health care reform in maryland looking back & looking forward leni preston, chair...

Health Care Reform in Maryland

Looking Back &

Looking ForwardLeni Preston, [email protected](301) 351-9381

© 2012 Maryland Women’s Coalition For Health Care Reform

mailto:[email protected]

Maryland: A National Leader

• Commitment & Leadership

• Pro-Active & Effective Process

• Stakeholder Engagement


Health Benefit Exchange Timeline

4/12/2011Governor O’Malley Signed Health Benefit

Exchange Act into

Law

6/3/2011Exchange Board 1st Meeting

9-11/2011 Advisory

Committees Met

1/1/2013 Exchange Must be

Certified by Federal

Government

10/1/2013 Individuals and Groups

Begin Enrolling in Exchange

1/1/2014 Maryland

Health Benefit

Exchange will be

Operational


Source: A Report to the Governor and Maryland General AssemblyMaryland Health Benefit Exchange, December 23, 2011, p. 1

Landmark ACA Legislation signed into Law 3/23/2010 by President Obama

General Assembly 2012

• Three Major Bills –Health Benefit Exchange Act of 2012

(SB238/HB443)–Health Improvement & Disparities

Reduction Act of 2012 (SB234/HB439)– Cultural Competency & Health Literacy

– Education Support (HB679)


Health Benefit Exchange Act of 2012

What’s An Exchange?An Insurance Marketplace

• Each Plan will be set out with monthly cost and co-pays; plan performance on quality measures; ratings by quality and price

• Compare Apples to Apples and if you can’t decide between a Fuji and a Rome, you can get help through a website, telephone hotline, and navigators


• Legislation builds on 2011 legislation to ensure Exchange is operational by 1/1/2014

• Reflects recommendations in the 12/23/2011 Exchange Board report

• Developed through a collaborative and consensus process with stakeholders at the table

• Coalition worked with its partners, legislators, and Carolyn Quattrocki in the Governor’s Office of Health Care Reform to ensure passage


The Legislative Process



Key Provision: Operating Model• 2014-2016 – All carriers can participate;

all plans must be certified by Exchange– Stakeholder Committee will advise Exchange

on appropriate standards

• 2016 – Exchange may propose “active purchasing” strategies (competitive bidding &/or negotiation) to further decrease health care costs and increase quality of health care



Key Provision: Navigator Program

• The Navigator Program will provide outreach & education to individual consumers & small businesses on:– Eligibility for Medicaid (up to 133% FPL)– Eligibility for financial assistance (133% to

400% FPL) – Tax credits for small businesses – Appropriate health insurance plans

• Navigators will also facilitate enrollment


Health Benefit Exchange Act of 2012Key Provision: Navigator Program/

Individual Exchange

• The Exchange will contract with navigator entities (including community-based organizations) to provide all outreach, education, eligibility & enrollment services

• Individual navigators will receive training & certification to conduct outreach & education activities

• Stakeholder Committee will provide expertise & advice on the further design of the program


Health Benefit Exchange Act of 2012Key Provision: Navigator Program/

SHOP Exchange

• SHOP Navigator Program will be separate from individual exchange

• SHOP Navigators will be overseen by MIA• Insurance producers/brokers must obtain

authorization and training to sell plans in either the SHOP or individual Exchange

• Producers will be paid by the carriers



Key Provision: Design of the SHOP• Separate from individual exchange– Serves small businesses - up to 50 employees,

expands to 100 employees in 2016

• Two ways to offer insurance to employees:– Employer picks one carrier & designates plans

from which employee can choose– Employer picks coverage level (platinum, gold,

silver, & bronze) & employee chooses plan from any carrier at that level



Key Provision: Qualified Health Plans

• Only Qualified Health Plans (QHP) will be sold in the Exchange. These must:– Include the Essential Health Benefit Package– Be certified by the Exchange

• Exchange will also offer stand-alone and bundled qualified dental and vision plans

• Pediatric dental and vision benefits must be part of the Essential Benefit Package



Key Provision: Financing• Maryland has received over $34 million in

federal grants to fund establishment of the Exchange

• State will submit its request for Level 2 Establishment Grant in June

• ACA requires Exchange to be self-sustaining by 2015

• Joint Executive-Legislative Committee will provide recommendations– Stakeholder Committee will provide

advice • Legislation is expected in 2013


Health Benefit Exchange Act of 2012Key Provision: Essential Health

Benefits• Beginning in 2014 - all health insurance

plans sold in and outside the exchanges must include essential health benefits. These will be based upon an existing “benchmark” plan.

• Health Care Reform Coordinating Council working with a stakeholder group will determine what the plan will be. – Decision deadline is September 30, 2012


Essential Health Benefits & Behavioral Health

• Behavioral health treatment must be included as one of the 10 essential health benefit categories

• These benefits must be compliant with the Mental Health Parity and Addiction Equity Act (MHPAEA) – Requires that limits or cost-sharing for behavioral health

treatment be no more restrictive than for physical health

• Qualified Health Plans in Maryland will demonstrate compliance with MHPAEA– Plans would demonstrate that cost-sharing, medical management

policies and procedures, or authorization requirements for behavioral health are not more restrictive

• For more information on mental health parity– Contact Adrienne Ellis, Director Maryland Parity Project

[email protected]– Please take our short survey

https://www.surveymonkey.com/s/parityconsumer



https://www.surveymonkey.com/s/parityconsumer

General Assembly Additional Legislation

• Health Improvement & Disparities Reduction Act of 2012 (SB234/HB439)

• Cultural Competency & Health Literacy – Education Support (HB679)


Communications: Framing the MessageWhat Works

• Pre-existing conditions – Insurance plans will no longer deny insurance due to pre-existing conditions & thanks to ACA that’s true for children now

• Security – Those currently uninsured, or worried about job loss and loss of insurance, will have the security of knowing they can go to the Exchange

• Peace of Mind - Members of Congress will be required to get their health insurance from the same Exchanges as everyone else

• Fairness/No Discrimination – Women can no longer be charged higher rates for their insurance than men

Following particularly effective with men:

• Personal Responsibility – Exchange encourages personal responsibility and control over your own health care

• Competition – Insurance costs will come down as competition among insurance companies increases © 2012 Maryland Women’s Coalition For Health Care

Reform

Source: Tips prepared by the Herndon Alliance based on a February 2012 poll.

Communications: Countdown to Coverage

Senator Mikulski’s Women’s Preventive Services Amendment - A win for women!

On August 1, 2012, all new plans must cover preventive care

for women w/o co-pays or deductibles including:• Comprehensive contraceptive care• Screening & counseling for domestic partner

violence• Screening for gestational diabetes• Breastfeeding counseling & equipment • Screening for sexually transmitted diseases• Well women preventive care visits

http://countdowntocoverage.org/storage/countdown-resources/CtC%20checklist%20-%20Affordable%20Prevention%20Care%20-%20FINAL.pdf


Communications: Learn More

• Office of Health Care Reform Website http://www.healthreform.maryland.gov/

• Coalition-sponsored Forums – Reform. It’s Good For Your Health – Health Care. Women of Color Get It on

September 8, 2012 in Baltimore

• HealthCare Access Maryland (HCAM) Forum– For CBOs in Baltimore City & Metro Area to

get the latest information on health care reform, the Navigator Program, and more – June 13, 2012

– Call 410.649.0519 for more information


http://www.healthreform.maryland.gov/

Looking Forward: Coalition Priorities

• Making the Exchange Work for Consumers

• Health Equity – “The nation is either making no progress or is heading in the wrong direction in reducing racial, ethnic, and income-related disparities in access to care.” – Forum – Health Care. Women of Color Get It –

September 8, 2012– Issue Brief – Health Equity: Maryland’s Call To

Action – Release date – September 8, 2012– Maryland’s State Health Improvement Process

www.dhmh.state.md.us/ship

Source: Agency for Health Research & Quality (AHRQ)


http://www.dhmh.state.md.us/ship

Get Involved: Make A Difference

• Coalition Initiative – Outreach to Groups Representing Women of Color

• Forums• State Health Improvement Process &

Local Health Improvement Coalitions http://dhmh.maryland.gov/ship/SitePages/Home.aspx

• Share Our Stories


http://dhmh.maryland.gov/ship/SitePages/Home.aspx

http://dhmh.maryland.gov/ship/SitePages/Home.aspx

Resources You Can Use

• Maryland – Health Benefit Exchange

www.dhmh.maryland.gov/healthreform/exchange/index.html

– Department of Health & Mental Hygienewww.dhmh.maryland.gov

– Maryland Health Insurance Plan (MHIP)www.marylandhealthinsuranceplan.state.md.us

– Health Care Reform Coordinating Councilwww.dhmh.maryland.gov/healthreform/index.html

• Federal– Department of Health & Human Services

www.healthcare.gov© 2012 Maryland Women’s Coalition For Health Care

Reform

http://www.dhmh.maryland.gov/healthreform/exchange/index.html

http://www.dhmh.maryland.gov/healthreform/exchange/index.html

http://www.dhmh.maryland.gov/

http://www.marylandhealthinsuranceplan.state.md.us/

http://www.dhmh.maryland.gov/healthreform/index.html

http://www.healthcare.gov/

Stay Informed & Get Involved

• Join the Coalition– Newsletters, Alerts, Member Calls & Webinars– Educational forums:

September 8th in Baltimore

– Facebook and Twitter

• Encourage others to joinMDHealthCareReform.org


Contact Us

• Leni Preston, Chair [email protected]• Sandy Kick, Health Policy Analyst – Issue

Brief & Forum [email protected]• Jamie Shopland – Outreach & Education

[email protected]

MDHealthCareReform.org





Everyone Call in to 712-432-1690

access code 841045#please for the voice portion

of the webinar

Copyright 2011 Maryland Women’s Coalition For Health Care Reform

health care reform in maryland looking back & looking forward leni preston, chair...

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