Health Care Coverage Reform ACA / Medicaid Overview · Provide overview of Federal and State health...

Health Care Coverage Reform

ACA / Medicaid Overview December, 2013

Milwaukee Health Care Partnership

Mission Public / private consortium dedicated to improving health care for underserved populations in Milwaukee County (Medicaid and Uninsured) Members 5 Health Systems, 4 federally qualified health centers, MCW and City, County and State Health Departments Goals 1. Secure adequate & affordable coverage for low income

individuals 2. Ensure access to quality primary & specialty care 3. Improve care coordination across the community

Milwaukee Enrollment Network

Purpose

• Multi-stakeholder collaborative

• Organized to support the enrollment of Milwaukee County residents in public health benefits or private insurance via the Marketplace

• Focus on providing assistance to low income, vulnerable populations

Co-Conveners

• Milwaukee Health Care Partnership

• Covering Kids & Families

• State of Wisconsin Department of Health Services

Milwaukee Enrollment Network

2014 Goals • Train and Deploy +160 Enrollment Assisters

Certified Application Counselors (CACs)

• Enroll 33,000 in Medicaid * - 75% Take-Up Rate / Priority

• Enroll 26,500 in Marketplace Coverage

Strategies 1. Support Consumer Outreach and Education

2. Build the Capacity and Capability of Enrollment Assisters

3. Support Targeted Take-Up and Retention

4. Measure and Monitor Outcomes

The Affordable Care Act (ACA) and new State Medicaid (BadgerCare+) reforms present Challenges and New Opportunities for Wisconsin residents

Purpose of Presentation 1. Provide overview of Federal and State health

insurance coverage reforms 2. Share information about enrollment and

supports resources

Health Care Coverage Reform

Outreach and Education vs.

Debate Merits of Federal or State Policies “ObamaCare” or “WalkerCare”

Personal Lens/Biases 1. Access to Heatlh Care is a basic Human Right

Insurance is gateway to access 2. Health Care Access is a “Public Good” 3. Government does and should play a role 4. Personal Responsibility

Foster accountability and independence

Focus

• Nationally over 50 Million people without health insurance o Decline in employer based insurance o Growing “Underinsured” o Growing Uncompensated Care

• Lack of coverage/substandard coverage results in barriers to access, insufficient care, greater morbidity and avoidable high-end utilization

• Spend 17% of GDP on health care • U.S. ranks 37th in health outcomes yet paying 3x

more for health care than any other country

Why Coverage Reform is Necessary ?

120,764 Uninsured in Milwaukee County 13% of County Population 80% <300% FPL (Income <$34,000/year)

51% 30%

1%

5% 10% 3%

Race and Ethnicity

White Black

American Indian Asian

Other Race Two or More Races

Employed 69,439 57.5%

Un-employed

24,394 20.2%

Not in Labor Force

26,930 22.2%

Employment Status

Milwaukee County Enrollment

Large Medicaid Population BadgerCare+ (Children/Parents/Pregnant) 204,069 Elderly/Blind/Disabled (unchanged) 90,299 Total Medicaid Beneficiaries 294,368

31% of County Residents Enrolled in Medicaid 52% of All Children are Enrolled in Medicaid

27% of All Medicaid Beneficiaries live in Milwaukee

Milwaukee County Enrollment

• The Affordable Care Act (ACA) passed in March, 2010 and

upheld by Supreme Court in July, 2012

• Three Pillars of Reform Health Care Financing Delivery System Reform Coverage Reform / Expansion

• Establishes New Avenues to secure Adequate and

Affordable Health Insurance Coverage Health Insurance Marketplace (aka. Exchange) State Medicaid Expansion

Overview of ACA

• Preventive care for those with insurance, including Medicare

• Financial assistance for prescription drugs for seniors

• Young adults can remain on parent’s private insurance plan up to 26 years of age

• Children cannot be denied insurance coverage for pre-existing condition

• Tax breaks for small businesses to provide coverage

Current ACA Coverage Provisions

• Guaranteed Issue - Adults can’t be denied insurance coverage for pre-existing conditions

• No annual limits on coverage

• People will be required to have insurance or pay a penalty – Individual Mandate

• The Health Insurance Marketplace (aka. Exchange) opened for enrollment October, 2013 for coverage beginning January 1, 2014

• Premium tax credits / discounts available for Marketplace

coverage for low income individuals • Optional State Medicaid Expansion

2014 Coverage Provisions

Most people will be required to have insurance or pay penalty

• 2014: $95 per adult or 1% of income* • 2016: $695 per adult or 2.5% of income

Some individuals exempt from mandate and the penalty:

• Religious conscience; • Membership in a health care sharing ministry; • Member of an Indian tribe; • Hardship (based on personal circumstance or a lack of affordable

coverage); and • Below 133% FPL and ineligible for Medicaid

Individual Mandate

Public Programs (Medicaid/CHIP/Medicare)

Employer-based and Private Coverage

Health Insurance Marketplace Coverage

Access to Insurance

November 11, 2013

The Marketplace/Exchange

• A place where people can go to: determine eligibility compare insurance plans choose healthcare coverage and apply for discounts (tax credits) on their

premiums

• Wisconsin has a Federally Facilitated Marketplace (FFM) www.healthcare.gov

What is the Marketplace/Exchange?

• No Wrong Door: An Individual or family can determine eligibility and apply for: o Medicaid / Wisconsin BadgerCare+ o Private insurance plans with tax credits o Catastrophic plans

• There will also be a Marketplace for small

businesses called the SHOP Exchange available in 2014; on-line 2015

What is the Marketplace/Exchange?

Citizens who are not incarcerated and do not have access to “affordable” insurance through their employer can access coverage via the Marketplace

Insurance is deemed “affordable” if the premium is less than 9.5% of the person’s household income

Who’s eligible for Marketplace coverage?

• First Open Enrollment Period: October 1, 2013 - March 31, 2014

• Consumers looking for insurance coverage can apply:

Online: www.healthcare.gov Call center: 1-800-318-2596 Via mail In-person assistance:

Navigators (6-10 state-wide) Certified Application Counselors (CACs) Agents or Brokers

How does the Marketplace work?

Insurance Plans Available Vary by County

Common Ground Healthcare Cooperative Compcare Health Services Insurance Corporation (Anthem/BCBS) Dean Health Plan, Inc. Group Health Cooperative of South Central Wisconsin Gundersen Health Plan, Inc. Health Tradition Health Plan Medica Health Plans of Wisconsin MercyCare HMO, Inc. Molina Healthcare of Wisconsin, Inc. Physicians Plus Insurance Corporation Security Health Plan of Wisconsin, Inc. Unity Health Plans Insurance Corp. Arise (WPS Health Plan, Inc.)

WI Insurers in the Marketplace

All Qualified Health Plans (QHPs) in the Marketplace must cover Essential Health Benefits (EHBs):

• Ambulatory services • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance use disorder services • Prescription drugs • Rehabilitative and habilitative services and devices • Laboratory services • Preventive and wellness services, • Chronic disease management • Pediatric services, including oral and vision care

Essential Health Benefits

Qualified Health Plans (QHPs) range in value/cost • 89 plan options in Milwaukee County

Metal Level Tiers • Bronze • Silver • Gold • Platinum

Bronze Plans Have Minimum Benefits / Lowest Premium / Higher Out-of-Pocket Expenses

• Co-pays • Deductibles • Co-Insurance

Insurance Plans in the Marketplace

What is the cost of coverage?

• Costs will vary based on the plan and tier level • Cost is influenced by:

tobacco use geographic location age

• Individuals and families will pay between 2-9.5% of their income

• Go to the Kaiser Premium calculator for a cost estimate: http://kff.org/interactive/subsidy-calculator/

Is there financial assistance available?

• 301,000/482,000 in Wisconsin may qualify for financial assistance for health insurance costs through the Marketplace

• Premium subsidies (tax credits) are available for those between 100-400%FPL and a limit on the out-of-pocket costs for those with incomes below 250%FPL

• People can apply for subsidies at the time of

application to reduce the cost of each monthly premium, or they can be delayed until taxes are filed

Annual Income Categories: Federal Poverty Level (FPL), 2013

Group

Size 100% FPL 133% FPL 200% FPL 300% FPL 400% FPL

1 $11,490 $15,282 $22,980 $34,470 $45,960

2 $15,510 $20,628 $31,020 $46,530 $62,040

3 $19,530 $25,975 $39,060 $58,590 $78,120

4 $23,550 $31,322 $47,100 $70,650 $94,200

5 $27,570 $36,668 $55,140 $82,710 $110,280

6 $31,590 $42,015 $63,180 $94,770 $126,360

For a family of 4 at 200% of the FPL, that is $47,100 per year

Premium Tax Credit - Individuals

Source: Center on Budget and Policy Priorities http://www.cbpp.org/files/QA-on-Premium-Credits.pdf

Premium Tax Credit – Family of 4

Source: Center on Budget and Policy Priorities

http://www.cbpp.org/files/QA-on-Premium-Credits.pdf

Badger Care+ Eligibility and Benefits Change Effective April, 2014 (pending) • Will lift cap on BadgerCare+ coverage for Childless

Adults and roll back eligibility for all adults from 200% FPL to < 100% FPL ($11,500/yr./individual)

• Eligibility for children and pregnant women remains at < 300% FPL

• Standard benefits for all BadgerCare+ enrollees

including behavioral health and dental coverage

State Medicaid Reforms

16,000 Transitioning off BC+ (>100%FPL)

2,500 Transitioning off HIRSP

44,000 Uninsured Newly Eligible for BC+ (<100%FPL)

80,000 Uninsured (>100%FPL; 60,000 between 100-300%FPL)

145,000 Milwaukee County Residents

125,000 Needing Enrollment Assistance

Does not include self-insured, employees transitioning from employer-

based insurance, small businesses

Impact of Medicaid Reforms in Milwaukee County

• October 1, 2013- March, 2014: Open Enrollment-Individuals can sign up for health insurance plans on the Marketplace

• December 23: First premium payment due and deadline to enroll for January 1 coverage

• After December 23: if enrolled between the 1st and 15th of the month, coverage will begin the 1st of the following month

• Special Enrollment Periods: Qualifying Life Events such as losing other insurance coverage, moving out of a plans service area or change in family status may qualify someone for a special enrollment period

• November 15 - December 31, 2014: Next Marketplace Open Enrollment Period

• Individuals may enroll in BadgerCare+ at anytime

Enrollment Periods

BadgerCare+ or Marketplace applicants can get help:

• By mail • By phone • On line • In person

Is enrollment assistance available?

By mail: Applicants can request a copy of the application be mailed to

them by calling 1-800-318-2596 or downloading from the www.healthcare.gov website

Some application sites will have copies of the paper application

By phone: Through a national call center 1-800-318-2596 (150 languages

and TTY option)

Online:

Chat with a Marketplace representative when filling out an application at www.healthcare.gov/chat

Marketplace Enrollment Assistance

In-Person Assistance - Open to the General Public Milwaukee Public Health Department- Community Healthcare Access Program (CHAP): 414-286-8620

• Central Public Library- Wednesdays, 3-5:45pm • Northwest Health Center- 7620 Mill Road • Keenan Health Center- 3200 N36th Street • Southside Health Center- 1639 S. 23rd Street

Central Library, 814 W. Wisconsin Ave. 414-286-6629 • Wednesdays 3-5pm

Milwaukee Enrollment Services (MilES): 1-888-947-6583 • Coggs: 1220 W. Vliet Street • UMOS: 2701 S. Chase Ave

Health Care Providers / Community and Faith-Based Organizations / Advocates

Dial 2-1-1 Agents and Brokers

Enrollment Assistance

•What you need to enroll: Birthdate and Social Security Numbers of household

members Employment information including any health

insurance available Income information (last tax return or W-2s) Medicaid notice / letter, if applicable Patience!

•Application assisters should have proof of certification •Never pay for enrollment assistance! • Complaints and reports of fraud can be made :

Calling 1-800-318-2596 https://ociaccess.oci.wi.gov/complaints-public/

What do enrollees need to know?

Federal Marketplace Website www.healthcare.gov

Consumer Information and enrollment

http://marketplace.cms.gov

Enrollment Assister brochures, videos, training and more information

State BadgerCare Website http://www.dhs.wisconsin.gov/health-care/

Consumer Information and enrollment

DHSHealthCare@dhs.wisconsin.gov

Enrollment Assister Information

Resources