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A Presentation of the Colorado Health Institute

The Changing LandscapeIn Colorado for Publicly-funded Health Insurance Programs

May 25, 2011

Colorado Health Care Leaders Webinar Series

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A Brief Introduction to CHICHI is a trusted and leading source of credible health information for Colorado leaders. Our insight is used to:– Inform policy– Contribute to effective implementation– Support state efforts to improve health

Access Quality Value Prevention

Introduction to Webinar

• How do I ask questions during the webinar?

• Special thanks to The Colorado Health Foundation

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Summary of presentation

• Overview of publicly-funded programs

• Recent changes • Looking towards the

future

Your Presenter

Amy Downs

Director for Policy and Research

Colorado Health Institute

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Medicaid • Health insurance program for low income

parents, children, elders and people with disabilities

• Financed by federal and state government, but administered by the states

• Provides acute and long-term care services (580,000 enrollees in Colorado)

• States that participate must cover mandatory populations and services

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Child Health Plan Plus (CHP+)

• Created in 1997 and jointly financed by states and the federal government

• Serves low income children and pregnant women who do not qualify for Medicaid (up to 250% of FPL)

• Families pay annual enrollment fee

• Currently 68,000 children and1,900 pregnant women enrolled

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Colorado Indigent Care Program

• CICP is not insurance coverage

• Clinics and hospitals partially compensated for care provided to uninsured and underinsured individuals (at or below 250% of the federal poverty level)

• 218,000 individuals served through CICP in FY 2009-10

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Current eligibility standards for programs in Colorado

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Medicaid caseloads have been increasing

SOURCE: Colorado Department of Health Care Policy and Financing, Executive Budget Request, Nov. 1, 2010

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Distribution of Medicaid enrollment and expenditures by eligibility category

SOURCE: Colorado Department of Health Care Policy and Financing, Executive Budget Request, Nov. 1, 2010

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Appropriations are increasing for HCPF

SOURCE: Colorado Department of Health Care Policy and Financing

NOTE: Includes all appropriations to the Department of Health Care Policy and Financing. FY 2010-11 includes original appropriation, FY 2011-012 includes Nov. 1, 2010 request.

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Colorado Health Care Affordability Act (H.B. 09-1293)

• Eligibility expansion funded without General Fund expenditures

• State assesses hospital fees and draws down federal Medicaid match

• State using additional federal funds to expand eligibility for Medicaid and the Child Health Plan Plus (CHP+)

• In return, hospitals receive increase in Medicaid and CICP payments

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Recent initiatives

• Increased outreach and enrollment• Medicaid Value-Based Care

Coordination Initiative • Utilization controls and benefits

reviews• Increased payment recoveries and

emphasis on fraud reduction• Denying claims for hospital re-

admissions within 48 hours

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Medical homes

• Team approach • Comprehensive, continuous,

coordinated care• Preventive care, health education,

coordination of care and medications

• Between 2009 and 2010, percentage of children without a physician visit declined from 32% to 6%

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Accountable Care Collaborative• Integrates patient-centered medical

home model with analysis of data • Outcome-based model of care • 7 Regional Care Collaborative

Organizations– Care coordination, medical and network

management– Shared accountability with providers for

outcomes and costs

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FEDERAL POLICY CHANGES TO PUBLICLY FUNDED HEALTH INSURANCE PROGRAMS

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Current eligibility standards for programs in Colorado

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Eligibility standards in Colorado after state and federal health reforms

NOTES: Federal health reform does not make changes to Medicaid eligibility for elders and people with disabilities. CICP will likely continue to serve individuals who do not qualify for Medicaid or CHP+ or are uninsured or underinsured.

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Other federal initiatives addressing cost and quality

• Center for Medicare and Medicaid Innovation

• Medical and health homes• Accountable care organizations• Bundled and global payments • Federal Coordinated Health Care

Office

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Future webinars

• June 8 – The Private Market• June 22 – A Profile of Your

Community’s Health• July 20 – The Colorado Health

Insurance Exchange

Register for all webinars at:www.coloradohealthinstitute.org/webinars

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Questions?

Amy Downs Director for Policy and Research Colorado Health Institute

(720) 382-7091downsa@coloradohealthinstitute.org