Washington Health Benefit Exchange

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AAPWA Conference

Brian Peyton, Director of Legal Services

November 1O, 2015

Some Early Lessons Learned

ACA Health Exchanges -

Combining commercial health insurance, Medicaid and the Income Tax.

What could go wrong?

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Exchange Basics

▪ Entry point for Medicaid, Qualified Health Plans

▪ AHP: Individuals >138% of FPL and small groups (1-50)

▪ Tax credits available for individuals 138%-400% of FPL

▪ Cost sharing reductions available for <250% FPL

▪ Metallic tiers for different coverage levels

▪ Apples-to-apples comparisons for consumers, one-stop shop 10 essential health benefits

▪ Robust Customer Support Network▪ Call Center▪ State-Wide Navigator and Broker Enrollment assistance

programs

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Using Federal Data to Verify Eligibility:

The Federal Data Services Hub

But he that filches from me my good name Robs me of that which not enriches him And makes me poor indeed.

- Shakespeare, Othello

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Eligibility Criteria Verified

▪ Citizenship/Lawful Presence

▪ Residence

▪ Not Incarcerated

▪ Income

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Common Problems

▪ Citizenship/Legal Residency not Verified

▪ Incarceration

▪ Social Security number not verified

▪ Newborn baby

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Calculating Tax Credits

“The hardest thing in the world to understand in the world is the income tax. “

-Albert Einstein

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Advanced Payments & Premium Tax CreditYour Premium Share is a Percent of Income

Up to 133% FPL 2% of income

133-150% FPL 3 – 4% of income150-200% FPL 4 – 6.3% of income200-250% FPL 6.3 – 8.05% of income

250-300% FPL 8.05 – 9.5% of income

300-400% FPL 9.5% of income

BUT……

What income is Included?

Changes in income

Fluctuating income

Household composition

You Must File a Return -”Failure to Reconcile”

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Health Literacy

Many kids come out of college, they have a credit card and a diploma. They don’t know how to buy a house or a car or health insurance or life insurance. They do not know basic microeconomics.

–Jesse Jackson

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Choosing and Using Health Insurance is New to Many

▪ Language Barriers

▪ Terminology- “deductible”, “coinsurance”, etc.

▪ The lowest premium is not always the best deal.

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Health Literacy Campaign Vision: All Washington residents know how and where to access health insurance. All Washington residents understand their health insurance options, their rights, their cost, their responsibilities and their coverage. All Washington residents know the value of health insurance in staying healthy across the lifespan.

Clear and Simple DesignReading Level: 5.3

Key Terms Translated in 8 Languages

Health Literacy Campaign ▪ Popular Consumer Tools:

▪ User’s Guide to Key Terms▪ Road Map to Health▪ The ABC’s of Health Insurance

▪ New tools in development:

▪ Metal Levels and Cost Sharing Reductions▪ You Enrolled into Coverage; Next Steps

▪ Focus Navigator training on plan info and costs. Incorporate insurance literacy into the enrollment process.

▪ Broker partnerships

▪ Insurance Literacy website: knowyourplan.org

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And now, some Good News…..

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EXCHANGE ENROLLMENT

QHP Medicaid Expansion

January 2014 63,320 231,483

May 2014 147,154 400,728

January 2015 99,614 511,607

May 2015 163,778 549,000

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Current Snapshot

Decreased uninsured rate One of the largest drops in rate of uninsurance nationwide

Census: 14% (2013) to 9.2% (2014) Gallup: 16.8% (2013) to 6.4% (mid-July 2015)

44% drop in hospital charity care; 47% drop in hospital bad debt in WA in 2014

Enrollment success (August Dashboard)– nearly 1 in 4 WA residents QHP: 155,484 Medicaid (new adult): 555,934; 1.47M (total MAGI Medicaid/CHIP)

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Health Care Research Center, Office of Financial Management

QHP eligible uninsured

less than 100

100-499

500-999

1,000 or more

Health Care Research Center, Office of Financial Management

QHP eligible uninsured

less than100

100-499

500-999

1,000 or more

Health Care Research Center, Office of Financial Management

Medicaid eligible uninsured

less than 100

100-499

500-999

1,000 or more

Health Care Research Center, Office of Financial Management

Medicaid eligible uninsured

less than 100

100-499

500-999

1,000 or more

2013 QHP Eligible Uninsured

2015 QHP Eligible Uninsured

2013 Medicaid Eligible Uninsured

2015 Medicaid Eligible Uninsured

SOURCE: http://www.ofm.wa.gov/healthcare/healthcoverage/default.asp *Estimates for 2015 are preliminary and do not account for net changes in employer-sponsored coverage and other private insurance coverage outside the Exchange.

“America enjoys the best health care in the world, but the best is no good if folks can’t afford it, access it and doctors can’t provide it.”

-Sen. Bill Frist

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