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The Arkansas Health Connector and Arkansas's Approach to Implementing the
Health Insurance Marketplace*****
Developmental Disabilities Provider AssociationSeptember 10, 2013
*****
Cindy Crone, Deputy CommissionerBruce Donaldson, Accounts Specialist
Arkansas Insurance Department, Arkansas Health Connector Division
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What is a Health Insurance Marketplace (Exchange)?
• Competitive marketplace where individuals, families and small employers can shop for, select and enroll in high quality, affordable private health plans that meet their specific needs at competitive prices.
• Marketplaces will also help eligible individuals receive premium tax credits and cost sharing reductions or help them enroll in other state or federal public health programs.
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Enrollment OptionsHow?• Internet• Phone• In-Person• Mail
Who can help?• Agents and Brokers• Guides• Navigators• Certified
Application Counselors
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Status of Marketplaces
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State-Based MarketplaceState-Based Marketplace (SHOP only)Partnership MarketplaceFederal Marketplace
State Partnership Marketplace
Plan Management• Certify/Decertify QHPs for Marketplace• Monitor Plans – Prices, Benefits, Networks, Non-
Discriminatory Design, etc.
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Uninsured
Those without insurance coverage in Arkansas number 550,000.
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Health Care Independence Act of 2013“Private Option”
A concept embraced and supported by Governor Beebe and the Republican Leadership as a way to cover more low-income Arkansans with insurance but not grow the Medicaid Program
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Arkansas’s “Private Option”• Private Option eligible Arkansans will enroll in private
insurance plans doing business on the Marketplace.
• Allows Medicaid dollars to pay 100% of premiums; some Medicaid “wraps” for services (Federal dollars pay 100% for first three years; 90% by 2020).
• No deductibles; no other cost-sharing for those under 100% FPL in the first year. After the first year, those between 50% - 100% of FPL will likely have some cost-sharing.
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Federal Approval
• Arkansas needs to obtain a waiver from the federal government to operate the Private Option.
• The Arkansas Department of Human Services has submitted the waiver.
• Approval is expected soon.
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Money infusion
• More than $1 billion a year in federal money will come into Arkansas a result of the Private Option.
• Money comes from increased Medicaid expenditures paid toward private plan premiums.
• Businesses, especially health care providers, will benefit greatly.
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Private Option Eligible Individuals in 2014
• Childless adults between 19-64 with incomes below 138% FPL
• Parents between 19-64 with incomes between 17% and 138% FPL
• Those not on Medicare and not disabled
• Those determined to not be more effectively covered under the standard Medicaid program, such as persons with complex medical conditions requiring a high level of care coordination.
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Arkansas Health Insurance Marketplace
• Expected enrollment in 2014 about 460,000, including Private Option population.
• An estimated 211,000 >138% FPL will enroll.
• An estimated 250,000 <138% FPL will enroll.
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Stakeholder Engagement
The AID has long sought to build relationships with those affected by the ACA, specifically through the Arkansas Health Connector Division.
We have representatives from the insurance industry, health care providers, community activists, and the Legislature, among others on our advisory committees.
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Cooperation
• AID has worked diligently with numerous agencies to prepare for open enrollment and to implement the Private Option, a first-ever program of its kind.
• Those agencies include Human Services, Health, Arkansas Center for Health Improvement, and the Department of Higher Education.
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Committees
• Steering Committee
• Plan Management Advisory Committee
• Consumer Assistance Advisory Committee
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Stakeholder Input
• The advisory committees have offered valuable assistance, helping Arkansas tailor the Marketplace to best serve your constituents.
• The benchmark plan, habilitative services, regional rates, service areas, and tobacco upcharges were all shaped locally with stakeholder input.
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Qualified Health Plan (QHP) Benefits• Must meet at least 60% Actuarial Value • Must provide Essential Health Benefits
Outpatient Services Hospitalization Emergency Services Maternity and Newborn Care Mental Health and Substance Use Disorder Treatment Prescription Drugs Rehabilitative and Habilitative Services/Devices Laboratory Services Preventive, Wellness, and Chronic Disease
Management Pediatric Services, Including Oral and Vision Care
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Habilitative Services
• The Steering Committee approved the definition and coverage scope of Habilitative Services in January, 2013, affirming the recommendation of the Plan Management Advisory Committee in December 2012.
• Commissioner Bradford adopted the recommendations.
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Coming together
• An ad hoc committee of healthcare providers and insurers worked together in spirited meetings to propose acceptable definitions.
• Consumers weighed in.
• Staff worked closely with David Ivers and other advocates and healthcare professionals to craft language acceptable to the provider and consumer communities.
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Definition
“Habilitative Services are services provided in order for a person to attain and maintain a skill or function that was never learned or acquired and is due to a disabling condition.”
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Scope of Coverage
“Subject to permissible terms, conditions, exclusions and limitations, health benefit plans, when required to provide essential health benefits, shall provide coverage for physical, occupational and speech therapies, developmental services and durable medical equipment for developmental delay, developmental disability, developmental speech or language disorder, developmental coordination disorder and mixed developmental disorder.”91013
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Collaboration
• The debate regarding Habilitative Services is a prime example of how Arkansas stakeholders of various interests worked together to conceive a policy best for Arkansans.
• Demonstrates the wisdom of keeping the Partnership model as opposed to defaulting to the Federal model.
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Certification
The habilitative services definitions were applied during the plan certification process.
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Where are we Now?
• Qualified Health Plans and Stand-Alone Dental plans were reviewed for compliance with QHP criteria and submitted on the July 31 deadline to the federal government for approval.
• We expect to hear back on our recommendations and know more about rates this month.
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Guide Organizations
• 26 organizations have contracts with AID to serve as Guide Organizations.
• Approximately 300 Guides have completed Phase I Training by AATYC.
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Guide Assisters
• We anticipate having 537 across the state for open enrollment, which starts October 1.
• Will serve each county in the state.
• 22 two-year colleges and one-four year college across the state are helping train the IPAs.
• This activity is occurring in many of your counties and helping local economies.
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Other Types of Assisters
• Agents and brokers
• Navigators
• Outreach and Education Workers
• Certified Application Counselors
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Outreach and EducationBroad multi-media campaign across Arkansas
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Video
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Statewide Campaign
• Working hard to make sure people in each county learn about their insurance options.
• Marketing campaign reaches across the state.
• Goal is to visit each county seat.
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Touching Arkansas
• From July 1 to August 20, there have been 179,000 total visits to the website (www.ARHealthConnector.org) including 156,000 unique visitors.
• During July more than 64 million media impressions were made across the state using television, radio, billboards, Internet, local newspaper and other media.
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Other outreach
• Arkansas Health Connector Resource Center, 855-283-3483
• Speakers Bureau, in partnership with the Arkansas Department of Health and the University of Arkansas
• Enrollment events across Arkansas
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Act 1500
Arkansas Health Insurance Marketplace Act
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• Creates the pathway for Arkansas to set up a State-Based Marketplace.
• Structure would be a “non-profit legal entity” that is also a “political subdivision, instrumentality, and body politic of the State of Arkansas.”
• Would NOT be a state agency.
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• July 1, 2015, is the earliest date the Partnership’s functions would transfer to the State Marketplace.
• The decision is up to the Board whether or not to pursue the changeover.
• The Board may extend that deadline if it chooses.
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• Starting July 1, 2015, the Board may apply for and spend any grant to assist with the implementation of the Marketplace.
• Before July 1, 2015, the Insurance Department may apply for such grants to help with development of the Marketplace.
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October 1, 2013 is Very Soon!Full Coverage January 1, 2014
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Who Can Shop in the Marketplace?
• Individuals and Families
• Businesses with 50 or fewer full time equivalent (FTE) employees.
– Businesses with 100 or fewer FTE employees will be Marketplace eligible as soon as 2016.
– Businesses with more than 100 employees will be Marketplace eligible at State option beginning in 2017.
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Premium Tax Credit Eligibility
• Household income 139% - 399% FPL
• Enrolled in a QHP through the Exchange
• Lawfully present
• Not incarcerated post conviction
• Not eligible for other coverage such as Medicare, Medicaid, or affordable employer-sponsored insurance.
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Premium Limits Based on IncomeINCOME PREMIUM LIMIT
0 - 138% FPL (Medicaid Expansion) 0100 - 138% FPL (non-Medicaid eligible) 2% of income138 – 149% FPL 3 – 4% of income150 – 199% FPL 4 – 6.3% of income200 – 249% FPL 6.3 – 8.05% of income250 – 299% FPL 8.05 – 9.5% of income300 – 399% FPL 9.5% of income
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2013 Federal Poverty Guidelines
FAMILY SIZE 100% 138% 200% 400%
1 $11,490 $15,856 $22,980 $45,960
2 $15,510 $21,404 $31,020 $62,040
3 $19,530 $26,951 $39,060 $78,120
4 $23,550 $32,499 $47,100 $94,200
5 $27,570 $38,047 $55,140 $110,280
6 $31,590 $43,594 $63,180 $126,360
7 $36,610 $49,142 $71,220 $142,440
8 $39,630 $54,689 $79,260 $158,520
For each Additional person, add $4,020 $5,347 $8,040 $16,080
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What Are Employer Requirements?
• No coverage requirement for employers with fewer than 50 full time equivalent (FTE) employees (>30 hours a week).
• If > 50 FTE employees, employers must provide affordable insurance options for full time employees ‐beginning in 2015.
• Grandfathered plans are continuing plans that covered employees on or before March 23, 2010.
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Few Businesses Affected
According to an analysis by CNN, Fortune and Money magazines, of the 6.5 million workplaces in the United States, only about 71,000 must take action and provide insurance.
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Why?
• Only businesses with at least 50 or more employees must provide insurance under the ACA.
• There are about 200,000 such businesses nationally and many of those already provide insurance.
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What are Employer Penalties?
• If fewer than 50 FTEs, no penalty.
• If >50 FTEs, must offer affordable coverage (< 9.5% of wages for individual premium portion) of at least 60% actuarial value beginning in 2015.
• Penalties beginning in Plan Year 2015 if employee(s) get subsidy on Marketplace– $2,000 per employee (after first 30) if not offering coverage– If offering coverage, $3,000 per each employee that has
unaffordable option or coverage at <60% actuarial value.
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Small Business Tax Credit
The Small Business Health Care Tax Credit significantly helps small businesses comply with the ACA by offsetting some of the cost increases that may come with providing quality and affordable health insurance to employees.
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How does it work?
To be eligible for the credit, businesses must:
• Have fewer than 25 full-time equivalent employees
• Cover at least 50 percent of the premium cost of an individual plan for employees
• Pay average wages of less than $50,000 a year.
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• The Small Business Health Care Tax Credit equals a maximum of 35 percent of the costs incurred by small business employers (25 percent for small tax-exempt employers) toward premiums for their employees.
• Tax exempt employers receive credit through a payroll refund.
• On top of that, employers may continue to claim tax deductions for the insurance costs not covered by the credit.
• The credit took effect for tax year 2010 and continues through tax year 2013.
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• In 2014, the credit increases to 50 percent.
• The credit increases to 35 percent for small tax-exempt employers.
• Employers receive the credit only if they provide insurance to employees through SHOP.
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Contact
www.ARHealthConnector.org855-283-3483
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