Embed Size (px)
Citation preview
PRESENTED BY PORTICO
HEALTHNET
Public Health Care Programs in Minnesota – Changes With
Health Reform
2
Health Access Line
Portico Healthnet operates the 489-CARE line
(866-489-4899)
Callers throughout the state can access information about low-cost medical, dental and mental health resources.
Uninsured callers are transferred to Portico’s Community Health Workers for assistance in applying for Minnesota Health Care Programs or Portico coverage
3
Outreach Program
Our Community Health Workers (CHWs) screen for potential eligibility for Minnesota Health Care Programs and MNSure plans
CHWs assist with the application and enrollment process
Our staff provide linguistically and culturally appropriate information and referrals for the diverse groups we serve.
4
Portico Healthnet Coverage Program
Prevention-basedProvides coverage for a comprehensive
continuum of services, including:- Primary and preventive medical care- Specialty and urgent clinic care- Outpatient mental health services- Prescription medications/DME- Interpreter services for medical appointments
Care management component helps participants manage their health and navigate complicated health care systems
5
Eligibility Guidelines for Portico Coverage
Resident of Dakota, Ramsey, Hennepin or Washington county
UninsuredNot eligible for Minnesota Health Care
ProgramsIncome at or below 275% FPL
($63,408 per year for family of 4)
6
Minnesota Health Care Programs
Medical Assistance For single adults, families, people over 65, people with disabilities You must meet income and asset limits to be eligible Applications are processed through the county where you live No cost
7
Minnesota Health Care Programs
MinnesotaCareo For adults without children and
familieso You must meet income and asset
limits to be eligibleo There are rules about other health
insurance available to youo Income limits higher than
Medical Assistanceo You must pay a monthly fee
to be enrolledo Application processed by the state
8
MHCP and Immigration status
Minnesota Health Care Programs are not available to everyone. Immigration status affects whether you can qualify Citizens, refugees, and some permanent residents can qualify People who are undocumented, people with visas, and people with
work authorizations usually don’t qualify. In case of an emergency health need, people who don’t usually
qualify might be eligible for Emergency Medical Assistance to cover a hospital stay or an ER visit.*
*Must meet all other Medical Assistance eligibility guidelines
9
Over 60% of uninsured Minnesotans are eligible for a state-funded health coverage program
Medical Assistance
MinnesotaCare
2011- 490,000 uninsured in MN
Barriers to MHCP enrollment:
Awareness of eligibility
Complexity of the application process
Documentation required
Communication with case workers
10Who will enroll through MNSure?
1.1 million Minnesotans
300,000 previously uninsured
October 1, 2013
Open Enrollment began
January 1, 2014
Coverage began
MNSure: Minnesota’s Health Insurance
ExchangeOnline marketplace where people
can find health coverage Enroll in public health care
programsCompare and purchase private
insuranceTax credits for private insuranceSmall Employers
11
Applying for Coverage Through MNSure
• Streamlined online application
Streamlined verifications
Renewal improvementsNo asset testNew method for
counting income
12
MAGI
Modified Adjusted Gross Income
MAGI methodology will be used to determine eligibility for certain Medicaid groups and for Advanced Premium Tax Credits (APTC)
Affects household composition for certain Medicaid groups
13
MA Expansion
Effective January 1st, 2014 Income limit for adults is 138% FPL* ($1,316/month for 1 person)Will continue to cover childless adults, parents and 19 and 20 year
oldsNo asset limit
*Income limit is actually 133% FPL but there is a 5% income disregard which brings the limit to 138% FPL
Previously no asset test for MA-Expansion group or 19 and 20 year olds. Parents previously had $20,000 asset limit.
Parents and 19&20 year olds previously have 100%FPL limit for MA
Income limit for children 0-18 is now 275% FPG
14
MinnesotaCare Basic Health Plan
o 2014 Income limit=200% FPLo Income limit was previously 275% FPL for
parents so this is a step back for themo Remove $10,000 inpatient hospital capo Remove 4 month and 18 month insurance
barrierso Remove asset limito Will follow Minimum Essential Coverage
Guidelineso Affordability- cost no more than 9.5% of
income for self-only coverageo Plan must cover 60% of the Actuarial Value
o Comply with premium guidelineso Lower premiums
o Use MAGI methodology instead of gross income
o No more sponsor income or asset deeming for LPR’s
15
Advance Premium Tax Credits
Individuals with household incomes up to 400% FPG will now be eligible to receive Advance Premium Tax Credits to help them purchase private insurance through the Health Exchange-MNSure Household of 1: $45,000/year Household of4:
$92,000/yearIf individual has access to
Minimum Essential Coverage they are not eligible to receive APTC’s
16
Quality Benefits/Standards for MEC
HospitalizationsAmbulatory ServicesEmergency ServicesPrescription DrugsLaboratory ServicesMaternity and Newborn Care (Pregnancy,
childbirth and breast-feeding support)Pediatric Dental and Vision servicesMental and behavioral health
17
Free Preventive Services
Vaccinations and flu shotsBlood pressure and diabetes screeningsCancer screenings: Mammograms and
Colonoscopies
18
Out of pocket maximums
Everyone who buys coverage through MNsure will have a cap on their total out-of-pocket spending (includes deductibles, co-pays, co-insurance) for covered services offered by in-network providers Maximum for individual is $6,350
Maximum for family is $12,700
Some plans offer lower out-of-pocket maximum costs
19
Options for Coverage in 2014
MNSure:
0% 138%~1,322/mo for HH of 1~2,611/mo for HH of 2
Medical Assistance
MinnesotaCare
Private InsuranceWith APTC’s Private
Insurance
200%~$1,915/mo for HH of 1~$3,255/mo for HH of 4
400%~$3,330/mo for HH of 1~$7,850/mo for HH of 4
Children 0-18 will be eligible for MA up to 275%FPGThis does not apply to non-MAGI populations
275% ~$3,468/mo HH of 2~$5,284/mo HH of 4
Children 0-18 Medical Assistance APTC’s
Adults
Children 0-18
20
Plan Levels of Coverage
Levels of Coverage Plan Pays on Average Enrollees Pay on Average (in addition to the monthly plan premium)
Bronze 60% 40%
Silver 70% 30%
Gold 80% 20%
Platinum 90% 10%
21
When can you enroll?
Initial open enrollment runs October 1, 2013 through March 31, 2014
Annual open enrollment periods after that run October through December
Special enrollment periods available in certain circumstances throughout the year
Members of federally-recognized tribes may enroll or change plan designations one time per month
Small employers can enroll/renew throughout the year at one time of their choosing
Individuals may apply and be eligible for Medicaid throughout the year
22
Individual Mandate
Must have Minimum Essential Coverage or may be subject to a penalty*
Some exemptions granted for religion, tribal membership, cost of insurance, and some other reasons.
Year Penalty Amount
2014 $95 or 1% of income
2015 $365 or 2% of income
2016 $695 or 2.5% of income
23
Navigator Role and In Person Assistor Roles
New service required by ACA, provided through the state Health Exchange. Incorporates outreach and enrollment assistance roles
Portico’s Community Health Workers and Care Management Coordinators are certified Navigators and IPA’s
MNSure’s website has a list of all certified Navigators, IPA’s and brokers in the state.
Navigators and IPA’s perform same duties, difference has to do with programs they facilitate enrollment for, funding sources and per-enrollment compensation.
24
Portico’s Navigators
We are on-site offering application and enrollment assistance at over 10 community sites
Computer bank events
We accept new clients from anywhere in the state.
25
Eligibility Tool
Simple tool to give people an idea of possible eligibility
To determine actual eligibility a person should go to MNSure, a Navigator or Broker.
26
Portico Healthnet’s mission is to reduce the number of people without coverage for health care services.Rebecca LozanoOutreach Program [email protected]
Sara CaseyOutreach Program [email protected]
Portico Healthnet2610 University Ave W #550
Saint Paul, MN 55114
651-489-CARE(2273)
