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. 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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2013-2014 Webinars

• November 14

• December 12

• January 9

• February 13

• March 13

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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

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

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Spanish version delayed

until 11/1

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

– Bronze plans: 11

– Silver plans: 10

– Gold plans: 8

– 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

– 25 year old: $144.23

– 40 year old: $183.60

– 55 year old: $320.36

Lowest cost for a bronze plan

– 25 year old: $196.28

– 40 year old: $249.85

– 55 year old: $435.96

Lowest cost for a silver plan

– 25 year old: $187.36

– 40 year old: $238.49

– 55 year old: $416.14

Lowest cost for a gold plan

– 25 year old: $234.57

– 40 year old: $298.59

– 55 year old: $521.02

Source: US Department of Health & Human Services

Provider Networks

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Average Premium Cost

Plan Mt. Carmel OhioHealth OSU

Highest Molina Will have one hospital in network

Medical Mutual

X X X

Anthem X

Lowest CareSource X

Source: Columbus Dispatch, October 7, 2013

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

Consumer Assistance Funding

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State-Based Exchange

16 States + DC

Consumer assistance

entities: 319

Total Funding:

$161,191,503

Funding per uninsured

person: ~$11

State-Partnership Exchange

8 States

Consumer assistance

entities: 107

Total Funding:

$62,446,474

Funding per uninsured

person: ~$16

Federally-Facilitated Exchange

26 States

Consumer assistance

entities: 85

Total Funding:

$53,793,991

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

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Navigators

– Individuals hired by certified organizations

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

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Certified Application Counselors

– 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

– To learn more: OhioONCE@gmail.com

Enroll America

– Ohio chapter is working to coordinate enrollment efforts across the

state

– To learn more: www.enrollamerica.org

Medicaid Expansion

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0%

100%

200%

300%

400%

500%

Children 0-18without coverage

Parents Childless Adults Disabled Workers Other Aged, Blindand Disabled

Fed

eral

Po

vert

y Le

vel (

FPL)

Medicaid

Private Insurance $92,200*

(family of 4)

Disabled Ohioans in this income range “spend down” their income to qualify for Medicaid

$31,809* (family of 4)

Health Benefit Exchange

Optional ACA Medicaid Expansion to 138%

* The 2012 poverty threshold is $11,170 for an individual and $23,050 for a family of four.

Current Ohio Medicaid Eligibility Federal Exchange Eligibility Not Covered by Ohio Medicaid or Federal Exchange

2014 Federal Health Coverage Expansion

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26 3

Source: The Washington Post

6

25

11 8

1 0

5

10

15

20

25

30

1965 1966 1967 1970 1982

States

History of Medicaid Participation by States

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Medicaid Expansion Scenarios and Implications to business, government, health care, and the social sectors of Franklin County

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

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

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

Medicaid Eligibility System

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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 System-

Enhanced (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

Where does Medicaid expansion stand?

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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

Q&A

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Future ACA Learning Sessions

• Monthly webinar to provide objective information about ACA

implementation.

• Sessions held the second Thursday of the month from 1:00-2:00PM

• 2013-2014 Webinars

• November 14

• December 12

• January 9

• February 13

• March 13

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