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Health Care Reform in Maryland
Looking Back &
Looking ForwardLeni Preston, [email protected](301) 351-9381
© 2012 Maryland Women’s Coalition For Health Care Reform
Maryland: A National Leader
• Commitment & Leadership
• Pro-Active & Effective Process
• Stakeholder Engagement
© 2012 Maryland Women’s Coalition For Health Care Reform
Health Benefit Exchange Timeline
4/12/2011Governor O’Malley Signed Health Benefit
Exchange Act into
Law
6/3/2011Exchange Board 1st Meeting
9-11/2011 Advisory
Committees Met
1/1/2013 Exchange Must be
Certified by Federal
Government
10/1/2013 Individuals and Groups
Begin Enrolling in Exchange
1/1/2014 Maryland
Health Benefit
Exchange will be
Operational
© 2012 Maryland Women’s Coalition For Health Care Reform
Source: A Report to the Governor and Maryland General AssemblyMaryland Health Benefit Exchange, December 23, 2011, p. 1
Landmark ACA Legislation signed into Law 3/23/2010 by President Obama
General Assembly 2012
• Three Major Bills –Health Benefit Exchange Act of 2012
(SB238/HB443)–Health Improvement & Disparities
Reduction Act of 2012 (SB234/HB439)– Cultural Competency & Health Literacy
– Education Support (HB679)
© 2012 Maryland Women’s Coalition For Health Care Reform
Health Benefit Exchange Act of 2012
What’s An Exchange?An Insurance Marketplace
• Each Plan will be set out with monthly cost and co-pays; plan performance on quality measures; ratings by quality and price
• Compare Apples to Apples and if you can’t decide between a Fuji and a Rome, you can get help through a website, telephone hotline, and navigators
© 2012 Maryland Women’s Coalition For Health Care Reform
• Legislation builds on 2011 legislation to ensure Exchange is operational by 1/1/2014
• Reflects recommendations in the 12/23/2011 Exchange Board report
• Developed through a collaborative and consensus process with stakeholders at the table
• Coalition worked with its partners, legislators, and Carolyn Quattrocki in the Governor’s Office of Health Care Reform to ensure passage
Health Benefit Exchange Act of 2012
The Legislative Process
© 2012 Maryland Women’s Coalition For Health Care Reform
Health Benefit Exchange Act of 2012
Key Provision: Operating Model• 2014-2016 – All carriers can participate;
all plans must be certified by Exchange– Stakeholder Committee will advise Exchange
on appropriate standards
• 2016 – Exchange may propose “active purchasing” strategies (competitive bidding &/or negotiation) to further decrease health care costs and increase quality of health care
© 2012 Maryland Women’s Coalition For Health Care Reform
Health Benefit Exchange Act of 2012
Key Provision: Navigator Program
• The Navigator Program will provide outreach & education to individual consumers & small businesses on:– Eligibility for Medicaid (up to 133% FPL)– Eligibility for financial assistance (133% to
400% FPL) – Tax credits for small businesses – Appropriate health insurance plans
• Navigators will also facilitate enrollment
© 2012 Maryland Women’s Coalition For Health Care Reform
Health Benefit Exchange Act of 2012Key Provision: Navigator Program/
Individual Exchange
• The Exchange will contract with navigator entities (including community-based organizations) to provide all outreach, education, eligibility & enrollment services
• Individual navigators will receive training & certification to conduct outreach & education activities
• Stakeholder Committee will provide expertise & advice on the further design of the program
© 2012 Maryland Women’s Coalition For Health Care Reform
Health Benefit Exchange Act of 2012Key Provision: Navigator Program/
SHOP Exchange
• SHOP Navigator Program will be separate from individual exchange
• SHOP Navigators will be overseen by MIA• Insurance producers/brokers must obtain
authorization and training to sell plans in either the SHOP or individual Exchange
• Producers will be paid by the carriers
© 2012 Maryland Women’s Coalition For Health Care Reform
Health Benefit Exchange Act of 2012
Key Provision: Design of the SHOP• Separate from individual exchange– Serves small businesses - up to 50 employees,
expands to 100 employees in 2016
• Two ways to offer insurance to employees:– Employer picks one carrier & designates plans
from which employee can choose– Employer picks coverage level (platinum, gold,
silver, & bronze) & employee chooses plan from any carrier at that level
© 2012 Maryland Women’s Coalition For Health Care Reform
Health Benefit Exchange Act of 2012
Key Provision: Qualified Health Plans
• Only Qualified Health Plans (QHP) will be sold in the Exchange. These must:– Include the Essential Health Benefit Package– Be certified by the Exchange
• Exchange will also offer stand-alone and bundled qualified dental and vision plans
• Pediatric dental and vision benefits must be part of the Essential Benefit Package
© 2012 Maryland Women’s Coalition For Health Care Reform
Health Benefit Exchange Act of 2012
Key Provision: Financing• Maryland has received over $34 million in
federal grants to fund establishment of the Exchange
• State will submit its request for Level 2 Establishment Grant in June
• ACA requires Exchange to be self-sustaining by 2015
• Joint Executive-Legislative Committee will provide recommendations– Stakeholder Committee will provide
advice • Legislation is expected in 2013
© 2012 Maryland Women’s Coalition For Health Care Reform
Health Benefit Exchange Act of 2012Key Provision: Essential Health
Benefits• Beginning in 2014 - all health insurance
plans sold in and outside the exchanges must include essential health benefits. These will be based upon an existing “benchmark” plan.
• Health Care Reform Coordinating Council working with a stakeholder group will determine what the plan will be. – Decision deadline is September 30, 2012
© 2012 Maryland Women’s Coalition For Health Care Reform
Essential Health Benefits & Behavioral Health
• Behavioral health treatment must be included as one of the 10 essential health benefit categories
• These benefits must be compliant with the Mental Health Parity and Addiction Equity Act (MHPAEA) – Requires that limits or cost-sharing for behavioral health
treatment be no more restrictive than for physical health
• Qualified Health Plans in Maryland will demonstrate compliance with MHPAEA– Plans would demonstrate that cost-sharing, medical management
policies and procedures, or authorization requirements for behavioral health are not more restrictive
• For more information on mental health parity– Contact Adrienne Ellis, Director Maryland Parity Project
[email protected]– Please take our short survey
https://www.surveymonkey.com/s/parityconsumer
© 2012 Maryland Women’s Coalition For Health Care Reform
General Assembly Additional Legislation
• Health Improvement & Disparities Reduction Act of 2012 (SB234/HB439)
• Cultural Competency & Health Literacy – Education Support (HB679)
© 2012 Maryland Women’s Coalition For Health Care Reform
Communications: Framing the MessageWhat Works
• Pre-existing conditions – Insurance plans will no longer deny insurance due to pre-existing conditions & thanks to ACA that’s true for children now
• Security – Those currently uninsured, or worried about job loss and loss of insurance, will have the security of knowing they can go to the Exchange
• Peace of Mind - Members of Congress will be required to get their health insurance from the same Exchanges as everyone else
• Fairness/No Discrimination – Women can no longer be charged higher rates for their insurance than men
Following particularly effective with men:
• Personal Responsibility – Exchange encourages personal responsibility and control over your own health care
• Competition – Insurance costs will come down as competition among insurance companies increases © 2012 Maryland Women’s Coalition For Health Care
Reform
Source: Tips prepared by the Herndon Alliance based on a February 2012 poll.
Communications: Countdown to Coverage
Senator Mikulski’s Women’s Preventive Services Amendment - A win for women!
On August 1, 2012, all new plans must cover preventive care
for women w/o co-pays or deductibles including:• Comprehensive contraceptive care• Screening & counseling for domestic partner
violence• Screening for gestational diabetes• Breastfeeding counseling & equipment • Screening for sexually transmitted diseases• Well women preventive care visits
http://countdowntocoverage.org/storage/countdown-resources/CtC%20checklist%20-%20Affordable%20Prevention%20Care%20-%20FINAL.pdf
© 2012 Maryland Women’s Coalition For Health Care Reform
Communications: Learn More
• Office of Health Care Reform Website http://www.healthreform.maryland.gov/
• Coalition-sponsored Forums – Reform. It’s Good For Your Health – Health Care. Women of Color Get It on
September 8, 2012 in Baltimore
• HealthCare Access Maryland (HCAM) Forum– For CBOs in Baltimore City & Metro Area to
get the latest information on health care reform, the Navigator Program, and more – June 13, 2012
– Call 410.649.0519 for more information
© 2012 Maryland Women’s Coalition For Health Care Reform
Looking Forward: Coalition Priorities
• Making the Exchange Work for Consumers
• Health Equity – “The nation is either making no progress or is heading in the wrong direction in reducing racial, ethnic, and income-related disparities in access to care.” – Forum – Health Care. Women of Color Get It –
September 8, 2012– Issue Brief – Health Equity: Maryland’s Call To
Action – Release date – September 8, 2012– Maryland’s State Health Improvement Process
www.dhmh.state.md.us/ship
Source: Agency for Health Research & Quality (AHRQ)
© 2012 Maryland Women’s Coalition For Health Care Reform
Get Involved: Make A Difference
• Coalition Initiative – Outreach to Groups Representing Women of Color
• Forums• State Health Improvement Process &
Local Health Improvement Coalitions http://dhmh.maryland.gov/ship/SitePages/Home.aspx
• Share Our Stories
© 2012 Maryland Women’s Coalition For Health Care Reform
Resources You Can Use
• Maryland – Health Benefit Exchange
www.dhmh.maryland.gov/healthreform/exchange/index.html
– Department of Health & Mental Hygienewww.dhmh.maryland.gov
– Maryland Health Insurance Plan (MHIP)www.marylandhealthinsuranceplan.state.md.us
– Health Care Reform Coordinating Councilwww.dhmh.maryland.gov/healthreform/index.html
• Federal– Department of Health & Human Services
www.healthcare.gov© 2012 Maryland Women’s Coalition For Health Care
Reform
Stay Informed & Get Involved
• Join the Coalition– Newsletters, Alerts, Member Calls & Webinars– Educational forums:
September 8th in Baltimore
– Facebook and Twitter
• Encourage others to joinMDHealthCareReform.org
© 2012 Maryland Women’s Coalition For Health Care Reform
Contact Us
• Leni Preston, Chair [email protected]• Sandy Kick, Health Policy Analyst – Issue
Brief & Forum [email protected]• Jamie Shopland – Outreach & Education
MDHealthCareReform.org
© 2012 Maryland Women’s Coalition For Health Care Reform
Copyright 2011 Maryland Women’s Coalition For Health Care Reform
Copyright 2011 Maryland Women’s Coalition For Health Care Reform
Everyone Call in to 712-432-1690
access code 841045#please for the voice portion
of the webinar
Copyright 2011 Maryland Women’s Coalition For Health Care Reform