health exchange briefing
DESCRIPTION
Health Exchange Briefing. Wisconsin Access Coalition Meeting, July 23, 2012. David Riemer , Senior Fellow Michael Bare, Research and Program Coordinator. Project for Health Insurance Exchange Education (PHIXE). Overview. We’ll answer three main questions: Where do exchanges fit? - PowerPoint PPT PresentationTRANSCRIPT
David Riemer and Michael Bare“Health Exchange Briefing” 1
Health Exchange Briefing
Wisconsin Access Coalition Meeting, July 23, 2012
Project for Health Insurance Exchange Education (PHIXE)
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Overview
We’ll answer three main questions:
I. Where do exchanges fit?
II. What are the exchanges?
III. What is Wisconsin’s path?
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States Now Have the Option to Expand/Contract Medicaid
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Expanded CoverageEssential Health Benefits Package:
• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services, including
behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic
disease management
• Pediatric services, including oral and vision care
States can also add to the package.
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Three Types of ACA Exchanges
1. State-Based• States can choose to create their own exchanges with a state law or “rule,” and seek funding from the federal government.
2. Federally-Facilitated• If a state chooses not create exchanges, the federal government will facilitate them (Details TBD).
1. Partnerships• States can enter into partnerships with the federal government to operate the exchange.
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Authority Options:
1. State-Based• States can designate a governmental agency to facilitate the exchange, or establish a non-profit entity; and• The authority must have a governing board with strict conflict of interest protections.• Law is specific, as are final rules from HHS, DOL and IRS.
2. Federally-Facilitated• The federal government can designate a non-profit or operate the exchange itself• Details TBD by federal rules, general guidance exists (15 pages)
1. Partnerships• General guidance only (2 pages).
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Exchange Authority Must:
1. Consult during the design, implementation, and operational phases of the exchange with six types of stakeholders;
2. Certify, re-certify, and de-certify qualified health plans;
3. Designate navigators in compliance with ACA;
4. Establish enrollment procedures (online portal, phone help line, and a path for agents and brokers)
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Subsidies within Exchanges
Generally, individuals with incomes between 100% and 400% of the FPL will be eligible for subsidies within the exchange.
Calculator: http://healthreform.kff.org/SubsidyCalculator.aspx
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Establishment Options
State Law?
Executive Order?
Federal “Takeover”?
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TimelineMarch 23, 2010: ACA signed by President Obama
June 28, 2012: Supreme Court decision upholding ACA
November 6, 2012: Presidential election
November 16, 2012: Exchange blueprints due to HHS
January 1, 2013: HHS determines if state will be ready
January 20, 2013: Inauguration Day
October-December, 2013: Exchanges begin operations
January 1, 2014: Exchange must be fully operational
10 days!
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Please feel free to contact us:
Community Advocates Public Policy Institute728 North James Lovell Street, Milwaukee, WI 53233
David Riemer, Senior [email protected], 414.270.2943
Michael Bare, Research and Program [email protected],
414.270.2976
Thank you!