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

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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.

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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