Know the Ropes: Exchange Development Issues for Kids and Families Charting the Way: Progress and...
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Transcript of Know the Ropes: Exchange Development Issues for Kids and Families Charting the Way: Progress and...
Know the Ropes: Exchange Development Issues for
Kids and Families
Charting the Way: Progress and Priorities for Child and Family Coverage
July 18, 2012
2
Children Parents -
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
7,000,000
8,000,000
9,000,000
Expected Exchange Enrollment, US
Source: Genevieve M. Kenney, et al., Improving Coverage For Children Under Health Reform Will Require Maintaining Current Eligibility Standards For Medicaid And CHIP, Health Affairs, December 2011.
FL
NC
SC
GALATX
AL
AR
KS
OKAZ TN
MS
NVUT
NM
CA
WYID
WA
ORND
SD
NE
MT
MO
IN
MI
WI
IL
ME
OH
KY
HI
AK
WV VA
CTNJ
DEMD
RI
NHVT
DC
MA
CO
IA
NYMN
PA
Where Do States Stand?
States committed to state-based exchange
States committed to partnership exchange
FL
NC
SC
GALATX
AL
AR
KS
OKAZ TN
MS
NVUT
NM
CA
WYID
WA
ORND
SD
NE
MT
MO
IN
MI
WI
IL
ME
OH
KY
HI
AK
WV VA
CTNJ
DEMD
RI
NHVT
DC
MA
CO
IA
NYMN
PA
Exchange Establishment Grants
States that have received exchange establishment grants
5
The Timeline AheadDate Milestone
Oct. 1, 2012 States choose EHB benchmark plan
Nov. 16, 2012 State submits Exchange Blueprint
Jan. 1, 2013HHS (conditionally) certifies exchanges
Oct. 1, 2013 Exchanges begin enrollment
Jan. 1, 2014 QHP coverage begins
6
Exchange Blueprints
State BasedMust detail all
exchange activities
Can use federal services for:• Subsidy
determination• IRR exemption• Risk/reinsurance
Partnership
Must detail Plan Management and/or Consumer Assistance
activities
Can use federal services for:• Medicaid/CHIP
eligibility• Reinsurance
FFENo Application
required, Declaration Letter
requested
Can use federal services for:• Medicaid/CHIP
eligibility• Reinsurance
7
Responderso Sabrina Corlette
o Georgetown University Center on Health Insurance Reforms
o Anna Strongo Arkansas Advocates for Children and Families
o Christina Peterso Children’s Alliance
8
Guest Speakero Yvette Fontenot,
Deputy Directoro HHS Office of
Health Reform
*Maine, Massachusetts, New Jersey, New York, and Vermont required insurers to provide coverage to individuals on a guaranteed basis prior to the Affordable Care Act and, thus, already prohibited the denial of coverage to children under age 19. **Kentucky issued a regulatory order which is binding on all insurers marketing individual health insurance.***Nevada issued a temporary regulation which expired. The state currently has no special rules regarding child-only coverage.****Texas passed a new law allowing the Department of Insurance to adopt rules to “increase the availability of coverage to children younger than 19 years of age” but no new regulations have yet been issued.Source: Authors’ analysis.
Exhibit 1. State Action to Promote the Availability of Child-Only Coverage, as of January 2012
Issued new regulation regarding child-only market
Issued sub-regulatory guidance regarding child-only market
Passed new law regarding child-only market
FL
NC
SC
GA
LATX****
AL
AR
KS
OKAZ TN
MS
NV***
UT
NM
CA
WY
ID
WA
ORND
SD
NE
IN
MT
MO
MI
WI
IL
ME*
OH
KY**
HI
AK
PA
WV VA
CTNJ*
DE
MD
RI
NHVT*
DC
MA*
CO
NY*
IA
MN
Took no official action regarding child-only market
* The Arkansas Plan Management Advisory Committee has selected the three largest small group plans for benchmarking and referred the final decision regarding which plan to the Insurance Commissioner.
Exhibit 2. Essential Health Benefits Benchmark: State Action, as of May 31, 2012
Conducting analysis (internal or public)
Made a selection
Conducting analysis and seeking public input
FL
NC
SC
GA
LA TX
AL
AR*
KS
OKAZ TN
MS
NV
UT
NM
CA
WY
ID
WA
ORND
SD
NE
IN
MT
MO
MI
WI
IL
ME
OH
KY
HI
AK
PA
WV VA
CTNJ
DE
MD
RI
NHVT
DC
MA
CO
NY
IA
MN
No public action