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TRANSCRIPT
Children’s Health Insurance Program (CHIP)
Advisory Council Meeting
April 15, 2020
Agenda
• Welcome and Introductions
• COVID-19 CHIP Coverage and Guidance
• State Based Exchange
• CHIP by the Numbers
• Marketing Updates
• Policy Update
• Quality Assurance Updates
• Closing and Wrap-Up
2
Welcome and Introductions
3
COVID-19 and CHIP
Achievements to Date
• Waive copays for testing and treatment for COVID-19.
• Issued direction that families are not losing coverage.– Data fix to ensure continuation of coverage.
– Policy guidance 2020-05.
4
COVID-19 and CHIP
Achievements to Date
• Application Processing– CHIP is continuing to process applications.
– Reporting income changes and reassessment.
• CHIP Call Center– The CHIP Call center is responding to consumer inquiries.
– Callers should not experience a difference in their customer service experience.
5
COVID-19 CHIP Coverage and Guidance
• CHIP Disaster Relief State Plan Amendment– What is the Disaster Relief State Plan Amendment
– Flexibility descriptions• COVID-19 copay waiver
• Premium payment delays
• Renewal Due Date extension
• Self-Attestation
6
COVID-19 CHIP Coverage and Guidance
Guidance to Date
• Continuation of Coverage• MCOs are not terminating enrollees for failure to provide
renewal information, failure to pay premiums, failure to provide information regarding disability, or whereabouts unknown.
• Families are still responsible for premium payments.
• Families who experience financial hardship during this time should be assessed to see if income changes lower their premium payment or are appropriate for transfer to MA.
• MCOs are to work with families on payment plans for premiums
7
COVID-19 CHIP Coverage and Guidance
Guidance to Date
• Waiver of COVID-19 Copays• MCOs are waiving copays related to the testing, screening
and treatment of COVID-19
• Waiver of Prior Authorizations• MCOs are waiving prior authorizations related to the
testing, screening and treatment of COVID-19
• Early Refills Available• MCOs are authorizing enrollees to receive early refills of
non-opioid prescriptions
• Member Services• MCOs continue to serve members and take member
inquires during this time
8
COVID-19 CHIP Coverage and Guidance
Guidance to Date
• Self-Attestation• Applicants may utilize self-attestation of eligibility
information if they cannot provide documentation
• MCOs and CHIP will continue to review available electronic databases to verify eligibility information at application and renewal
• Applications and renewals must be signed to utilize self-attestation
• Enrollment prior to first premium payment• Children are being enrolled in CHIP at eligibility
• Premium payments still apply but may be collected after initial enrollment
9
State Based Exchange
Zachary ShermanExecutive Director,
Health Insurance Exchange Authority
Pennsylvania Health Insurance Exchange Authority
Pennsylvania Health Insurance Exchange AuthorityExecutive Director Zachary ShermanApril 15, 2020
Meeting Agenda
1. Exchange Authority Overview and Critical Milestones
2. Uninsured Data
Exchange Authority | 12
Pennsylvania Health Insurance Exchange Authority
Overview of the Exchange Authority
13
2014: HealthCare.Gov (FFE) and state-based exchanges (SBE) launched to varying degrees of success
Initial availability of federal grant funding and enhanced matching funds for Medicaid programs led to large system integration approaches in many states
A few states failed to go-live effectively and transitioned back to the FFE
Many states, including PA, assessed the implementation risk as too high and deferred operational management to the federal government
2015 - 2018: States slowly began to transition from the FFE to SBE or a hybrid approach using the federal platform (SBE-FP)
Idaho successfully transitioned to a SBE from the FFE in 2015, declining to integrate with Medicaid or operate a small business exchange
AK, NM, NV and OR became SBM-FPs
2019 - 2020: Led by Nevada, more states decided to begin transitioning to SBEs
NV procured a vendor solution for technology and customer service and went live for Open Enrollment in November 2019
NJ, NM, OR and PA are transitioning to a SBE and taking similar approaches to NV with their procurements
History of State-Based ExchangesThe evolution of State-Based Exchanges over time
Exchange Authority | 14
The mission of the Pennsylvania Health Insurance Exchange Authority is to improve the accessibility and affordability of individual market
health coverage for Pennsylvanians.
Our goal is to serve Pennsylvania’s individual health insurance market customers without disruption, operate a state-based exchange and support the needs of consumers purchasing health insurance while ensuring the stability and affordability of the health and dental offerings available through the Exchange Authority.
Who is the Exchange Authority?
Exchange Authority | 15
A seamless transition A vendor solution that will stand up fully-functioning exchange technology
platform and customer service center on-time and on-budget
Successful conversion of existing customers to the state exchange system
Limited technical and operational disruption and change to community and insurer partners as well as the Department of Human Services
Higher quality access and customer service Accountability to Pennsylvanians looking to access subsidized and unsubsidized
individual market health insurance
Data reporting that is accurate and timely, and can respond to all stakeholder needs
Flexibility to accommodate changing operational and customer needs
Ability to better serve PA families churning between individual market and Medicaid
Lower costs and lower premiums Operation of the exchange at a significantly lower cost than current
Healthcare.Gov price-tag
Reduction of individual market premiums in 2021 by 5-10% through reinsurance
Strategic Goals
PHIEA | 16
Successful Implementation and Operations
Measures of Success
Strategic Goals
To date we have:
Been working diligently with our technology platform and customer service vendor
Begun testing the enrollment and eligibility system design
Engaged stakeholders – consumer advocates, producers, medical and dental insurers, legislators, business and community groups, Exchange Assister, etc.
Begun developing our brand
Established much of the infrastructure necessary to operate a new, self-sustaining entity
Progress against GoalsWhere we are today
Exchange Authority | 17
Critical Milestones
Exchange Authority | 18
JANDECNOVOCTSEPAUGJULJUNMAYAPRMARFEB2020 JAN
Call CenterRepresentative Training Begins
OEP Begins!
Call CenterOperational
Exchange Assisters and
Broker Training
2021 Plans Loading
Public Brand Launch
Customers are Auto-Renewed
Insurer Integration Starts 2/14
Launch of Outreach & Education Workgroup and Broker Workgroup
Medicaid Integration Complete 6/30
2021 Coverage Begins
Stakeholder and Customer OutreachPlatform
Call Center/training
Stakeholder Engagement continues
Pennsylvania Health Insurance Exchange Authority
Overview of Pennsylvania’s Uninsured Population
19
There are over 12.5 million residents in the Commonwealth of Pennsylvania in 2018
Insured: 11.9 million (Through employer or government programs)
Uninsured: Nearly 700,000 (5.5% of the state’s population)
Adjusted to exclude uninsured undocumented immigrants and uninsured individuals with PA German ancestry, there are an estimated 607,000 uninsured residents, 4.8% of the population
Characteristics of the 607,000 uninsured and likely to be eligible and interested in enrolling
Income
28% are below 138% of the federal poverty level (FPL)
53% are between 138-400% of FPL
19% are at or above 400% of FPL
Demographics
67% identify as White alone (not Hispanic or Latinx)
14% identify as Hispanic or Latinx, nearly twice percent of population (7.6%)
14% identify as Black or African American, disproportionately higher than percent of population (11%)
Overview of the Uninsured in PA
Exchange Authority | 20Source: SHADAC analysis of the United States Census Bureau's American Community Survey (ACS).
52.0%
6.2%
15.4%17.5%
8.9%
54.6%
5.6%
14.6%
19.7%
5.5%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Employer Sponsored Individual Market Medicaid/CHIP Medicare Uninsured
Health Insurance by Coverage Type
United States Pennsylvania
Current Health Coverage LandscapeThe vast majority (94.5%) of PA residents had health insurance; over 60% through commercial insurance and ~34% through government programs
Exchange Authority | 21Source: SHADAC analysis of the United States Census Bureau's American Community Survey (ACS).
64,000
28,000
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
Number Uninsured by Group
Undocumented Immigrants German Ancestry
Uninsured and Unlikely to EnrollUndocumented immigrants are ineligible for exchange coverage; Amish and Mennonite populations have historically not enrolled in exchange coverage
Exchange Authority | 22
34.9%
19.4%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
Uninsured as a Percentage of Population
Undocumented Immigrants German Ancestry
Source: SHADAC analysis of the United States Census Bureau's American Community Survey (ACS).
699,000
607,000
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
Number Uninsured Unadjusted vs. Adjusted
Uninsured Adjusted Uninsured
Uninsured and Likely EligibleAdjusted to exclude undocumented immigrants and residents with German ancestry, the likely eligible uninsured rate is 4.8%
Exchange Authority | 23
5.5%
4.8%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
Percent Uninsured Unadjusted vs. Adjusted
Uninsured Adjusted Uninsured
Source: SHADAC analysis of the United States Census Bureau's American Community Survey (ACS).
167,000
317,000
113,000
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
<138% of thepoverty
threshold
138% to 399%of the poverty
threshold
At or above400% of the
povertythreshold
Total Uninsured by Income
Uninsured By IncomeThe majority (53%) of the uninsured are eligible for subsidized coverage through the Exchange; uninsured rate is highest for Medicaid eligible; kids in low-income households are 1.5x likelier to be uninsured
Exchange Authority | 24
7.4%
6.4%
2.2%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
<138% of thepoverty threshold
138% to 399% ofthe povertythreshold
At or above400% of the
poverty threshold
Uninsured as a Percentage Total Population by Income
Notes: Uninsured has been adjusted to exclude uninsured undocumented immigrants (likely ineligible for ACA coverage) and uninsured individuals who indicate Pennsylvania German ancestry. Civilian noninstitutionalized population.Sources: SHADAC analysis of the United States Census Bureau's American Community Survey (ACS).Pennsylvania Partnerships for Children, State of Children’s Health Care – October 2019
Emphasis on Financial Assistance Individuals between 100-400% of the Federal Poverty Level (FPL) are eligible for advance premium tax credits (APTC) through the exchange
Exchange Authority | 25Source: ASPE – Coverage year 2020
Salary
317,000 uninsured individuals are eligible for financial assistance.
$17,236 $23,336
$29,435 $35,535
$49,960
$67,640
$85,320
$103,000
$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
Single 2 3 4
100% FPL 138% FPL 400% FPL
Household Income by FPL
5.0%
4.1%
8.8%
10.4%
8.4%
6.4%
4.7%
0.4% 0.3%0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
Under 6years
6 to 18years
19 to 25years
26 to 34years
35 to 44years
45 to 54years
55 to 64years
65 to 74years
75 yearsand older
PA Uninsured by Number and Percentage
Uninsured Percentage Uninsured Number
Age Demographics of the UninsuredFive percent of children under six years of age are uninsured; Approximately 124,000 children under 19 are uninsured statewide
Exchange Authority | 26Source: SHADAC analysis of the United States Census Bureau's American Community Survey (ACS).
40 Percent of Pennsylvania’s Uninsured Kids Live in Five CountiesLancaster, Allegheny, Berks, Chester and Philadelphia counties have the highest uninsured rate for children
Exchange Authority | 27
Source: Pennsylvania Partnerships for Children, State of Children’s Health Care – October 2019
Where do the uninsured live?Five counties (Chester, Delaware, Lancaster, Montgomery and Philadelphia) in the southeast make up 36.6% of the uninsured
Exchange Authority | 28
Notes: Uninsured has been adjusted to exclude uninsured undocumented immigrants (likely ineligible for ACA coverage) and uninsured individualswho indicate Pennsylvania German ancestry. Civilian noninstitutionalized population.Source: SHADAC analysis of the United States Census Bureau's American Community Survey (ACS).
WAY2,433
WYO1,065
LAC7,958
ELK814
VEN2,909
FOR94 CAME
114 PIK2,549LYC
5,372
SUL409
MER5,827 CLI
2,437CLA2,593
LUZ12,778JEF
2,648COL2,273
CEN6,767
CLE3,528
MONROE9,062
NORTHUMBERLAND3,996
BUT5,623
ARM2,667
MONTOUR749UNI
3,457CAR2,381
LAW3,810
NORTHAMPTON11,655SCH
6,219IND6,071
SNY3,871BEA
6,327MIF4,458
LEH16,924
BLA5,373
HUN1,795
CAMB4,991
JUN1,989 BER
19,483
WES11,221
ALL43,514
DAU12,106PER
3,334BUC
18,851LEB10,296
WAS6,992
MONTG21,022
BED2,932
CUM10,993 LAN
52,785
FRA12,027
SOM4,305
CHE20,651
YOR19,802FUL
858
FAY5,860
PHI104,860
ADA4,569
DEL22,836
GRE1,568
ERI12,149
BRA3,442TIO
2,682
WAR1,744
SUS2,451MCK
1,592 POT1,023CRA
6,693
<5k
5-10k
10-20k
20-50k
>50k
Legend
Where are the highest uninsured rates?Lancaster County’s uninsured rate is the highest; several Central PA counties have higher than average rates
Exchange Authority | 29
Notes: Uninsured has been adjusted to exclude uninsured undocumented immigrants (likely ineligible for ACA coverage) and uninsured individuals who indicate Pennsylvania German ancestry. Civilian noninstitutionalized population.Source: SHADAC analysis of the United States Census Bureau's American Community Survey (ACS).
WAY5.1
WYO3.9
LAC3.8
ELK2.7
VEN5.6
FOR2.9 CAME
2.4 PIK4.6LYC
4.8
SUL6.8
MER5.4 CLI
6.3CLA6.7
LUZ4.1JEF
6.1COL3.5
CEN4.3
CLE4.7
MONROE5.4
NORTHUMBERLAND4.5
BUT3.0
ARM4.1
MONTOUR4.2UNI
8.7CAR3.8
LAW4.4
NORTHAMPTON3.9SCH
4.6IND7.2
SNY9.6BEA
3.8MIF9.7
LEH4.7
BLA4.4
HUN4.3
CAMB3.8
JUN8.2 BER
4.7
WES3.2
ALL3.6
DAU4.5PER
7.3BUC3.0LEB
7.5
WAS3.4
MONTG2.6
BED6.1
CUM4.6 LAN
9.9
FRA7.9
SOM6.1
CHE4.0
YOR4.5FUL
5.9
FAY4.5
PHI6.7
ADA4.5
DEL4.1
GRE4.5
ERI4.5
BRA5.7TIO
6.6
WAR4.4
SUS6.0MCK
4.0 POT6.1CRA
7.9
<3%
3-5%
5-7%
7-8%
>9%
Legend
Pennsylvania Health Insurance Exchange Authority
Questions?
30
THANK [email protected]
Exchange Authority | 31
CHIP by the Numbers
CHIP Enrollment
33
178,000
179,000
180,000
181,000
182,000
183,000
184,000
185,000
186,000
187,000
Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20
180,970
181,385
182,971
183,564 183,431
184,333
184,812
183,072
184,912
185,553
185,959 186,093 186,191
CHIP Enrollment
MG18C Children
CHIP Enrollment Ages 0 to 4 TOTAL
July 2019 27,957
August 2019 28,121
September 2019 28,191
October 2019 27,939
November 2019 28,076
December 2019 28,069
January 2020 28,130
February 2020 28,250
34
MG18C Children TOTAL
July 2019 1,430
August 2019 1,558
September 2019 1,339
October 2019 1,742
November 2019 1,314
December 2019 1,575
January 2020 977
February 2020 1,040
• MG18C refers to MA Children age 0-4 that remain in MA until their renewal date when their family is over the MA income limits.
CHIP Successful Renewals
35
84%
94%97%
94% 95%
52%
72% 73%75%
85%
49%
65%69%
73%
83%
48%
66%70%
75%
84%
0%
20%
40%
60%
80%
100%
120%
Free Sub1 Sub2 Sub3 At Cost
CHIP Successful Renewals
Dec-19 Jan-20 Feb-20 Mar-20
Processing Times for CHIP Applications
36
Customer Calls to the CHIP Call Center
37
1-800-986-KIDS Calls Received
4,485 4,525
3,888
4,571
5,377
4,227
0
1000
2000
3000
4000
5000
6000
7000
September 2019 October 2019 November 2019 December 2019 January 2020 February 2020
38
CHIP Call Center Metrics (continued)
38
Apply Over the Phone:Completed Applications
567543
518
432447
518
020406080
100120140160180200220240260280300320340360380400420440460480500520540560580
August 2019 September 2019 October 2019 November 2019 December 2019 January 2020
Policy Updates
Policy Updates
40
Quality Assurance Updates
Encounter Data Validation
EQR Technical Reports
42
Quality Assurance (QA) Updates
Questions?
43
Closing and Wrap Up
• Topics of discussion for next meeting?
• Next Advisory Council meetings:• Wednesday, October 14, 2020
44