Kentucky Health Benefit Exchange Snapshot

Kentucky Health Benefit Exchange SnapshotKentucky Health Benefit Exchange Snapshot

KMAKMA Presentation Winter Update Kentucky Health Benefit Exchange

Kentucky Health Benefit Exchange

Disclaimer

KMAKMA Presentation Winter Update Kentucky Health Benefit Exchange

Current Current State of ExchangesState of Exchanges

(Kaiser) (Kaiser)


Cabinet for Health and Family Services(CHFS)


Letters of Intent•Anthem •Bluegrass Family Health•Humana X*•United Health Care•KY CO-OP

Coventry CaresHumana CareSourcePassportWellCare Others – Anthem, etc.

*regional plan

Large Employers

2015

Expansion Expansion 308,000 uninsured may gain Medicaid and will include:

Adults 19-64 with income under 138% of the FPL and not covered under current Medicaid eligibility criteria

Former foster care children up to age 26

Request for Proposal (RFP) for Medicaid expansion must be submitted by July 22, 2013

Bids will be for new vendors and will exclude Region Three MCOs currently under contract outside of Region Three (WellCare and

Coventry) will have an opportunity to amend their current contract.

In place – January 1, 2014

Medicaid

Household Size/FPLHousehold Size/FPL100%100% 138%138%1 $11, 4901 $11, 490 $15,856$15,8562 $15,4102 $15,410 $21,404$21,4043 $19, 5303 $19, 530 $26, 951$26, 9514 $23, 5504 $23, 550 $32, 449$32, 449


MAGI Premium Cost

Proposed Rule:Eligibility evaluations for premium tax credits and Medicaid eligibility will be based on the “honor system” and will be performed manually by the state exchanges rather than being based on IRS data provided to the exchanges through the new federal data hub.

8


50 or less

FTE


10


More than 50 FTE

Delayed - 2015

Cabinet for Health and Family Services(CHFS)



Kentucky Health Benefit Exchange Level Percentage of Medical

Expenses

Bronze 60%

Silver 70%

Gold 80%

Platinum 90%

Kentucky Health Benefit ExchangeBenefit Benefit

Ambulatory patient services Emergency services

Hospitalization Maternity and newborn care

Mental health and substance use disorder services, behavioral health

Prescription drugs

Rehabilitative and habilitative services and devices

Laboratory services

Preventive and wellness services and chronic disease management

Pediatric services including oral and vision care

*KCHIP


Navigators - Individuals or Entities that:Navigators - Individuals or Entities that:

•May include: Community/consumer-focused nonprofit groups, Chambers of commerce, resource partners of Small Business Administration, Health Care Providers, etc.

•Maintain expertise in eligibility, enrollment and programs;Provide information/services in fair, accurate, impartial way;Facilitate selection of Qualified Health Plans (QHPs); and

•Provide referrals to any applicable office, health insurance consumer assistance or ombudsman, or State agency for grievances, complaints, or questions about health plan.

16


ACA – Affordable Care Act

CHFS – Children and Family Services

E&E – Eligibility and Enrollment

EHB – Essential Health Benefits

KHBE – Kentucky Health Benefit Exchange

IT – Information Technology

MAGI – Modified Adjusted Gross Income

MCO – Managed Care Organization

QHP – Qualified Health Plan

SHOP – Small Business Health Option Program


http://healthbenefitexchange.ky.gov/

www.kyma.org


www.glms.org

Kentucky Medical AssociationLindy Lady, CPC, CPCOManager, Medical Business Advocacy4965 US Highway 42Suite 2000Louisville, KY 40222-6301502 426-6200/Extension [email protected]

Questions?



Documents

Kentucky Health Benefit Exchange Snapshot