Health Care Reform and West Virginia Medicaid Nancy V. Atkins, R.N., M.S.N., N.P.-B.C.

Health Care Reform and West Virginia Medicaid

Nancy V. Atkins, R.N., M.S.N., N.P.-B.C.

WV Medicaid•Medicaid provided healthcare services

to over 400,000 West Virginians in SFY 2010

•Total program expenditures in SFY 2010 - $2.6 billion

Health Care Reform

•What is Health Care Reform

•Key Areas of Reform

•Purpose of PPACA

•PPACA and the States

•PPACA Provisions for Medicaid

•PPACA Funding Opportunities

What is Health Care Reform?• This presentation is an overview of the purpose,

provisions and related funding of the Patient Protection and Affordable Care Act (PPACA, Act) as well as an overview of how the Act will affect the West Virginia Department of Health and Human Resources (DHHR) and Bureau for Medical Services (BMS).

• The Act is also referred to as the Affordable Care Act (ACA)

• The Obama Administration has stated that the intent of the Act is to “put individuals, families, and small business owners in control of their healthcare.”

Key Areas of ReformMuch of the PPACA must be resolved through regulations. Many of the provisions became effective upon enactment, and requirements of the Act continue through 2019. Most of the reform activities will occur between 2010 and 2014.

Health Insurance Reform

Employers Offering Health Insurance to Employees

Public Programs Including Medicaid, the Children’s Health Insurance Program (CHIP), Medicare, and Public Health

Healthcare Workforce Training

Elimination of Fraud, Waste, and Abuse in Healthcare

Improving the Quality of Healthcare

The Purpose of PPACA

PPACA creates powerful incentives so that more health care providers

start delivering the kind of coordinated, patient-centered care

that has been shown to get best results.

•The critical role of state governments is in managing and financing the Medicaid and CHIP Programs. The PPACA creates new requirements for expanded coverage and accountability mandates for those programs.

•States must also create, manage and regulate new insurance exchanges for both individual residents and businesses.

•The extensive new regulations for the health insurance plans must be enforced by the states as well.

PPACA and the States

PPACA Provisions for Medicaid

Continues Medicaid coverage to any individual who has been in foster care under the age of 26.

Develops a core set of health care quality measures for Medicaid-eligible adults.

PPACA Provisions for Medicaid

Eliminates fraud, abuse and waste in the system which may require outside vendor procurement and outside contracting meeting the federal requirements.

Provides new options to states to provide Medicaid long-term care services and supports.

PPACA Funding Opportunities

•The Medical Home State Options offers states enhanced match of 90 percent FMAP for two years and small planning grants may be available to promote the use of medical homes for enrollees with chronic conditions. West Virginia has been a leader in developing the medical home concept.

•WV has applied and received a planning grant for this opportunity. Health Homes for persons with Chronic Conditions.

•WV has received a Money Follows the Person grant.

Electronic Health Records (EHR)

• Health care providers and hospitals are encouraged to use Electronic Health Records to allow them to securely share patients’

• information.

• There are incentive payments• for using EHR.

• The result is improved health care.

What is a Health Insurance Exchange?

• Offers consumers a choice of health insurance plans.

• • One website will provide information

about premiums and coverage so consumers can comparison shop.

• Enrollment will also be through the website.

• Reforms the insurance market.

• Health insurance program created in 2004 by WV Legislature.

• For West Virginians who have been unable to get private health insurance because of a pre-existing medical condition.

• The individual pays the premiums.

Pre-existing Condition Insurance Plan

• Apply online.• https://www.pcip.gov

• Apply over the phone.• 1-866-717-5826• TTY: 1-866-561-1604

Nancy V. Atkins, RN, MSN, NP-BCCommissionerBureau for Medical Services

wwwww.dhhr.wv.gov/bms