600 FTEs
  • Approx. 166 Sites
    • Primary care clinics
    • OB/GYN, Pediatrics
    • Dental clinics
    • School-based clinics
    • Mobile medical units

Source: 2012 UDS Data

303 079 chc patients in mississippi
303,079 CHC Patients in Mississippi
  • 894,772 visits annually
  • Over 249,000 (82%) live at or below 200% FPL
  • Over 128,000 (42%) are uninsured
  • Over 84,000 (28%) are insured through Medicaid
  • Over 50,000 (16%) are privately insured
  • Services provided to special groups:
    • Over 900 migrant/seasonal farm worker patients/transitional
    • Over 7,400 military veterans
    • Over 8, 600 homeless patients
    • Over 19,000 school-based patients
  • Race: 63% African American – 32% White – 5% Other
  • Gender: 60% Female – 40% Male

Source: 2012 UDS Data

chc utilization by payor mix
CHC Utilization by Payor Mix

Total Users: 303,079

Source: 2012 UDS State Summary Report

coastal family health center patients
Coastal Family Health Center Patients
  • 30,730 patients
  • 83,369 visits
  • 27,713 (90.2%) live at or below 200% FPL
  • 15,362 (50%) are uninsured
  • 8,880 (28.9%) are insured through Medicaid
  • 3,292 (10.7%) are privately insured
  • Services provided to special groups:
    • 201 migrant/seasonal farm worker patients
    • 212 military veterans
    • 3,019 homeless patients
    • 643 school-based patients
  • Race: 38.7% African American – 53.4% White – 7.9% Other
  • Gender: 59% Female – 41% Male

Source: 2012 UDS Data

coastal family health center utilization by payor mix
Coastal Family Health Center Utilization by Payor Mix

Total Users: 30,730

Source: 2012 UDS Data

about aca
About ACA
  • Implementation began formally in 2010 and will continue through 2015 and later
  • ACA consists of three major parts

Insurance coverage reforms

Insurance expansions

Delivery system reforms

key features of aca
Key Features of ACA
  • Individual Mandate: purchase coverage or pay penalty, with income-based subsidies up to 400% of poverty (41,000/$88,000) to make coverage affordable
  • Employer Contribution: offer coverage or pay penalty
  • Medicaid Expansion: all individuals up to 138% of poverty (major new group: adults)
  • Health Insurance Exchanges: marketplace for consumers, with competing plans
  • Insurance market reforms, to end discrimination (gender, pre-existing conditions, MLR, etc)
  • Workforce Training Reforms, especially Primary Care
  • Payment System Reforms, especially Integrated Care
health center funding thru aca
Health Center-Funding thru ACA
  • New Funding for Health Centers:

$11 Billion over 5 Years (dedicated funding), over and above the $2.2 billion in

annual CHC funding

  • $9.5 billion for CHC operations under Section 330
  • $1.5 billion for Capital over 5 years
  • Permanent Authorization: Original Sanders language with increasing authorization levels
ms aca roll out insurance market place
MS ACA Roll-Out & Insurance Market Place
  • MPHCA ACA presentations to:

1) CHCs Members

2) State Partner Organizations

3) Local Advocacy Groups

4) Community-Based Organizations

5) Faith-Based Organizations

  • Insurance Market Place Development

1) Mississippi Insurance Department State-Based Exchanged Development

a. 2011 Legislation

b. Exchange Advisory Board and Sub-committees Developed

c. Exchange Planning & Development Funding

d. State-Based Exchange Default/Insurance Commissioner vs. Governor

e).Federally Facilitated Exchange Implementation and QHP Development

2) Medicaid/QHP (275,000)

ms aca roll out insurance market place continued
MS ACA Roll-Out & Insurance Market Place(continued)
  • Non-Medicaid Expansion

1) Total Medicaid Enrollees – 645,134 (as of Sept. 2013)

2) Total State Uninsured – approx. 275,000

3) Number in coverage gap – 137,800

4) Percent in coverage gap below 100% FPL – 89%

fqhc outreach and enrollment supplemental funding awards staffing and impact
FQHC Outreach and Enrollment Supplemental Funding Awards, Staffing and Impact
  • HRSA Outreach and Enrollment Awards
  • Outreach and Enrollment Staffing
  • Outreach and Enrollment Impact
supplemental funding award criteria funding requirements for chcs
Supplemental Funding Award Criteria & Funding Requirements for CHCs

HRSA awarded the funds through a formula-based supplemental award criteria for eligible section 330 funded health centers.

Health centers receiving outreach and enrollment funding must:

1) Increase the CHC’s Outreach and Enrollment assistance capacity

2) Ensure all CHC Outreach and Enrollment assistance workers are trained

3) Demonstrate the capacity to conduct “in reach” and “outreach”

4) Demonstrate collaboration with other CHCs and providers in their service area

5) Comply with all Section 330 Requirements of the PHS Act, as amended

fqhc use of outreach and enrollment supplemental funding
FQHC Use of Outreach and Enrollment Supplemental Funding

Allowable use of funds:

  • Adding a Minimum of 1.0 New FTEs
  • Pre-award Costs
  • Hiring of Veterans as O/E Assistance Workers
  • Fringe Benefits for O/E Assistance Workers
  • Moveable Equipment and Supplies to Support O/E Assistance Workers
  • Leasing of Temporary Space
fqhc use of outreach and enrollment supplemental funding cont
FQHC Use of Outreach and Enrollment Supplemental Funding (cont.)

Allowable use of funds:

  • Training in support of the grant
  • Local travel in support of the grant
  • Personal computers/laptops
  • Educational materials
  • Wireless cards
  • Technology to Protect Personally Identifiable Information (PII)
fqhc use of outreach and enrollment supplemental funding cont1
FQHC Use of Outreach and Enrollment Supplemental Funding (cont.)

Non-Allowable use of funds:

  • Provision of primary health care services or personnel other than O/E assistance workers
  • To supplant other resources (federal, state, local, or private) intended to support O/E assistance activities
pca outreach and enrollment supplemental funding award and pca support for chcs
PCA Outreach and Enrollment Supplemental Funding Award and PCA Support for CHCs

MPHCA has received $143,724 from HRSA to support its member CHCs in the coordination and execution of their outreach and enrollment activities via:

  • Ongoing communications about training opportunities
  • Continued partnerships with state agencies in the development of the overall, state-wide FFE strategy
  • Coordination with other consumer assistance efforts in the state
  • Continuing to work with the Qualified Health Plans for Mississippi - Magnolia Health Plan and Humana
  • Providing training and technical assistance to CHCs
  • Monitoring and reporting of successes and barriers regarding CHC O/E activities
ms o e activities as of 11 12 13
MS O&E Activities (As of 11/12/13)
  • MPHCA Lead Staff Appointed
  • Applied to Become Certified Application Counseling Organization (CACO) – Certification Obtained late October
  • Provided on-site enrollment training assistance for eleven (11) CHCs
  • Participated in numerous Health Fairs, Town Hall Meetings, Church and Community Meetings
  • CHCs received CACO Certification
  • 79 CACs Trained, 90% certified
  • Over 1,000 Customers Assisted by Outreach & Enrollment CHC Staffs
  • Conducted Several State Level Meetings and ongoing reporting to Federal, State and Regional Partners, such as CMS, BPHC, NACHC, MS Dept. of Insurance, UMMC, Oak Hill Baptist Church, Magnolia Health Plan /Ambetter and Humana
  • Participated in development of Cover MS State Coalition
  • Developed MPHCA O & E Web Page.
market place website foas
Market Place Website & FOAs
  • MPHCA O & E Webpage: www.mphca.com/outreach-and-enrollment-resources
  • www.healthcare.gov
  • www.CoverMS.org
  • www.getcoveredms.org (Navigators)

-Oak Hill Missionary Baptist Church Ministries Incorporated

-University of Mississippi Medical Center

-Enroll America

-Mississippi Health Advocacy Program

-Aaron E. Henry Community Health Services Center

  • University Mississippi Medical Center: www.ummchealth.com/healthplan
  • Oak Hill Missionary Baptist Church: www.info@getcoveredMississippi.org
  • www.mid.ms.gov
  • FAQ website: www.healthreformbeyondthebasics.org
market place website foas continued
Market Place Website & FOAs (continued)
  • Marketplace Eligibility, enrollment periods, plans & premiums
  • Individual Responsibility to have health coverage
  • Minimum Essential Coverage
  • Help paying private health insurance premiums
  • Cost sharing reductions
  • Tobacco surcharge for premiums
  • Marketplace verification and appeals
  • Young Adults and Students
  • Pregnancy
  • Non Traditional Households
  • Immigrants
  • Agricultural Workers
  • Workers/Families with job-based health coverage questions
  • Early retirees
  • People with variable incomes
  • Medicare

FAQ Website Categories

contact
Contact

Robert M. Pugh, MPH

Executive Director

Email: rmpugh@mphca.com

Mississippi Primary

Health Care Association (MPHCA)

P.O. Box 11745 l Jackson, MS 39283

Phone: 601.981.1817 l Fax: 601.981.1217

www.mphca.com