STUDY OF THE IMPACT OF THE ACA IMPLEMENTATION IN KENTUCKY

Quarterly Snapshot: April - June 2015

The Study of the Impact of the Affordable Care Act (ACA) on Health Coverage,

Access, Quality, Cost, and Outcomes in Kentucky, funded by the Foundation for

a Healthy Kentucky, is a three-year mixed methods study is conducted by the

State Health Access Data Assistance Center (SHADAC), a health policy research

institute at the University of Minnesota. As part of the Study, the research team

produces Quarterly Snapshots to track ACA implementation indicators in a timely

way. Sources and technical notes are included on page 5. Please visit us at:

http://healthy-ky.org or follow us on twitter @healthyky and @shadac.

2

Newly coveredCHILDREN (<18)

Newly coveredADULTS (18-64)234,000 16,000

2013 2014554,000

320,000

60,00044,000

Uninsurance rates dropped for children and adults in Kentucky from 2013 to 2014. New data from the Census Bureau make these estimates possible.

0%

5%

10%

15%

20%

25%

December 2013 December 2014June 2014 June 2015

17.1%

12.9%11.4%

20.4%

11.9%

9.8%9.0%

15.4% 13.4%

12.5%10.2%

U.S. Kentucky Neighboring States

Compared to the nation and its neighboring states (IL, IN, MO, OH, TN, VA and WV), Kentucky experienced a larger drop in uninsurance rates for adults ages 18+ from 2013 to 2015.

COVERAGE AND COST

Numbers of Newly Covered

Uninsurance Rates

2nd Quarter 2015

Percentage Point Drop in Uninsurance2013 to 2015

5.7

11.4

5.2

Neighboring States U.S. Kentucky

This is the second Quarterly Snapshot produced under the Study of the Impact of the ACA Implementation in Ken-tucky. All sections have been updated with new data and/or data points since the first Quarterly Snapshot.

3

KHIP REGIONS

Greater LexingtonWestern KentuckyGreater LouisvilleNorthern KentuckyEastern Kentucky

Fulton

Hickman

Carlisle

BallardMcCracken

GravesCalloway

Marshall

Livingston

Lyon

Christian

Trigg

Hopkins

MetcalfeWarren

Allen

Muhlenberg

HartButler

Ohio

Logan

Simpson

McLeanWebster

Caldwell

Todd

Crittenden

Edmonson

JohnsonBreckinridge

Floyd

Henderson

Marion

WashingtonNelson

Daviess

MeadeHancock

UnionHardin

Larue

Monroe

Barren

Grayson

Lee

Breathitt

Leslie

Owsley

Harlan

Bell

Knox

Clay

JacksonRockcastle

LaurelPulaski

Casey

WhitleyMcCrearyWayne

Clinton

Cumberland

Russell

Adair

Taylor

Green Perry

Morgan

Magoffin

Menifee

Letcher

Wolfe

Knott

Harrison

Nicholas

Bourbon

Clark

Fayette

Nicholasville

Mercer

Boyle

Lincoln

Garrard

Madison

Powel

Estill

Martin

Pike

Robertson

Fleming

Lewis Greenup

CarterBoyd

LawrenceElliott

RowanBath

Montgomery

Franklin

Anderson

Woodford

Mason

Scott

Kenton Campbell

Pendleton

Owen

Grant

Gallatin

CarrollTrimble

Jefferson

OldhamHenry

Shelby

SpencerBullitt

Boone

Bracken

MEDICAIDChild Medicaid Enrollment

Of all Kentucky children enrolled in Medicaid during the past quarter (April-June 2015)...

Medicaid Preventive Services

Diabetes screening

Hepatitis C screening

Breast cancer screening

Colorectal cancer screening

4,857 1,181 10,191 6,516

During the past quarter (April-June 2015), Medicaid cov-ered thousands of needed services for traditional in-come-based and ACA Medicaid expansion enrollees ages 19 to 64.

2nd Quarter 2015

Substance Abuse Treatment Services

29% live in Eastern Kentucky 27% live in Western Kentucky 20% live in Greater Louisville 16% live in Greater Lexington 8% live in Northern Kentucky

Medicaid Dental Visits (April-June 2015)

SNAPSHOT HIGHLIGHT

6,600 treatment services were provided to traditional income-based and expansion enrollees ages 19-64.

Adults(Ages 19-64) Other

Dental Visits

Children(0-18)

Preventive Dental Visits

Adults(Ages 19-64)

Children(0-18)

41,304

42,617

Medicaid includes dental coverage for children as a mandatory benefit, but states have the option of whether to offer dental coverage to adults. Kentucky opted to include adult dental coverage in Medicaid, covering limited care.

ACA Medicaid Expansion 9,003Traditional Income-Based Medicaid 1,188

Breast Cancer Screening Breakout

6,600

5-10%10-15%15-20%20-25%25%+

4

20%21%Bronze

53%

68%Silver

7% 14%

Gold

12%3%

Platinum

Kentucky United States

69.8%

83.7%Percent of Enrollees

receiving APTCs

$223

$270Average

Monthly APTCKY U.S.

2nd Quarter 2015

KYNECTMarketplace Enrollment by Metal Level

Advance Premium Tax Credits Cost-Sharing by Metal Level

60% 40%

Bronze

70% 30%

Silver

80% 20%

Gold

90% 10%

Platinum

Health Plan Consumer

Advance premium tax credits (APTCs) help reduce premium costs for people who purchase coverage through kynect. APTCs are available to those with low to moderate incomes.

Health Plan Rate Changes (2016)

Rate IncreasesAnthem 12.2%CareSource Kentucky Co. 11.8%Humana 5.2%Rate DecreaseWellCare Health Plans -10.98%New Plans on kynectAetna N/ABluegrass Family Health N/AUnitedHealthCare N/A

Metal levels reflect the different premium and cost-sharing arrangements available through the marketplace.

During the 2nd quarter, insurance carriers requested 2016 rate changes from the Kentucky Department of Insurance. Here are the approved changes for plans sold on kynect starting November 1. Actual premiums depend on age, county, smoking status, family size, and subsidies.

Although the 2nd quarter was not part of an open enroll-ment period, kynect (non-Medicaid) enrollment figures were updated at the end of the quarter, and included updat-ed information on metal levels and subsidies for enrollees.

Health Plan Changes for OEP3

5

2nd Quarter 2015

This is the second Quarterly Snapshot produced under the Study of the Impact of the ACA Implementation in Kentucky. All sections have been updated with new data and/or data points since the first Quarterly Snapshot.

Uninsurance Rates and Percentage Point Drop in Uninsurance: Gallup-Healthways Well-Being Index, data through June 30, 2015. Gallup produces state-level estimates of coverage twice a year. The uninsurance esti-mates are derived from the following survey question: “Do you have health insurance coverage?” Notes: SHADAC calculates the “neighboring states” esti¬mate by averaging Gallup’s published uninsurance rates for IL, IN, MO, OH, TN, VA, and WV. The estimates presented here are for adults ages 18 and older. Numbers of Newly Covered by Age: SHADAC analysis of the 2013 and 2014 American Community Survey.

Medicaid Enrollment and Services Indicators: SHADAC analysis of data provided by the Kentucky Cabinet for Health and Family Services (CHFS). Notes: For service utilization counts, we include only traditional income-based Medicaid and ACA expansion Medicaid enrollees ages 19 to 64. For map, we include traditional income-based Medicaid and ACA expansion Medicaid enrollees ages 0 to 18. We exclude special enrollee categories: Medi-care-Medicaid dual eligible; foster, former foster, and kinship care; intermediate care facility, nursing home, and hospice populations; Medicare savings and special populations; SSI recipients; waiver populations, or incomplete claims that do not show enrollee category. Services are calculated based on claims data with dates of service from 4/1/15-6/30/15, retrieved on 9/22/15 by CHFS.

Metal Levels: SHADAC analysis of data from the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, “June 30, 2015 Effectuated Enrollment Snapshot.” Notes: Catastrophic plans are excluded from the graphic; these represented about 1% of the total.

kynect Rate Changes: from Kentucky Department of Insurance, as reported in https://www.healthinsurance.org/kentucky-state-health-insurance-exchange/.

Advance Premium Tax Credits: SHADAC analysis of data from the U.S. Department of Health and Human Ser-vices, Centers for Medicare and Medicaid Services, “June 30, 2015 Effectuated Enrollment Snapshot.” Note: APTCs are available to individuals between 100-400% of the Federal Poverty Level, although in Medicaid expan-sion states like Kentucky, individuals between 100-138% of the Federal Poverty Level, are eligible for Medicaid and therefore not eligible for APTCs.

Cost-Sharing by Metal Level: “What the Actuarial Values in the Affordable Care Act Mean,” Kaiser Family Founda-tion, April 2011. Available at www.kff.org.

Quarterly Snapshot Technical Notes