(formerly Access HealthColumbus)
Monthly Affordable Care Act (ACA) Webinar Series December 12, 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. 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. 4. Provide an update on healthcare system transformation activities.
Today’s agenda •
(formerly Access HealthColumbus)
Welcome & Introduction -Jeff Biehl, Healthcare Collaborative of Greater Columbus
• 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
• Update on Healthcare Delivery Transformation -Jeff Biehl
ACA: Key Areas of Change
Near Universal Insurance Coverage
Health Benefit Exchanges
Affordable Care Act
Improvement Initiatives
Guaranteed Issue & Insurance Mandate
By 2020… not 1/1/2014
New Insurance Marketplace
Health Benefit Exchanges
Near Universal Insurance Coverage
Affordable Care Act
Improvement Initiatives
Effort to Bring All into Guaranteed Insurance Marketplace Guaranteed Issue & Insurance Mandate
Expansion of Medicaid
Health Benefit Exchanges
Near Universal Insurance Coverage
Affordable Care Act
Improvement Initiatives
Subsidized commercial insurance for middle-income families (market based) Guaranteed Issue & Insurance Mandate
Healthcare Insurance Exchange
Key Insurance Provisions
Guaranteed issuance of coverage
Medicaid up to 133% of FPL
No pre-existing condition exclusions
Exchanges (ie., Marketplaces)
Premium rates cannot vary based on health status, but only based on age and smoking status
Subsidies for people from 100% to 400% FPL
Key Dates for Exchanges
October 1, 2013 - Open enrollment begins
December 23, 2013 - Open enrollment for coverage effective January 1, 2014 ends
March 31, 2014 - Open enrollment ends
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Coverage bought before the 15th of the month is effective the first day of the next month.
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People must buy coverage by March 31, 2014 to avoid any penalties
April 1 to November 15, 2014 – open enrollment closed –
Only special enrollments are allowed
November 15 to December 7, 2014 – open enrollment for 2015
Key Dates for Exchanges What needs to be done by December 23rd for coverage January 1? –
Select and enroll in a health plan through Healthcare.gov or direct enroll through an insurance company that sells coverage on the Marketplace.
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Conflicting reports about whether the premium needs to be paid by December 23rd, or consumer can wait until January 1st.
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HHS reported that different insurers have different deadlines, and that a consumer should contact the insurance company whose product they purchased to determine the payment due date.
Source: Enroll America
Keeping Your Plan
White House gave state insurance commissioners permission to allow consumers to keep current coverage through 2014. To keep current coverage, the coverage must have been in effect on Oct. 1, 2013
Consumers may also renew current coverage in 2014 for another year. The deadline for making such a renewal is October 1, 2014.
Ohio Department of Insurance gave companies permission to continue coverage Source: The Columbus Dispatch (11/28/2013)
Keeping Your Plan
Some companies in Ohio are allowing consumers to keep their current coverage.
For the most part, current coverage which a consumer choses to keep will stay the same, except that:
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If the coverage is renewed in 2014, it will no longer have annual limits and must comply with federal mental health parity.
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Premium rates for the coverage may go up based on increases in medical costs.
Consumers with current coverage have choices: –
Keep their current coverage and renew it again in 2014 for another year.
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Purchase coverage subject to the ACA now.
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Keep current coverage into 2014, and purchase an ACA compliant coverage at renewal.
Affordable Care Act Lawsuits
The U.S. Supreme Court will hear two cases challenging the ACA requirement that employer’s cover contraceptives. –
These two cases about whether corporations may decide not to cover contraceptives based on the beliefs of their owners.
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In another case, Notre Dame University challenged the requirement that it provide contraception coverage to employees.
Other cases pending in lower courts raise the following issues: –
Whether federal exchanges may provide low income subsidies because the federal law authorizing subsidies appears limited to state exchanges.
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Whether the employer mandate is constitutional.
We will have to wait and see. . . . .
Navigators and Certified Application Counselors (CAC)
Exchange Enrollment Ohio Enrollment 6,000
5,672
5,000
4,000 3,000
Ohio Enrollment
2,000 1,000
1,150 Source: The Columbus Dispatch 12/11
0 End of October
End of November
Certified Application Counselor Experience
Medicaid Expansion
Source: Health Policy Institute of Ohio
Where does Medicaid expansion stand? ď Ź
Lawsuit challenging the legality of controlling board decision has been expedited by the Ohio Supreme Court.
ď Ź
Ruling in the case is expected any day.
Medicaid Reform
SB 206, passed by the state legislator 12/4, creates a joint committee to oversee the state's Medicaid program.
Bill seeks to limit increases in Medicaid spending and move individuals who have other options for health care out of the program.
Republican legislators indicated more Medicaid reform bills are in the works.
Source: Record-Courier, 12/5/13
Source: Ohio Governor’s Office of Health Transformation
Benefits.Ohio.Gov
Online enrollment began on December 9th
1,165 low income Ohioians signed up for coverage on the first day.
No technical failures or glitches have been reported.
Eventually, the system will process food stamps, welfare and other government assistance.
Source: The Columbus Dispatch 12/9/2013
Near Universal Insurance Coverage
Health Benefit Exchanges
Shift from volume to value-based health care
Affordable Care Act
Improvement Initiatives
Guaranteed Issue & Insurance Mandate
Ohio: Current Initiatives Modernize Medicaid Reform nursing facility reimbursement Integrate Medicare and Medicaid benefits Rebalance spending on long-term services and supports Create health homes for people with mental illness Restructure behavioral health system financing Improve Medicaid managed care plan performance Streamline Health and Human Services Consolidate mental health and addiction services Create a cabinet-level Medicaid department Modernize eligibility determination systems Integrate HHS information capabilities Coordinate programs for children Share services across local jurisdictions Improve Overall Health System Performance Pay for health care based on value instead of volume Encourage Patient-Centered Medical Homes Accelerate electronic Health Information Exchange
5-Year Goal for Payment Innovation Goal
80-90 percent of Ohio’s population in some value-based payment model (combination of episodes- and population-based payment) within five years
State’s Role
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Year 1
Year 3 Year 5
Shift rapidly to PCMH and episode model in Medicaid fee-for-service Require Medicaid MCO partners to participate and implement Incorporate into contracts of MCOs for state employee benefit program
Patient-centered medical homes
Episode-based payments
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In 2014 focus on Comprehensive Primary Care Initiative (CPCi)
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Payers agree to participate in design for elements where standardization and/or alignment is critical
State leads design of five episodes: asthma (acute exacerbation), perinatal, COPD exacerbation, PCI, and joint replacement
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Payers agree to participate in design process, launch reporting on at least 3 of 5 episodes in 2014 and tie to payment within year
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Multi-payer group begins enrollment strategy for one additional market
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Model rolled out to all major markets 50% of patients are enrolled Scale achieved state-wide 80% of patients are enrolled
▪ 20 episodes defined and launched across payers
▪ 50+ episodes defined and launched across payers
Q&A