1National Association of Public Hospitals and Health Systems
Medicaid Expansion and Exchange Marketplaces at the Ground Level
April 26, 2013
Xiaoyi Huang, Esq.Assistant Vice President for Policy
NAPH
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Agenda
Introduction What will happen on Jan. 1? What does it all mean? Q&A
National Association of Public Hospitals and Health Systems
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ABOUT NAPH MEMBER HOSPITALS
National Association of Public Hospitals and Health Systems
4National Association of Public Hospitals and Health Systems
NAPH Members by Bed Size, 2010
5National Association of Public Hospitals and Health Systems
Discharges by Race/Ethnicity at NAPH Members, 2010
6National Association of Public Hospitals and Health Systems
Discharges by Age at NAPH Members, 2010
7National Association of Public Hospitals and Health Systems
Gross Charges by Payer Source at NAPH Members, 2010
8National Association of Public Hospitals and Health Systems
Hospital Margins, 2010
9National Association of Public Hospitals and Health Systems
NAPH Member Sources of Financing for Unreimbursed Care, 2010
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WHAT WILL HAPPEN ON JAN. 1?
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Important Dates
Effective date for exchange coverage and Medicaid expansion: Jan. 1, 2014
Exchange open enrollment: Oct. 1 2013 to Mar. 31, 2014
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Medicaid Expansion – Yea or Nay?
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Medicaid Expansion in IL
2+ million people on IL Medicaid today
700,000 current uninsured >> eligible~180K under current rules (regular FMAP)~520K under expansion rules (enhanced
FMAP)
~500,000 – 600,000 people will enroll
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Issues to Consider
Do you have capacity to take on additional Medicaid patients, including those who have been forgoing care?
What will be the impact on your bottom line?
Will your Medicaid shortfall increase? Will this shift in payer mix impact your
supplemental payments? What will be the impact on DSH?National Association of Public Hospitals and Health Systems
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Exchange Marketplace
IL is pursuing the partnership model until at least 2015
Until then, IL plans to take on consumer assistance and plan management functions
Federal government will take on eligibility determination, enrollment, and financial management functions
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Profile of Exchange Population
Depending on uptake, between 300,000 to 700,000 will enroll in IL’s partnership exchange
Median poverty level: 235% of FPLTwo-thirds: 200-400% of FPL
78% employed Access and utilization more like uninsured
than insured population
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Issues to Consider
What happens when people move between Medicaid and exchange coverage?
What if patients need services that are not covered by the EHB benchmark package?
What if the cost-sharing is too high? What if people can’t afford the premiums?
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Special Issues to Consider as an Essential Community Provider (ECP)
Part of QHPs’ network adequacy standards to include a sufficient number and type of ECPs
If not already established, can you develop beneficial relationships with issuers on the exchange?
If not, will existing patients (the newly eligibles) go elsewhere once they are covered?
What will happen if these patients lose their coverage and need medical care?
Will you continue to provide a disproportionate share of uncompensated care?
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And Don’t Forget the Residual Uninsured
1.8 million people in IL uninsured today
Those who move in and out of coverage Those who can’t afford the premiums Those who choose not to purchase
insurance Those who are exempt from the individual
mandate Undocumented ImmigrantsNational Association of Public Hospitals and Health Systems
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WHAT DOES IT ALL MEAN?
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Adequacy of Reimbursement Rates
Persistent and growing Medicaid underpayments
Adequacy of negotiated rates with plans on the exchange marketplaces
1. Uncompensated costs of covered services2. Unpaid cost sharing for covered services3. Uncompensated cost of uncovered services
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Cuts Already in Law and Ongoing Deficit Reduction
Medicaid DSH reductions (FYs 14 to 22)Can it be offset with Medicare DSH?
Sequestration cuts to Medicare ($11b this year)
New documentation & coding cuts ($11b from FYs14 to 17)
Annual market basket reduction and productivity adjustment ($200b over 10 years)
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Changing Medicare and Medicaid Landscape
VBP Readmissions HACs (HCACs in Medicaid)
ACOs Bundled payments Medicaid health homes Community health teams
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Questions?
Xiaoyi Huang, Esq.Assistant Vice President for [email protected]
National Association of Public Hospitals and Health Systems
