A service of Maryland Health Benefit Exchange

Maryland Health Benefit

Exchange Update

Standing Advisory Committee Meeting

May19, 2014

Carolyn A. Quattrocki

Interim Executive Director

Maryland Health Benefit Exchange

QUALIFIED HEALTH PLANS OFFERED ON MHC

2

Recap of First Open Enrollment

Qualified Health Plans by Carrier

ParentCompany

Licensed Entity # of Plans

Metal Levels

CareFirst •CareFirst Blue Choice

•CareFirst of Maryland Inc.

•Group Hosp. and Medical Services Inc.

11

2

2

1 platinum, 3 gold, 3 silver, 3 bronze, 1 catastrophic

1 platinum, 1 bronze

1 platinum, 1 bronze

Evergreen •Evergreen Health Cooperative 9 4 gold, 4 silver, 1 bronze

Kaiser Permanente •Kaiser Foundation Health Plan 9 2 gold, 3 silver, 3 bronze, 1 cat.

UnitedHealthcare •All Savers Insurance Co. 8 1 gold, 4 silver, 2 bronze, 1 cat.

CareFirst(Multi-State Plan)

•CareFirst of Maryland Inc.

•Group Hosp. and Medical Services, Inc.

2

2

1 gold, 1 silver

1 gold, 1 silver

Total 45

3

Recap of First Open Enrollment

• 36 include embedded pediatric dental

• 24 plans offer statewide coverage

• Product types

PPO 8; POS 9; HMO 20; EPO 8

Metal levels correspond to the plan actuarial value:Bronze = 60% (+/- 2%) Silver = 70% (+/- 2%)Gold = 80% (+/- 2%) Platinum = 90% (+/- 2%)

STAND-ALONE DENTAL PLANS OFFERED ON MHC

4

Recap of First Open Enrollment

Dental Plans by Carrier

ParentCompany

Licensed Entity # of Plans

Tier

Delta Dental •Alpha Dental Programs

•Delta Dental of PA

4

4

2 low (pediatric and family), 2 high (pediatric and family)

2 low (pediatric and family), 2 high (pediatric and family)

DentaQuest •DentaQuest Mid-Atlantic 4 2 low (pediatric and family), 2 high (pediatric and family)

Dominion Dental •Dominion Dental Services 4 2 low pediatric, 2 low family

United Concordia •United Concordia Life and Health 4 2 low (pediatric and family), 2 high(pediatric and family)

Total 20

ENROLLMENT – October 1, 2013 through April 18, 2014

66,203 qualified health plan (QHP) enrollments;95,889 Medicaid enrollments through Primary Adult Care program conversion;262,219 additional individuals newly enrolled in Medicaid TOTAL: 329,000 enrolled into coverage through MHC

HIX CHALLENGES

Early website performance limitations

Improved performance and moderate increases in functionality

MULTIPLE OUTREACH “CAMPAIGNS”

January 1 retroactive coverage campaign

MHIP bridge and transition

May 1 coverage campaign

8 enrollment fairs in March5

Recap of First Open Enrollment

Preliminary Trends and Analysis:

Very rough preliminary estimates…

HIX-generated enrollments

– Over 160,000 enrollments through HIX

– Approx. 68% of non-PAC MA/MCHP enrollments

– Approx. 75% of QHP enrollments

MA vs. QHP

– MA enrollment above national average

– QHP enrollment slightly below national average

Age

– Approx. 1/3 of QHP enrollments under age 35

2014 Open Enrollment

6

Preliminary Trends and Analysis:

Geographic

– QHP enrollments track roughly with population distribution

2014 Open Enrollment

7

QHP Enrollments by Region

Central

Capital

Upper EasternShoreLower EasternShoreSouthern

Western

Connector Entity Program6 connector entities with local community-based partners

183 navigators; 218 assisters

8

Consumer Assistance

CONSUMER ASSISTANCE

Caseworkers

1,500 in local DSS offices

Producers

1, 877 authorized producers, incl. 52 captive producers;

Broker Referral Program with 50 participants;

Application Counselors

33 Application Counselor Sponsoring Entity organizations

ACSEs will engage over 500 Certified Application Counselors (CACs)

Consolidation Services Center

120 consumer assistance representatives on 10/1; after December spike in volume, tripled staff and expanded space;

363 consumer assistance representatives; additional 53 supervisory, quality control and support staff

9

Other Consumer Assistance

Consumer Support Center

10

Calls Received

AverageDaily Calls

Rec'd Calls AnsweredCalls

Abandoned % Abandoned

Average Speed

AnswerService Level

Average Talk Time

October 44325 1430 42573 1327 3% :22 85% 8:12

November 40939 1412 30247 6353 16% 3:03 48% 12:11

December 83620 2787 36407 40260 48% 37:54 8% 17:48

January 95627 3084 44230 51015 53% 28:30 15% 17:36

February 81,148 N/A 61,142 19,480 24% 7:10 36% 6:23

March 144, 732 N/A 106,588 37,306 26% 8:16 31% 20:11

Key Challenges

Finishing up open enrollment

Consumers who experienced technical problems were able to enroll through 4/18/14.

Managing life events, special enrollment periods, and continuing Medicaid eligibility determinations and enrollments

Consumers with changes in circumstances like marriage, divorce, birth of baby, change in immigration status can qualify for 60-day special enrollment period (SEP)

SEPs available also for consumers with faulty eligibility or enrollment attributable to technical problem or errors on part of Exchange or consumer assistance personnel.

Certification of 2015 plans

Rate and form filings with insurance regulatory agency

New plan certification standards11

What’s Next?

Connecticut transfer:

– Will serve as our MAGI rules engine and single point of entry for health care coverage

– Will be able to integrate with other State programs and support interoperability with social services, providing better service to Maryland residents

– Will provide a Medicaid solution that allows Maryland to support State preferences more easily

– Will be able to capitalize on significant consumer assistance network in place

– Able to support core functionality by next open enrollment, with additional functionality to be added in future releases

– Appeals handled manually

Transfer of New System

12

SC-FE 1.1.1-001: CT HIX Homepage

Homepage

Spanish Version

Create User Account

SC-FE 1.1.1-003: Create User Account

Start Your Application

SC-EL 1.3.4.1-001 Info Page: Start Your Application

My Inbox

SC-FE 1.1.1-016: My Inbox

Document Upload

SC-EL 1.3.4.1-060a Document Upload

Work Item Inbox for Consumer Assistance Workers

SC-FE 1.1.3-004: Worker Account Home

Key Challenges

Readiness IT System Consumer Assistance Programs

Lessons learned from initial open enrollment New strategies for under-represented targeted populations, e.g. pop-up sites

Marketing and Outreach In-person, social media, modes of paid advertising

Affordability Rates State Reinsurance or Subsidy Wrap-Around Programs Delivery system innovations

Continuity of Care Management of churn

Safety Net for Remaining Uninsured20

2014-15 Open Enrollment

Critical MHBE Issues

Board requests:

ECP

Network Adequacy

Communications/Outreach

Re-engagement campaign

Advertising/mass communications

Community partnerships

Plan Certification

Transition to new platform

21

2015 and Beyond

Draft Standing Advisory Bylaws

Article 1: Policy and Mission Statement

Consider issues at request of Board, Staff, SAC Members

Provide broad-based feedback to Board

Article 2: Committee Membership

MHBE Board Liaison

General Qualifications (Maryland resident or stakeholder)

Geographic Representation

Gender, Race, Economic Diversity

Term

Vacancies (Board appointment and member vote)

22

SAC Bylaws

Draft Standing Advisory Bylaws

Article 3: Meetings

Minimum number of meetings

Notice

Order of Business (minutes, reports back to group, reports of subcommittees, consideration of requests)

Quorum (majority)

Voting

Membership, Co-Chairs, Create subcommittees

Feedback to Board won’t require votes

23

SAC Bylaws

Draft Standing Advisory Bylaws

Article 4: Officers

Two Co-Chairs

One year term

Article 5: Committees

SAC can create Ad Hoc Subcommittees

Appoint membership

Report back to SAC

24

SAC Bylaws