Monthly Affordable Care Act (ACA) Webinar Series October 10, 2013
Purpose We strive to provide objective updates of useful information as the ACA moves into a key phase of implementation over the coming months. 2013-2014 Webinars
Today’s Objectives 1. Provide an update on ACA Healthcare Insurance Exchanges 2. Provide an update on ACA Healthcare Insurance Navigators and Certified Application Counselors in Ohio. 3. Provide an update on Medicaid expansion and changes in Ohio.
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November 14
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December 12
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January 9
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February 13
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March 13 1
Today’s agenda •
Welcome & Introduction -Jeff Biehl, Access HealthColumbus
• Update on Healthcare Insurance Exchanges -Doug Anderson, Bailey Cavalieri LLC
• Update on Navigators and Certified Application Counselors (CAC) -Isi Ikharebha, Physicians CareConnection
• Update on Medicaid Expansion -Jeff Biehl
• Q&A
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By 2020… not 1/1/2014
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Healthcare Insurance Exchanges
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Healthcare Insurance Exchanges October 1st: Exchanges open for business; people can shop for and enroll in coverage. January 1st: Coverage bought before Dec. 15 becomes effective
March 31st : Open enrollment for 2014 ends; after March 31st, coverage is not available until the next open enrollment period except for “special enrollments� (eg., loss of a employment and coverage) October. 15, 2014: Open enrollment for 2015 begins
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Enrollment Process Spanish version delayed until 11/1
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The Exchange in Central Ohio
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Counties: Delaware, Fairfield, Fayette, Franklin, Knox, Licking, Logan, Madison, Pickaway, Union
5 companies will offer exchange plans in Central Ohio
Total qualified health plans: 32 –
Catastrophic plans: 3
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Bronze plans: 11
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Silver plans: 10
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Gold plans: 8
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Platinum plans: 0 Source: US Department of Health & Human Services
Central Ohio: Monthly Base Premiums (before subsidy)
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Lowest cost for catastrophic coverage
Lowest cost for a gold plan
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25 year old: $144.23
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25 year old: $234.57
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40 year old: $183.60
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40 year old: $298.59
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55 year old: $320.36
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55 year old: $521.02
Lowest cost for a bronze plan –
25 year old: $196.28
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40 year old: $249.85
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55 year old: $435.96
Lowest cost for a silver plan –
25 year old: $187.36
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40 year old: $238.49
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55 year old: $416.14 Source: US Department of Health & Human Services
Provider Networks Average Premium Cost Highest
Lowest
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Plan Molina
Mt. Carmel
OhioHealth
OSU
Will have one hospital in network
Medical Mutual
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Anthem
X
CareSource
Source: Columbus Dispatch, October 7, 2013
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X
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Delayed Rules
SHOP Exchange enrollment delayed until November 1
Spanish-language individual exchange delayed until November 1
Employer mandate and employer reporting requirements
Employee choice of plans in the SHOP Exchange
Coordinated out-of-pocket spending limits for medical and dental plans sold by separate companies
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Navigators and Certified Application Counselors (CAC)
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Navigators & Certified Application Counselors Overview
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Consumer Assistance Funding State-Based Exchange
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State-Partnership Exchange Federally-Facilitated Exchange
16 States + DC
8 States
26 States
Consumer assistance entities: 319
Consumer assistance entities: 107
Consumer assistance entities: 85
Total Funding: $161,191,503
Total Funding: $62,446,474
Total Funding: $53,793,991
Funding per uninsured person: ~$11
Funding per uninsured person: ~$16
Funding per uninsured person: ~$2
The federal government distributed a total of $67 million in Navigator grants to Partnership and FFE states Source: Manatt Health Solutions
Certification Process: Navigators
Navigators –
Individuals hired by certified organizations
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Navigators in Ohio are required to receive federal funding
Navigator must complete online training session
Takes 20 hours to complete
Ohio Association of Foodbanks (OAF) having navigators train for 40 hours
OAF navigators completed federal government certification on October 1
Ohio Department of Insurance has not certified any navigators to operate in Ohio
Certification Process: Certified Application Counselors
Certified Application Counselors –
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Individuals enter into agreement with certified organizations
Memorandum of understanding provided by federal government
Orgs have no limit on how many CACs they can register
Orgs will be fined if patient privacy is breached
Individual must complete online training session
Given access # by certified organization
Takes ~6-8 hours to complete
Requires 80% to pass
Certification must be renewed every 12 months
Enrollment Collaboratives
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ONCE (Ohio Network for Health Coverage and Enrollment) –
Collaborative coordinated by HPIO focused on coordinating enrollment efforts across the state
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To learn more: OhioONCE@gmail.com
Enroll America –
Ohio chapter is working to coordinate enrollment efforts across the state
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To learn more: www.enrollamerica.org
Medicaid Expansion
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2014 Federal Health Coverage Expansion 500%
Private Insurance Federal Poverty Level (FPL)
400%
$92,200* (family of 4)
Health Benefit Exchange 300%
Disabled Ohioans in this income range “spend down� their income to qualify for Medicaid
200% Optional ACA Medicaid Expansion to 138%
$31,809* (family of 4)
100%
Medicaid 0% Children 0-18 without coverage Current Ohio Medicaid Eligibility
Parents
Childless Adults
Federal Exchange Eligibility
Disabled Workers Other Aged, Blind and Disabled Not Covered by Ohio Medicaid or Federal Exchange
* The 2012 poverty threshold is $11,170 for an individual and $23,050 for a family of four.
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History of Medicaid Participation by States 30 25
25 20 15
States 11
10
8
6
5 1 0 1965
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1966
1967
1970
1982 Source: The Washington Post
Medicaid Expansion Scenarios and Implications to business, government, health care, and the social sectors of Franklin County ACA/Full Medicaid Expansion • Welcome mat= ~28,000 + New eligible = ~41,000 in Franklin County • Strong revenue and economic benefit for Ohio and counties • Post January 1, 2014 scenario = partial loss of 100% federal funding • Ballot scenario = target of Fall 2014, partial loss of 100% federal funding Partial Medicaid Expansion after Jan 2014 • Insured: welcome mat + some new eligibles • Ohio House and Senate sub-committees looking at “reform” versus “expansion” • Potential HHS waiver similar to Arkansas No Medicaid Expansion • Welcome mat = ~28,000 in Franklin County currently eligible • Loss of $13 billion in additional federal dollars to the state over six years • $59 to $88 million yearly penalties statewide for employers with low-income workers • Loss of significant DSH/HCAP funding for hospitals that serve low-income people • Loss of $1.8-1.9 billion in new net savings and revenue for state budget • Loss of economic impact between $8.6-19.8 billion • Loss of sales tax revenues for counties ~$375 million
Medicaid Eligibility System
Controlling Board approved $116 million Department of Administrative Services appropriation increase request for the Integrated Eligibility Project.
Will replace Ohio’s 32 year old Client Registry Information SystemEnhanced (CRIS-E) software
New system will be able to adapt to policy changes without being rebuilt
Will take ~2 years to fully transition to new system Gongwer News Service, September 22, 2013
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Where does Medicaid expansion stand?
Speculation is rampant that on Oct. 21, Kasich will ask the seven-member legislative-spending oversight panel to give him the authority to spend federal money to expand Medicaid
The Controlling Board is made up of one governor’s appointee and six legislators — two Republicans and one Democrat from each chamber. The appointee and the Democrats would likely vote for expansion, and at least one Republican must join them.
The Senate plans to roll out a bipartisan Medicaid bill this week — without an expansion component. Sponsored by Sens. Dave Burke, R-Marysville, and Capri Cafaro, D-Hubbard, it is designed to reduce costs and improve efficiencies. Source: The Columbus Dispatch, 10/9/13
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Q&A
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Future ACA Learning Sessions
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Monthly webinar to provide objective information about ACA implementation.
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Sessions held the second Thursday of the month from 1:00-2:00PM
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2013-2014 Webinars •
November 14
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December 12
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January 9
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February 13
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March 13