Impact of Health Reform on MiPCT March 12, 2014 12:30-1:30pm.
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Transcript of Impact of Health Reform on MiPCT March 12, 2014 12:30-1:30pm.
Impact of Health Reform on MiPCT
March 12, 201412:30-1:30pm
How to Join the Webinar
Weblink: https://mphievents.webex.com/mphievents/onstage/g.php?MTID=efe50c3cd27d345cf7d84496cd4954e78Event number: 661 322 762Event password: mipctCall-in toll number: 1-650-479-3207Access code: 661 322 762
Agenda
•Webinar logistical details and goals (1o minutes)
•Theresa Landfair, Medicaid (10 minutes)•Juanita Vorel, Priority Health (10 minutes)•Stephen Chapoton, BCBSM (10 minutes)•Q & A (20 minutes)
Webinar Goals
•To share information with MiPCT POs and practices to help you prepare for health reform implementation
•To allow an opportunity to ask questions and share best practices for reform preparation
Key Questions Asked of Payers
•Which plans are offered on the exchange? Do they vary by region?
•Can you describe enrollment so far?•Which plans are expected to gain the
most enrollment? •How many new MiPCT patients are
expected?•What type of change do you expect in
HDHP enrollment?
Michigan Department of Community Health
The Healthy Michigan Plan and MAGI UpdateMarch 12, 2014
Presentation overview:◦The Healthy Michigan Plan◦New eligibility methodology – Modified
Adjusted Gross Income (MAGI)
Overview of ACA Impact
Affordable Care Act (ACA) authorization◦ New eligibility category.
Funding must be appropriated by State. House Bill 4714 Public Act 107 of 2013 was signed into law
by Governor Snyder September 16, 2013. This is called the Healthy Michigan Plan.
Federal Law and State Law
Public Act 107 0f 2013 did not have an immediate effect.
Cannot implement prior to 90 days after the end of legislative session.
This is roughly around the April 1, 2014 timeframe.
Implementation Timeframe
State law requires certain cost-sharing requirements (co-pays and contributions).
Some of these requirements are not stated in federal regulation.
Need a waiver amendment to implement what is in state law.◦ Amended our current Adult Benefits Waiver.
Waiver Amendment was submitted 11-8-2013. Approved December 30, 2013.
Federal Waiver
Federal government will pay 100% of the program cost for the first three years.
Will decrease federal match to 90% by 2020.
Current Match is about 64%
Federal Funding
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Impact on Low Income Citizens
Provides Health Insurance Coverage for Low Income Citizens
Dramatic Reduction in Uninsured in Michigan Primary Care Is Available Health Coverage Improves Health Status Improves Employability Anticipated that up to 400,000 – 500,000
people could be eligible for the Healthy Michigan Plan
13
Federal Eligibility Parameters
Includes people ages 19-64 Not receiving or eligible for Medicare Not eligible for current Medicaid
programs Not pregnant at the time of application Covers up to 133% of the federal
poverty level (5% disregard = 138%) No asset test Must meet other federal requirements
Children 0-6
Children 7-18
Parents Caretaker Relatives
19-20 year olds
Elderly Disabled Childless Adults
0%
50%
100%
150%
200%
250%
300%
350%
400%
Medicare
Exchange
Expansion
Current
Medicaid expansion fills the gap between current coverage and private health insurance coverage offered on the Exchange
% o
f fed
eral
pov
erty
leve
l
Eligibility for Healthy Michigan Plan and Current Medicaid
15
Michigan Medicaid CaseloadT
hous
ands
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20121,200
1,300
1,400
1,500
1,600
1,700
1,800
1,900
2,000
1,885,924
1. Ambulatory patient services2. Emergency Services3. Hospitalization4. Maternity and newborn care5. Mental Health and substance
use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services9. Preventive and wellness
services and chronic disease management; and
10. Pediatric services, including oral and vision care.
11. Other, Dental, vision, home health
Benefit coverage must be based on federal benchmark coverage and include the 10 essential health care services.
Covered Services
Healthy Michigan beneficiaries will enroll into the one of the current Health Plans.
Current populations that are exempt or voluntary from managed care will remain exempt or voluntary.
Will use the current Prepaid Inpatient Health Plan (PIHP) system of care.
Service Delivery System
Required by Public Act 107 of 2013 Cost-sharing
◦ Average co-pays◦ Contribution of 2% annual income for
beneficiaries with income between 100%-133% of the FPL.
Account will provide information on health care services cost and utilization.
Will show cost of services and amount of contribution in account.
Quarterly statements
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MI Health Account
Healthy Behaviors
Health risk assessment form completed
If beneficiary engages in healthy behavior can have reduction in cost-sharing.
Goal is to have beneficiary more involved in health care decisions and improve health outcomes.
19
MI Health Account
New eligibility determination methodology for Medicaid (excludes disabled population)
Uses a single streamlined application Provides for no wrong door for application
◦Online◦In person◦Telephone
Standardizes the calculation of income with consistent formula
Relies on electronic data matching to the greatest extent possible
Removes asset test20
Modified Adjusted Gross Income (MAGI)
New websites – www.michigan.gov/healthymichiganplan
The Healthy Michigan Plan waiver amendment and approval is posted.
Healthy Michigan Handbook is posted Link to Healthy Michigan plan policy Will continue to post information as it becomes available.
Information Sources
New toll-free numbers for MAGI related activities.
MI healthcare helpline is 855-789-5610. The phone application assistance helpline
is 855-276-4627. Call-line information will be updated when
the Healthy Michigan Plan is implemented.
Information Sources
Questions?
Presentation title herePresentation title here
Impact of Health Reform on MiPCT
Juanita Vorel, Health Reform Manager
Which plans are offered on the exchange?
Priority Health offers 19 individual plans
• 6 HMO plans- +3 HMO plans with HSAs
• 6 PPO plans- +3 PPO plans with HSAs
• Catastrophic plan
• Plans are available in bronze, silver & gold metal tiers
Can you describe enrollment so far?
• 3,000+ members as of Jan. 31 for Priority Health
• Silver plans most popular
Which plans are expected to gain the most enrollment?
• Priority Health HMO is new to the individual market in 2014
• HMO remains the most popular plan offering both at Priority Health and in Michigan
• Silver plans most popular
How many MiPCT patients are expected?
What is expected in HDHP enrollment?
• Remains popular among our pre-ACA members
• Dropping overall throughout the state
Doc ID
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
BCBSM and BCN 2014 Product Portfolio
March 12th, 2014 - MiPCT March Health Reform Webinar
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 31
2014 Individual Market Product Portfolio 18 product choices - 5 product lines
Blue Care NetworkSelect HMO Preferred HMO Broad PPO Broad PPO
Blue Cross®Select Value
Blue Cross®Select Bronze
Blue Cross®Select Silver
Blue Cross®Select Gold
Blue Cross®Preferred Gold
Blue Cross®Preferred Silver
Blue Cross®Preferred Bronze
Blue Cross®Preferred Value
Blue Cross®Premier Gold
Blue Cross®Premier Silver
Blue Cross®Premier Bronze
Blue Cross®Premier Value
Blue Cross® Gold,a Multi-State Plan*
Blue Cross® Silver,a Multi-State Plan*
$ Low $ High
$ High
Blue Cross®Partnered Value
Blue Cross®Partnered Bronze
Blue Cross®Partnered Silver
Blue Cross®Partnered Gold
Partnered HMOBCBSM
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 32
Blue Cross® Premier and Blue Cross® Multi-State Plan Product Lines
Blue Cross®Premier Gold
Blue Cross®Premier Silver
Blue Cross®Premier Bronze
Blue Cross®Premier Value
BCBSMBroad PPO
• Platform - Blue Cross Blue Shield of Michigan - Preferred Provider Organization (PPO)
• Network- Trust Network
- Members have a broad choice of doctors and hospitals within BCBSM’s unsurpassed statewide PPO network, including nationwide coverage.
• Service Area- Available statewide
Blue Cross® Gold,a Multi-State Plan
Blue Cross® Silver,a Multi-State Plan
BCBSMBroad PPO
Blue Cross® Gold,a Multi-State Plan
Blue Cross® Silver,a Multi-State Plan
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 33
Blue Cross® Preferred Product Line
Blue Cross®Preferred Gold
Blue Cross®Preferred Silver
Blue Cross®Preferred Bronze
Blue Cross®Preferred Value
BCNBroad HMO
• Platform - Blue Care Network- Health Maintenance Organization (HMO)
• Network- Blue Care Network Commercial Network
- Members have a broad choice of doctors and hospitals from BCN’s entire HMO network.
• Service Area- Available to residents of 70 Michigan counties
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 34
Blue Cross® Select Product Line
Blue Cross®Select Value
Blue Cross®Select Bronze
Blue Cross®Select Silver
Blue Cross®Select Gold
BCNSelect HMO
• Platform - Blue Care Network of Michigan- Health Maintenance Organization (HMO)
• Network- PCP Focus Network
- Members choose from a select network of quality primary care physicians (PCP Focus network) with complete access to specialists and hospitals within BCN’s entire HMO network.
• Service Area- Available to residents of 19 Michigan counties
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 35
Blue Cross® Partnered Product Line
Blue Cross®Partnered Value
Blue Cross®Partnered Bronze
Blue Cross®Partnered Silver
Blue Cross®Partnered Gold
BCNPartnered HMO
• Platform - Blue Care Network of Michigan - Health Maintenance Organization (HMO)
• Network- Partnered Network
- Members will receive care within the Mercy Health system of doctors and hospitals.
- Members may receive care within BCN’s entire HMO network, but outside the Mercy Health system, will require primary care physician and plan authorization.
• Service Area- Available to residents of Kent, Muskegon and Oceana
counties
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 36
Availability Varies By Geography