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Health Insurance Enrollment

September 19, 2013

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Webinar Recording and Evaluation Survey

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Today’s Speakers: Paul Dioguardi Director, Intergovernmental Affairs U.S. Department of Health and Human Services Hon. Jim McDonough Commissioner Ramsey County, MN Hon. Roy C. Brooks Commissioner Tarrant County, TX

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How many people are attending this webinar from your computer? a. 1

b. 2

c. 3

d. 4

e. 5 or more

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Is your state expanding Medicaid?

a. Yes

b. No

c. Not Sure

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What type of Health Insurance Marketplace will your state have?

a. Federally-facilitated Marketplace

b. State-based Marketplace

c. Federal-State Partnership

d. Not Sure

Update on the Affordable Care Act from the US Department of Health and Human Services

September 19, 2013

Insurance companies could take advantage of you and turn away the 129 million Americans with pre-existing conditions

Premiums had more than doubled over the last decade, while insurance company profits were soaring

Tens of millions were underinsured, and many who had coverage were afraid of losing it

50 million Americans had no insurance at all

The Problem

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Since March 23, 2010 • 105 million Americans no longer have a lifetime dollar limit on essential health

benefits • 71 million additional Americans now receive many preventive services without cost

sharing such as copays or deductibles • 3.1 million young adults who were uninsured have gained coverage by being able

to stay on their parent’s health plan • Over 107,000 Americans with pre-existing conditions have gained coverage • Over 6 million seniors and people with disabilities have saved more than $5.7

billion on prescription drugs Since January 1, 2011

• Free preventive care has been available to seniors, an estimated 34.1 million seniors in 2012 alone

• The 80/20 rule ensured premium dollars were spent primarily on health care and helped deliver rebates worth $1.1 billion to nearly 13 million consumers

Accomplishments

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The Marketplace (or Exchange) - Place for individuals and small employers to directly compare private health insurance options known as Qualified Health Plans (QHPs) • Can directly compare on the basis of price, benefits,

quality, and other factors

Introduction to The Marketplace

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Each state can choose between: • State Based Marketplace – State creates and runs its own

Marketplace • State Partnership Marketplace – State partners with

Federal government to run some Marketplace functions • Federally Facilitated Marketplace – State has a

Marketplace established and operated by the Federal government

Marketplace Establishment

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Employers averaging fewer than 50 Full Time Employees (FTEs) are not required to provide health insurance coverage • 96% of all employers in the U.S. have fewer than 50

employees

Employers averaging 50 or more FTEs may be subject to a shared responsibility payment under certain conditions

Are all employers required to provide health insurance in 2014?

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SHOP is a Marketplace for small businesses and their employees (fewer than 100 employees) • States may limit participation to those with 50 or fewer employees for

the first 2 years • Employer will access the SHOP where its principal business office is

located • Employer must offer coverage to all full-time employees • Sole proprietors buy through the individual Marketplace rather than

the SHOP Eligible employers can

• Define how much they’ll contribute toward their employees’ coverage • Have exclusive access to a small business tax credit • Benefit from larger pool of participants that helps them get real value

for consumer’s premium dollars

Small Business Health Options Program (SHOP)

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Marketplace initial open enrollment period starts October 1, 2013 and ends March 31, 2014

Annual open enrollment periods after that start on October 15 and end on December 7

Special Enrollment Periods available in certain circumstances during the year

When Consumers Can Enroll

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Finding Enrollment Help In Your Area

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Grant program sponsored by each Marketplace • Navigators will

Raise awareness about the Marketplace Provide unbiased information about enrollment Help consumers understand health plan differences

And help submit consumers’ choices to the Marketplace Provide culturally/linguistically appropriate information Give referrals May be an agent or a broker if standards are met

Can’t be paid by issuer for enrolling people in QHPs/non-QHPs Other assistance also may be available beyond

Navigators including agents, brokers, and community health centers

Navigator Program

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Application and Eligibility

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Submit single, streamlined application

to the Marketplace

Verify and determine eligibility

• Online • Phone • Mail • In Person

Supported by Data Services Hub

Eligible for Marketplace or Medicaid/CHIP

Enroll (Marketplace)

Enroll (Medicaid/CHIP)

Extends option for states to expand Medicaid eligibility to • Adults ages 19 – 64 with incomes up to 133% of the FPL

($15,282/year for an individual, $31,322/year for a family of 4)* • Limits renewals to once every 12 months

Ensures Medicaid coverage for all children • With incomes up to 133% of the FPL

Shifts to a simplified way of calculating income to determine Medicaid/CHIP eligibility • Known as Modified Adjusted Gross Income (MAGI)

Medicaid Eligibility in 2014

22 *2013 Amounts

Medicaid/CHIP Children

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133% FPL

241% FPL

400% FPL

Exchange Subsidies

Adults Children

Medicaid Adults

Varies by State

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Affordable Insurance Programs (2014): Without Expansion

For non-elderly, non-disabled individuals, based on current median state eligibility

133% FPL

Medicaid/CHIP Children

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241% FPL

400% FPL

Children

Varies by State

100% FPL 63% FPL 37% FPL

Other Adults

Jobless Parents

Working Parents

Exchange Subsidies

Pregnant Women

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www.HealthCare.gov (Consumers)

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Starting October 1, 2013, you will be able to apply through this site

Now - Sign up for Email and Text Alerts and Get Ready

Marketplace.cms.gov (Stakeholders)

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Get the latest resources to help people apply, enroll, and get coverage in 2014

Affordable Care Act Implementation: Medicaid Eligibility and Enrollment

Presentation by Ramsey County Commissioner Jim McDonough

National Association of Counties Webinar

September 19, 2013

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Discussion Outline

• Minnesota Context • Current Status of ACA Implementation

and Expanded Enrollment • Challenges • Future Outlook

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Minnesota Context

• Minnesota expanded Medicaid.

• Number of uninsured is rising.

• Minnesota’s electronic marketplace: MNsure

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Minnesota Context

• State supervised, county administered.

• A new Medicaid eligibility and enrollment system.

• Single site for health insurance – unsubsidized, subsidized, or Medicaid.

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Current Status

• A late start with a partisan divide.

• MNsure to be implemented October 1, 2013, insurance to be effective January 1, 2014.

• Marketing MNsure.

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Current Status

• Navigators and in-person assisters.

• Telephone service centers. • Additional temporary county staff

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Ongoing Challenges

• October 1: a huge implementation challenge.

• “Just in time” development.

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Ongoing Challenges

• Increased Medicaid enrollment, plus a new computer system.

• Rapidly increasing caseloads.

• Operational issues.

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Future Direction

• More residents ensured.

• Reduced complexity.

• Linking to other services.

• Additional county resident impacts.

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Thank You for Listening

Questions or Comments?

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Health Insurance Enrollment National Association of Counties (NACO) - Webinar

September 19, 2013

Presented by: Commissioner Roy C. Brooks

Tarrant County

Agenda Health Insurance Enrollment

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Overview of Affordable Healthcare Act (ACA)

The State of Texas Analysis

Impact on Underserved and Minority Populations

Tarrant County Community Outreach and Awareness

Timeline

Affordable Healthcare Act

State of Texas

• States had the option of establishing their own exchange o In 2012, Gov. Perry announced that Texas the state

would not establish its own exchange, nor would Texas expand its Medicaid program to include a larger group of uninsured Texans.

o Therefore, by default, the Texas health insurance exchange is run by the federal government..

State of Texas Who are the Uninsured in Texas?

• Texas is the uninsured capital of the United States.

• More than 6.3 million Texans - including 1.2 million children - lack health insurance.

• Texas' un-insurance rates, 1.5 to 2 times the national average, create significant problems in the financing and delivery of health care to all.

State of Texas Who are the Uninsured in Texas?

Population Uninsured %Uninsured Rank United States 186,727,700 41,160,200 22% Texas 15,001,7000 4,886,100 33% 1

Health Insurance Coverage of Adults 19-64

Health Insurance Coverage of Children 0-18

Population Uninsured %Uninsured Rank United States 79,284,600 7,951,800 10% Texas 7,358,300 1,247,300 17% 1

Health Insurance Coverage of Total Population

Population Uninsured %Uninsured Rank United States 305,191,100 49,903,900 16% Texas 24,840,100 6,234,900 25% 1

State of Texas

• Texas residents are able to shop for and enroll in health insurance plans at the federal health insurance marketplace portal: o HealthCare.gov and CuidadoDeSalud.gov.

• All plans offered in the Texas exchange cover

essential health benefits based on Blue Cross/Blue Shield of Texas’s Best Choice PPO plan.

The Texas Health Insurance Exchange

Impact on Underserved and Minority Populations

Percentage of Health Coverage by Race

Impact on Underserved and Minority Populations

• The law works to eliminate health disparities

that minorities face. o Funds research about health disparities o Promotes racial and ethnic diversity or

health professionals o Expands community health programs to

manage chronic conditions such as diabetes

Reduction in Health Disparities

Community Outreach and

Awareness • Collaboration is Key!

• Led efforts to coordinate collaboration among:

o Department of Health & Human Services o United Way of Tarrant County o Enroll America o Faith-Based and Community Organizations o Tarrant County

Community Outreach and

Awareness

• Recipient of 5.9 million grant to help uninsured Texans understand and navigate the Health Insurance Marketplace (largest award in country) o Will serve 220 Texas Counties and educate

people in purchasing health insurance o Employing 6 navigators (for Tarrant County) who

will provide face-to-face contacts with a minimum of 3,441 individual estimated for eligibility

United Way of Tarrant County

Community Outreach and

Awareness

• Host Community Leaders Roundtable (Faith-Based and Community) and Enrollment Drive.

• Distribution of information about the Marketplace, via materials, Website and social media platforms.

• Utilize “Constant Contact” email distribution.

• Speak at community events and meetings.

Outreach Efforts Include:

Community Outreach and

Awareness

• Certified Office as Certified Application Counselor (CAC) Organization o Allows staff to help people understand, apply, and

enroll for health coverage through the Marketplace.

• Participate in CMS Health Insurance Marketplace 101 Trainings.

• Provide computer stations in office(s) to allow constituents to use to enroll in the Marketplace.

Staff Training

Final Thoughts

• Open enrollment begins in the Health Insurance Marketplace on October 1st and will run through March 31st.

• New policies will take effect January 2014.

• Targeted community enrollment events scheduled for: o October 2013 (Community Leaders Roundtable) o November 2013 (Enrollment Drive) o January 2014 (2nd Enrollment Drive)

Question and Answers

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NACo Resources

• Health Reform Implementation Site

– Here you can find:

Counties as Employers Toolkit (Updated)

http://www.naco.org/healthrefomtoolkit

• Outreach and Enrollment Toolkit for Elected Officials

http://www.naco.org/legislation/Documents/Toolkit%20with%20Letter.pdf

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HHS Resources • Outreach and Enrollment Toolkit for Elected Officials

http://marketplace.cms.gov/getofficialresources/other-partner-resources/outreach-and-enrollment-toolkit-for-elected-officials.pdf

• For professionals learning about the Marketplace and helping people apply, please visit the Centers for Medicaid & Medicare Services’ Resources page

www.marketplace.cms.gov

• Individuals, families, and small businesses can find assistance at: www.healthcare.gov

• Customer Service Representative available 24/7 at 1-800-318-2596 (TTY: 1-855-889-4325)

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Type your question into the questions box and the moderator will read the question on your behalf during the Q&A session. If we are unable to answer all of the questions during the Q&A session, we will send you the questions and answers in an email.

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Upcoming Webinars and Events • County Health Rankings Webinar

o How can your county’s rankings be a starting point to drive community change? Learn about tools and resources available to address community needs.

o When: Thursday, October 10th at 2pm

• NACO 2013 Roadmaps to Health Forum o Join NACo to explore and identify opportunities

develop, enhance, and sustain positive health outcomes in your county

o When: October 31 to November 1, 2013 o Where: Dane County (Madison), WI

• Please contact Katie Bess at kbess@naco.org for more information.

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2014 Healthy Counties Forum

What: This forum will focus on using Accountable Care Communities (ACCs) to mobilize and advance healthy changes rural, mid-size, and large counties? What are counties doing as employers and public health leaders?

When: January 30-31, 2014

Where: San Diego County, CA

Please contact Emmanuelle St. Jean, MPH, Program Manager, 202.942.4267 or estjean@naco.org