Engineering an Exchange: A Look at State ... - State Refor(u)m
Engineering an Exchange: A Look at State ... - State Refor(u)m
Engineering an Exchange: A Look at State ... - State Refor(u)m
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St<strong>at</strong>e of Implement<strong>at</strong>ion Webinar Series!<br />
<strong>Engineering</strong> <strong>an</strong> Exch<strong>an</strong>ge: A<br />
<strong>Look</strong> <strong>at</strong> St<strong>at</strong>e Blueprints <strong>an</strong>d<br />
Decisions!<br />
Thursday, December 13 th 3:00-4:30pm ET!<br />
Call-in # 1-800-741-3792!<br />
Follow us on<br />
Twitter for live<br />
upd<strong>at</strong>es: !<br />
@st<strong>at</strong>ereforum!
Agenda!<br />
3:00 – 3:10pm! Introduction!<br />
Elizabeth Cronen, NASHP!<br />
David Adler, RWJF!<br />
3:10 – 3:25pm! Overview of St<strong>at</strong>e Progress on Exch<strong>an</strong>ges!<br />
Sarabeth Zemel <strong>an</strong>d Rachel Dol<strong>an</strong>, NASHP!<br />
3:25 – 4:00pm! P<strong>an</strong>el Discussion with St<strong>at</strong>es!<br />
Moder<strong>at</strong>or: Elizabeth Cronen, NASHP!<br />
P<strong>an</strong>elists:!<br />
• Peter Lee, California!<br />
• Colleen Burns, Illinois!<br />
• Norm Thurston, Utah!<br />
4:00 – 4:25pm! Question <strong>an</strong>d Answer!<br />
*Use the ch<strong>at</strong> fe<strong>at</strong>ure to submit your questions!<br />
4:25 – 4:30pm! Wrap-up!
Overview of St<strong>at</strong>e Progress on<br />
Exch<strong>an</strong>ges!<br />
Sarabeth Zemel!<br />
Program M<strong>an</strong>ager!<br />
N<strong>at</strong>ional Academy for St<strong>at</strong>e Health Policy!<br />
st<strong>at</strong>ereforum.org/user/sarabethzemel!<br />
Rachel Dol<strong>an</strong>!<br />
Policy Analyst!<br />
N<strong>at</strong>ional Academy for St<strong>at</strong>e Health Policy!<br />
st<strong>at</strong>ereforum.org/user/racheldol<strong>an</strong>!
Key Exch<strong>an</strong>ge Deadlines!<br />
December 14, 2012:!<br />
December 26, 2012:!<br />
J<strong>an</strong>uary 1, 2013:!<br />
February 15, 2013:!<br />
March 1, 2013:!<br />
April 2013:!<br />
June 2013:!<br />
October 1, 2013:!<br />
J<strong>an</strong>uary 1, 2014:!<br />
December 31, 2014:!<br />
• Letter of intent <strong>an</strong>d blueprint for st<strong>at</strong>e exch<strong>an</strong>ge<br />
due!<br />
• Benchmark pl<strong>an</strong> decision or default due!<br />
• Deadline for conditional approval from HHS to<br />
oper<strong>at</strong>e st<strong>at</strong>e-based exch<strong>an</strong>ge!<br />
• Letter of intent <strong>an</strong>d blueprint for st<strong>at</strong>e partnership<br />
due!<br />
• Approval of partnership exch<strong>an</strong>ges on a rolling<br />
basis before this d<strong>at</strong>e!<br />
• QHPs begin submitting applic<strong>at</strong>ions to federal<br />
exch<strong>an</strong>ge for 2014!<br />
• Federal navig<strong>at</strong>or gr<strong>an</strong>ts awarded!<br />
• Open enrollment on exch<strong>an</strong>ge!<br />
• Coverage begins!<br />
• Federal funding for exch<strong>an</strong>ges expires!
St<strong>at</strong>e Options for Running<br />
St<strong>at</strong>e Run!<br />
Federal-St<strong>at</strong>e<br />
Partnership!<br />
Federally Run!<br />
Exch<strong>an</strong>ge!<br />
• St<strong>at</strong>ewide, regional or sub-st<strong>at</strong>e?!<br />
• Individual <strong>an</strong>d small business exch<strong>an</strong>ges<br />
together or separ<strong>at</strong>e?!<br />
• St<strong>at</strong>e takes on consumer assist<strong>an</strong>ce?!<br />
• St<strong>at</strong>e takes on pl<strong>an</strong> m<strong>an</strong>agement?!<br />
• St<strong>at</strong>e takes on both consumer assist<strong>an</strong>ce<br />
<strong>an</strong>d pl<strong>an</strong> m<strong>an</strong>agement?!<br />
• Wh<strong>at</strong> is a st<strong>at</strong>eʼs role here?!<br />
• Regul<strong>at</strong>ing insur<strong>an</strong>ce?!<br />
• Educ<strong>at</strong>ing consumers?!<br />
• Referring to Federal exch<strong>an</strong>ge?!
St<strong>at</strong>e Action on Exch<strong>an</strong>ges<br />
http://www.st<strong>at</strong>ereforum.org/wherest<strong>at</strong>es-st<strong>an</strong>d-on-exch<strong>an</strong>ges
Govern<strong>an</strong>ce Models for <br />
St<strong>at</strong>e-Run Exch<strong>an</strong>ges!<br />
New or existing st<strong>at</strong>e<br />
executive br<strong>an</strong>ch agency<br />
under the governor!<br />
Quasi-governmental entity!<br />
Non-profit org<strong>an</strong>iz<strong>at</strong>ion!<br />
• Kentucky, New York, Rhode Isl<strong>an</strong>d,<br />
Minnesota, Vermont, West Virginia,<br />
Utah*!<br />
• California, Colorado, Connecticut, District<br />
of Columbia, Maryl<strong>an</strong>d, Oregon,<br />
Washington, Nevada, Massachusetts*!<br />
• Hawaii!<br />
*Utah <strong>an</strong>d Massachuse.s set up exch<strong>an</strong>ges prior to the ACA
St<strong>at</strong>es Awarded Establishment Gr<strong>an</strong>ts
Submit Your St<strong>at</strong>e’s Blueprint!<br />
http://www.st<strong>at</strong>ereforum.org/exch<strong>an</strong>ge-blueprint-chart<br />
ü Use the<br />
“comments”<br />
<strong>at</strong> the<br />
bottom of<br />
the page to<br />
submit a link<br />
to your<br />
st<strong>at</strong>eʼs<br />
blueprint!!
St<strong>at</strong>e Exch<strong>an</strong>ges: Key Policy Decisions!<br />
Outreach <strong>an</strong>d<br />
Educ<strong>at</strong>ion!<br />
Pl<strong>an</strong><br />
R<strong>at</strong>ing<br />
System!<br />
SHOP!<br />
St<strong>at</strong>e Details:!<br />
st<strong>at</strong>ereforum.org/<br />
exch<strong>an</strong>ge-policydecisions!<br />
Pl<strong>an</strong><br />
Certific<strong>at</strong>ion!<br />
Fin<strong>an</strong>cing/<br />
Sustainability!<br />
Eligibility<br />
Systems!<br />
Premium<br />
Aggreg<strong>at</strong>ion/<br />
Billing!
Eligibility <strong>an</strong>d Enrollment<br />
M<strong>an</strong><strong>at</strong>t Rules Assessment!<br />
http://www.st<strong>at</strong>ereforum.org/<br />
sites/default/files/<br />
m<strong>an</strong><strong>at</strong>t_assessment_rules.pdf!<br />
Submit single,<br />
streamlined<br />
applic<strong>at</strong>ion to<br />
the Exch<strong>an</strong>ge,<br />
Medicaid/CHIP<br />
!<br />
• Online!<br />
• Phone!<br />
• In-person!<br />
Eligibility is<br />
verified <strong>an</strong>d<br />
determined!<br />
• Medicaid/<br />
CHIP!<br />
• QHP!<br />
• APTC!<br />
IN MAGI Flowchart!<br />
http://www.st<strong>at</strong>ereforum.org/<br />
sites/default/files/<br />
magiflowchartfinalrule.pdf!<br />
Enroll in<br />
affordable<br />
coverage!<br />
• Medicaid<br />
/CHIP!<br />
• QHP!
Premium Aggreg<strong>at</strong>ion/Billing<br />
Carrier!<br />
Consumer!<br />
MD Billing Slides!<br />
http://www.st<strong>at</strong>ereforum.org/<br />
sites/default/files/nongroup_billing_<strong>an</strong>d_collections<br />
_111312_corrected.pdf!<br />
Exch<strong>an</strong>ge!
Consumer Assist<strong>an</strong>ce<br />
Navig<strong>at</strong>ors! In-Person Assisters!<br />
Required by ACA! Required for consumer assist<strong>an</strong>ce<br />
partnership exch<strong>an</strong>ges; optional<br />
for st<strong>at</strong>e exch<strong>an</strong>ges!<br />
No federal funding for oper<strong>at</strong>ions! Federal funding allowed!<br />
Functions <strong>an</strong>d conflict of interest<br />
requirements specified in<br />
regul<strong>at</strong>ions!<br />
Regul<strong>at</strong>ions pending!
Explicitly prohibited!<br />
• Colorado!<br />
• Hawaii!<br />
Unclear: !<br />
Iowa, New York,<br />
Kentucky,<br />
Mississippi,<br />
Minnesota!<br />
Active Purchasing!<br />
Either not addressed<br />
or not prohibited!<br />
• Nevada!<br />
• West Virginia!<br />
• Rhode Isl<strong>an</strong>d!<br />
• Washington!<br />
Expressly allowed!<br />
• California!<br />
• Connecticut!<br />
• District of<br />
Columbia!<br />
• Massachusetts!<br />
• Maryl<strong>an</strong>d!<br />
• Oregon!<br />
• Vermont!
Implic<strong>at</strong>ions: We have to get all three<br />
models right!!<br />
St<strong>at</strong>e Exch<strong>an</strong>ge<br />
Risks!<br />
St<strong>at</strong>e Exch<strong>an</strong>ge<br />
Benefits!<br />
Will the Feds be<br />
ready?!<br />
• Oper<strong>at</strong>ional risks th<strong>at</strong> it wonʼt launch well, <strong>an</strong>d<br />
residents will be unhappy.!<br />
• Fin<strong>an</strong>cial risk th<strong>at</strong> it wonʼt be fin<strong>an</strong>cially selfsustaining<br />
by 2015 <strong>an</strong>d cost the st<strong>at</strong>e money!<br />
• Better to let other st<strong>at</strong>es go first <strong>an</strong>d then design<br />
it when the road is easier to travel down!<br />
• Integr<strong>at</strong>ing health insur<strong>an</strong>ce exch<strong>an</strong>ge into<br />
health care system goals <strong>an</strong>d overall st<strong>at</strong>e<br />
coverage/ health str<strong>at</strong>egy!<br />
• St<strong>at</strong>e might be held accountable even if the<br />
federal government is running it!<br />
• Basic oper<strong>at</strong>ional concern about federal<br />
government running a program with a large<br />
impact on the st<strong>at</strong>e!<br />
• J<strong>an</strong> 1 might look more like FFE “beta”, with<br />
some delays <strong>an</strong>d d<strong>at</strong>a flow issues to improve,<br />
but the federal government will have known for<br />
nearly 3 years th<strong>at</strong> they need to be ready!!
Today’s P<strong>an</strong>el<br />
Elizabeth Cronen!<br />
Community M<strong>an</strong>ager!<br />
N<strong>at</strong>ional Academy for St<strong>at</strong>e Health Policy!<br />
!<br />
Peter Lee!<br />
Executive Director!<br />
California Health Benefit Exch<strong>an</strong>ge!<br />
Colleen Burns!<br />
Special Counsel for Health Policy!<br />
Illinois Department of Insur<strong>an</strong>ce!<br />
!<br />
Norm Thurston!<br />
Health <strong>Refor</strong>m Implement<strong>at</strong>ion Coordin<strong>at</strong>or!<br />
St<strong>at</strong>e of Utah!<br />
!
Wh<strong>at</strong> exch<strong>an</strong>ge model did your<br />
st<strong>at</strong>e choose <strong>an</strong>d why?
Illinois Health Insur<strong>an</strong>ce<br />
Exch<strong>an</strong>ge!<br />
On October 16, the Governor submitted a<br />
declar<strong>at</strong>ion letter to HHS confirming th<strong>at</strong><br />
Illinois will:!<br />
n Be a Partnership Exch<strong>an</strong>ge in 2014, as a<br />
bridge to a future St<strong>at</strong>e-Based Exch<strong>an</strong>ge!<br />
n Illinois does not currently have legisl<strong>at</strong>ive<br />
authority to pursue a St<strong>at</strong>e-Based<br />
Exch<strong>an</strong>ge!
Utah Exch<strong>an</strong>ge!<br />
¨ Request certific<strong>at</strong>ion of our existing<br />
vision<br />
¨ Keep all options on the table
How will you ensure the<br />
exch<strong>an</strong>ge has the right choice or<br />
bal<strong>an</strong>ce of pl<strong>an</strong>s? Wh<strong>at</strong> are<br />
some other ways you are<br />
working to make your exch<strong>an</strong>ge<br />
consumer friendly?
Choice of Pl<strong>an</strong>s<br />
¨ Allow priv<strong>at</strong>e sector to innov<strong>at</strong>e <strong>an</strong>d cre<strong>at</strong>e<br />
variety!<br />
¨ Use technology to assist consumers <strong>an</strong>d enable<br />
choice!<br />
¨ Don't overlook the value of professionals !
Qualified Health Pl<strong>an</strong> Solicit<strong>at</strong>ion:<br />
¨ Affordability<br />
¨ Quality<br />
¨ Offers me<strong>an</strong>ingful choice on a<br />
regional basis<br />
¨ Provides st<strong>at</strong>ewide coverage<br />
¨ Promotes effective inclusion<br />
of essential community<br />
providers<br />
¨ Fosters delivery system<br />
reform<br />
¨ Fosters long-term<br />
partnerships between issuers<br />
<strong>an</strong>d Covered California<br />
Evalu<strong>at</strong>ion Factors
Qualified Health Pl<strong>an</strong> (QHP)<br />
Review!<br />
¤ As a Partnership Exch<strong>an</strong>ge:!<br />
n Insurers will submit QHP applic<strong>at</strong>ions to DOI;!<br />
n DOI regul<strong>at</strong>ors will review QHP applic<strong>at</strong>ions!<br />
¤ DOI is currently developing a QHP applic<strong>at</strong>ion to<br />
issue to carriers!<br />
¤ All QHP applic<strong>at</strong>ions th<strong>at</strong> meet minimum<br />
st<strong>an</strong>dards will be recommended to HHS for<br />
certific<strong>at</strong>ion <strong>an</strong>d display on the Exch<strong>an</strong>ge!
Consumer Assist<strong>an</strong>ce!<br />
¨ DOI is currently developing <strong>an</strong> In-Person<br />
Assist<strong>an</strong>ce program!<br />
¤ Research is being conducted on the Illinois<br />
marketplace!<br />
¤ DOI is developing <strong>an</strong> RFP to solicit vendors to<br />
conduct training for our IPA program!<br />
¤ Working with CCIIO to provide feedback on<br />
development of the Navig<strong>at</strong>or program!
How do you pl<strong>an</strong> to work with<br />
the federal government to make<br />
sure your exch<strong>an</strong>ge is<br />
successful, whichever model<br />
your st<strong>at</strong>e has chosen?
Tr<strong>an</strong>sition to SBE!<br />
¨ We continue to work with the Illinois General<br />
Assembly to pass St<strong>at</strong>e Exch<strong>an</strong>ge legisl<strong>at</strong>ion with<br />
govern<strong>an</strong>ce <strong>an</strong>d fin<strong>an</strong>cing authority. !<br />
¤ DOI is currently reviewing 5 bids from IT Vendors<br />
to build the Exch<strong>an</strong>ge!<br />
¤ Medicaid agency has executed <strong>an</strong> IT contract to<br />
build <strong>an</strong> Integr<strong>at</strong>ed Eligibility System.!
Working with HHS!<br />
¨ On-going dialog<br />
¨ Main questions revolve around cost <strong>an</strong>d control!
Wh<strong>at</strong> factors are top-of-mind as<br />
you consider keeping the<br />
exch<strong>an</strong>ge sustainable <strong>an</strong>d<br />
affordable?
Sustainable <strong>an</strong>d Affordable<br />
¨ Development vs. oper<strong>at</strong>ing costs<br />
¨ Net impact on consumers
By Age <strong>an</strong>d FPL<br />
18 - 24!<br />
25 - 34!<br />
35 - 44!<br />
45 - 64!<br />
Covered California’s Target<br />
Segments<br />
139 – 199%! 200 – 400%! 400%+!<br />
Just Getting<br />
Started!<br />
275,241!<br />
9%!<br />
Working Families!<br />
786,323!<br />
26%!<br />
At Risk <strong>an</strong>d Older!<br />
313,789!<br />
10%!<br />
Independent <strong>an</strong>d<br />
Connected !<br />
595,049!<br />
20%!<br />
Calcul<strong>at</strong>ed Risk<br />
Takers!<br />
317,914!<br />
11%!<br />
Older <strong>an</strong>d Denied!<br />
703,409!<br />
24%!
Ethnic Mix of Covered California<br />
Subsidy Eligible Californi<strong>an</strong>s
Forecasted Applic<strong>at</strong>ion P<strong>at</strong>hways<br />
• Projections based upon CalSIM v1.7 March 22 nd 2012 base scenario!<br />
• Multi-Ch<strong>an</strong>nel Support (Ch<strong>at</strong>, Email, Fax <strong>an</strong>d Correspondence will be included in the projections)!<br />
Service Center<br />
Enrollments 20%<br />
Assister <strong>an</strong>d Agent<br />
Enrolled via Paper<br />
10%<br />
Assister <strong>an</strong>d Agent<br />
Enrolled via Web<br />
40%<br />
Self-Enrolled Online<br />
20%<br />
Self-Enrolled Paper<br />
Applic<strong>at</strong>ion 10%<br />
Notes:!<br />
!-Each area of enrollment may result in contacts to the Service Center!<br />
!-Ongoing case m<strong>an</strong>agement workload for Medi-Cal will be performed in the County of residence. Ongoing Covered<br />
California work will be performed by Covered California <strong>an</strong>d is estim<strong>at</strong>ed separ<strong>at</strong>ely!<br />
!!
“Aim High” <strong>an</strong>d Pl<strong>an</strong> for Uncertainty<br />
2,500,000 !<br />
2,000,000 !<br />
1,500,000 !<br />
1,000,000 !<br />
500,000 !<br />
Covered California Subsidized & Unsubsidized Enrollment<br />
Projection Profile <strong>an</strong>d Growth!<br />
- !<br />
J<strong>an</strong>-14! J<strong>an</strong>-15! J<strong>an</strong>-16! J<strong>an</strong>-17! J<strong>an</strong>-18! J<strong>an</strong>-19! J<strong>an</strong>-20!<br />
Low / Slow! Low! Base! Enh<strong>an</strong>ced!<br />
J<strong>an</strong>-14! J<strong>an</strong>-15! J<strong>an</strong>-16! J<strong>an</strong>-17! J<strong>an</strong>-18! J<strong>an</strong>-19! J<strong>an</strong>-20!<br />
Low / Slow! 150,000 ! 490,000 ! 850,000 ! 1,240,000 ! 1,410,000 ! 1,560,000 ! 1,560,000 !<br />
Low! 240,000 ! 780,000 ! 1,020,000 ! 1,240,000 ! 1,410,000 ! 1,560,000 ! 1,560,000 !<br />
Base! 300,000 ! 970,000 ! 1,280,000 ! 1,550,000 ! 1,770,000 ! 1,950,000 ! 1,950,000 !<br />
Enh<strong>an</strong>ced! 430,000 ! 1,380,000 ! 1,890,000 ! 2,300,000 ! 2,380,000 ! 2,430,000 ! 2,440,000 !<br />
Covered California is seeking to enroll as m<strong>an</strong>y Californi<strong>an</strong>s as possible. Covered California is working to<br />
meet <strong>an</strong>d exceed its goals, while <strong>at</strong> the same time pl<strong>an</strong>ning for lower enrollment by developing budgets th<strong>at</strong><br />
c<strong>an</strong> be adjusted <strong>an</strong>d const<strong>an</strong>tly adjusting its marketing, outreach <strong>an</strong>d oper<strong>at</strong>ions as needed based on new<br />
inform<strong>at</strong>ion <strong>an</strong>d experience.!
Pl<strong>an</strong>ned Enrollment <strong>an</strong>d Oper<strong>at</strong>ing<br />
Budget
Question <strong>an</strong>d Answer<br />
Submit your<br />
questions in the<br />
ch<strong>at</strong> box on the<br />
left!
Knowledge Network<br />
Experts will be available to <strong>an</strong>swer your questions! !<br />
Post them now on St<strong>at</strong>e <strong>Refor</strong>(u)m in our Exch<strong>an</strong>ge discussion!<br />
Camie Berardi!<br />
ACA Implement<strong>at</strong>ion M<strong>an</strong>ager!<br />
MA Health Connector!<br />
st<strong>at</strong>ereforum.org/user/camieberardi!<br />
Jenny Sulliv<strong>an</strong>!<br />
Director, Best Practices Institute!<br />
Enroll America!<br />
st<strong>at</strong>ereforum.org/user/jennysulliv<strong>an</strong>!<br />
P<strong>at</strong>ricia MacTaggart!<br />
Lead Research Scientist!<br />
George Washington University!<br />
st<strong>at</strong>ereforum.org/user/p<strong>at</strong>riciamactaggart!<br />
!<br />
http://www.st<strong>at</strong>ereforum.org/discussions/exch<strong>an</strong>ge-policy-decisions!
St<strong>at</strong>e <strong>Refor</strong>(u)m Resources!<br />
¨ Our Exch<strong>an</strong>ge charts<br />
¤ Share inform<strong>at</strong>ion<br />
upd<strong>at</strong>es!<br />
¤ Policy decisions<br />
¤ Govern<strong>an</strong>ce<br />
¤ Blueprints<br />
¨ Exch<strong>an</strong>ge Map<br />
Find the charts <strong>an</strong>d map <strong>at</strong>:<br />
http://www.st<strong>at</strong>ereforum.org/insight/topic/<br />
312<br />
¨ Exch<strong>an</strong>ge Discussion<br />
http://www.st<strong>at</strong>ereforum.org/<br />
discussions/exch<strong>an</strong>ge-policy-decisions
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