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Highlights of InterestPresented to the Central Kentucky Association of Health UnderwritersOctober 10, 2017Secretary Vickie Yates Brown Glisson DMS Commissioner, Steve Miller275 E. Main Street Frankfort, KY 40621VYB.Glisson@ky.gov Steve.Miller@ky.gov
All information based on Kentucky HEALTH Waiver proposal.Information is subject to change. Commonwealth of Kentucky Overview of Kentucky HEALTH
Challenges Facing Kentucky Nationally, Kentucky is ranked close to last in many crucial areas. The state’s unemployment rate, poverty rate, workforce participation rate and wages are all significantly below the national average. • Over the past decade, the opioid epidemic has wreaked havoc on our families, communities and economy. • Overdose deaths have climbed to more than 1,000 per year. • Kentucky’s rate of babies born drug-addicted is twice the national average. • Drug abuse has negative impacts on daily life and work functions, and is weakening people’s employability (attendance, teamwork, and productivity). • All of these factors cause higher unemployment. • Kentucky is among the worst nationally in several key population health metrics. • 1st in the nation for cancer deaths, 2nd highest in the nation for smoking. • Nearly 1/3 of Kentuckians struggle with weight issues (12th highest rate in the nation). • There are 6.8 infant deaths per 1,000 live births (17th highest rate in the nation). • 8 of 13 counties in the nation with largest declines in life expectancy since the 1980s are in Kentucky.
Unsustainable Growth • High poverty & high Medicaid enrollment • Workforce participation is 59.4%, 45th in the nation • 19% of Kentuckians live in poverty • 47th in the nation for median household income • Nearly 1/3 of total state population is enrolled in Medicaid • Poor health outcomes despite high spending • 1 out of 3 Kentuckians has weight-related health issues • Ranks 2nd highest in the nation for smoking • Ranks 1st highest in the nation for cancer deaths • Ranks 1st highest in nation for MCO profits • No long term financing plan • Kentucky is projected to spend approximately $1.2 billion over the next five years on expanded Medicaid benefits (SFY 2017-2021) The cost growth in Medicaid expansion threatens funding for traditional Medicaid coverage for the aged, blind, disabled, pregnant women, & children.
Access to healthcare alone has NOT dramatically improved the health of Kentuckians, and the cost to the Commonwealth is unsustainable. Personal Finance Proactive Health Services Kentucky HEALTH takes a holistic approach to improving health by integrating key components of a person’s wellbeing. Skills Development Community Engagement Financial Rewards & Advancement
Kentuckians Deserve More… 1 2 3 • The current Medicaid expansion has not improved any of these metrics. • Kentucky HEALTH encourages members to get involved in their healthcare, increase job opportunities, and practice healthy living. • Kentucky HEALTH would help stabilize the high costs of providing care to the most needy. Kentucky HEALTH seeks to provide a holistic solution to improve member health.
Kentucky Health Program Overview Kentucky HEALTH is the Commonwealth’s new program for certain low-income adults and their families. The program gets its name from its mission. H E A L T H Helping to Engage & Achieve Long Term Health This innovative program brings together existing state agencies and programs, and leverages federal funding to improve member access to health, educational, financial, and professional development resources that can help families and communities grow and thrive over the long term.
Kentucky HEALTH Vision • Kentucky HEALTH VisionKentucky HEALTH aims to re-envision public assistance as a temporary safety net, not a long-term plan. The program aims to improve health by: • Incentivizing positive health choices and member engagement in work and the community by rewarding member participation in activities geared towards health, education, and employment • Transforming members into active participants who are engaged in and accountable for their health • Requiring individuals to contribute by participating in community engagement activities, which could include work, training, and volunteer/or community service activities as a condition of eligibility VISION Kentucky HEALTH
Kentucky HEALTH Benefits • Kentucky HEALTH BenefitsKentucky HEALTH has many benefits for its members and the Commonwealth, including: • Giving members more control over their healthcare • Promoting self-sufficiency and encouraging individuals to be engaged in their communities • Creating opportunities for members to get involved in their healthcare and promoting healthy living • Implementing a more financially sustainable approach for Kentucky’s Medicaid services BENEFITS Kentucky HEALTH
Kentucky HEALTH Covered Populations NotIncludedin KentuckyHEALTH Traditional Medicaid(Aged,Blind&Disabled) Includedin KentuckyHEALTH Non-Disabled Adults & Children (Individuals covered before expansion, pregnant women, children, adult expansion population, Former Foster Youth to age 26 Model Waiver II – 1915(c) No Change • TraditionalMedicaid Adults EligiblePriorto Expansion • Premiums or Copays • No Change in Benefits (continue to get vision and dental through MCO) • Community Engagement required, unless primary caretaker of dependent • Medicaid Expansion Adults • Premiums or Copays • State Employee Benefits • Vision and Dental available through My Rewards Account • Community Engagement required, unless primary caretaker of dependent Homeand Community BasedWaiver-1915(c) No Change Michelle P Waiver – 1915(c) No Change Supports for Community Living – 1915(c) No Change Acquired Brain Injury – 1915(c) No Change Acquired Brain Injury, Long Term Care – 1915(c) No Change • Pregnant Women & Children (Traditional Medicaid and KCHIP) • No Premiums • No Change in Benefits • Community Engagement initiative not required • Medically Frail Adults • Optional Premiums (for access to My Rewards) • No Change in Benefits • Community Engagement initiative not required Nursing Facility and ICF/MR Residents No Change Qualified Medicare Beneficiaries No Change
Benefit Overview 2 • Kentucky HEALTH Medicaid State Plan/CHIP • Current benefits available to individuals outside of the Adult Group • Includes Medically Frail 1 • Kentucky HEALTH Alternative Benefit Plan • The following benefits are moved to My Rewards Account: • Vision • Dental • The following benefits are added to My Rewards Account: • Gym membership & fitness activities
Benefits by Population Note: Vision and dental coverage will continue to be covered by the MCOs (not the My Rewards Account) for all members with access to Medicaid State Plan benefits.
Innovative Components of Kentucky HEALTH Investment Members invest in their own health Cost Sharing: Members invest in their personal health by paying predictable monthly premiums based on their income, or copayments when they receive services. My Rewards Account: Members are incentivized to improve their health and be active members of the community by offering My Rewards dollars for activities like accessing preventive care services, taking health and financial literacy classes, and job trainings. Kentucky invests in member health, education and increased Substance Use Disorder coverage Substance Use Disorder (SUD) and Mental Health Treatment: Members will obtain enhanced mental health and substance abuse services. Kentucky HEALTH will elevate the standard of care for drug treatment to aggressively combat this epidemic.
Innovative Components of Kentucky HEALTH Understanding Members learn about commercial insurance and make informed decisions about their healthcare Cost Sharing: Members learn about key commercial market features, like making timely monthly premium payments, tracking deductibles, and managing an account similar to a healthcare flexible spending account. Premium Assistance: Members learn about their job-based coverage, provider networks, and covered services, while receiving wraparound coverage to make sure they have access to all Medicaid- covered services. Deductible Account: Members are empowered to be active healthcare consumers by receiving a $1,000 state-funded health savings-like account.
Innovative Components of Kentucky HEALTH Advancement Members are incentivized and empowered to develop practical knowledge and skills P.A.T.H. Program (Community Engagement): Research shows a link between community engagement (like volunteer work, public service, or employment) and an individual’s overall health and well-being. The Partnering to Advance Training and Health (PATH) program is a unique community engagement initiative designed to build and strengthen Kentucky’s health and workforce through a wide variety of options, such as employment, volunteering, caretaking, job training, and education. Education and Training: Members can access health, financial literacy, and parenting classes to help them gain and foster skills for long-term independence and success.
Kentucky HEALTH Proposed Roadmap 1/1/2018 4/1/2018 7/1/2018
Legislative History • Bill introduced in the Senate – January 3, 2017 • Signed by the Governor – March 16, 2017 • Took effect – June 29, 2017 • Goal: First step in tort reform • MRPs are a jurisdictional precursor to filing a medical malpractice civil action in court.
Medical Review Panels • Governor Bevin has said that he is confident the new medical review panels will reduce the number of frivolous lawsuits, drive down the high costs of medical malpractice insurance and help Kentucky attract much needed physicians and other healthcare providers. • Kentucky has been recognized for decades as having one of the worst legal climates for healthcare providers. The Governor believes these new medical review panels are an important step in addressing the medical liability crisis in this state.
Panel Timeframe – 9 months The filing of a proposed complaint tolls the statute of limitations until 90 days after the claimant has received the opinion of the MRP. All malpractice and malpractice-related claims against a health care provider, other than claims validly agreed for submission to a binding arbitration procedure, shall be reviewed by a medical review panel. Such an action may not be commenced in a court in Kentucky before: • The claimant’s proposed complaint has been presented to a medical review panel established under this chapter; and • An opinion is given by the panel. [BUT,] If the panel has not given its opinion within nine (9) months after the filing of the proposed complaint, the plaintiff may commence the action in court.
What Does the Panel Do? Who? • One attorney to serve as the Panel Chairperson and advise the Panel Members on any legal issues • Three licensed healthcare professionals of the same specialty as the named defendant(s) charged with reviewing the care in question What? Medical Review Panel renders one of three opinions: • Defendant(s) failed to comply with the standard of care and the conduct was a substantial factor in producing a negative outcome for that patient; OR • Defendant(s) failed to comply with the standard of care, but the conduct was not a substantial factor in producing a negative outcome for that patient; OR • No breach of the standard care as charged in the complaint How? Two of the three panelists must agree on the panel opinion
MRPs – The Latest • As of October 6, the Cabinet has received 63 complaints and 62 MRPs have been formed. • There is a lawsuit in Franklin Circuit Court challenging the constitutionality of the MRPs. A hearing was held on 8/24/17. A decision is expected soon. • For more information, visit our website mrp.ky.gov
Kentucky Health Benefit Exchange • Kentucky successfully transitioned the 2017 Open Enrollment to using healthcare.gov. for eligibility and enrollment purposes. • KY Exchange’s continuing focus - Facilitate the enrollment into affordable health coverage through the federal health insurance marketplace. • Primary functions of the Exchange continue to be: • Plan Management – Determining which health insurers provide qualifying coverages to be included for Exchange choices • Outreach, Training, and Education --- Facilitating knowledge and understanding for enrollment and eligibility with eligible enrollees and through assisting organizations and brokers/agents throughout Kentucky • CMS Planning and Implementation – Coordinating and advocating with CMS for continuing to improve the Exchange to make it easier for Kentuckians to shop for health insurance coverage for both individuals, families, and smaller employers. • Outreach, Training, and Education - Continuing to utilize Assister organizations and brokers/agents throughout Kentucky • Over 500 enrollment events expected to occur during Open Enrollment
Kentucky Health Benefit Exchange • For 2018 Exchange Open Enrollment: • Nov 1 to Dec 15 • “Passive” enrollment method • no active enrollment needed – if keeping same or similar plan • Enrollees will be enrolled in closest similar plan if insurer not offering exact same plan for 2018 • Healthcare.gov Notification Letters – sending Oct 15 – Nov 1 • Healthcare.gov Shopping Tool available with rate information – starting Oct 15 • Health Insurance Coverage Expectations – • Statewide coverage with no “bare” counties – 1 insurer per every county • Rates are: • CareSource - 56% avg. increase / Anthem - 41% avg. increase • Expectation - 80% of Kentuckians receiving Tax Credits that in certain cases fully offset these rate increases • Current enrollment – 76,000
Thank You Questions or Comments?