Health Reform in King County Housing Development Consortium November 13, 2012 Jennifer DeYoung Health Reform Policy Analyst, Public Health - Seattle &

Health Reform in King CountyHousing Development Consortium

November 13, 2012

Jennifer DeYoung Health Reform Policy Analyst, Public Health - Seattle & King [email protected]

Susan McLaughlinHealth and Human Services Integration Manager, Department of Community and Human [email protected]

Presentation Overview

• Health Reform in King County – Benefits to date

• Access and Outreach Efforts • Delivery System Reforms

– Managed Care– Health Homes

• Health Reform and Housing• Questions

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The Affordable Care Act: Four Key Strategies

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Timeline of Key Health Reform Activities Affecting Seattle & King County

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New Medicaid Managed

Care contracts in

effect

Medicaid beneficiaries with disabilities phased into

mandatory Managed Care

Open enrollment begins for

Exchange & Medicaid

Expansion (Oct 1)

Medicaid Expansion & Exchange Coverage Begins

(Jan. 1)

July2012

January 2013

January 2014

October 2013

March2010

Supreme Court ruling

June 2012

ACA signed into

law

Development of Health Benefit Exchange

Health Homes Initiative for high

risk Medicaid (Nov 1)

Benefits Today: Health Reform in King County

• About 736,000 individuals no longer face lifetime caps on their health benefits

• About 15,000 young adults up to age 26 are covered by their parents’health plans

• About 368,000 individuals have coverage for preventive care with no co-pays or deductibles

Source: Public Health-Seattle & King County, 2012.5

Next 14 Months: A Critical Time for King County to Shape Health Reform

• To gear up for enrollment

• To shape Medicaid delivery system changes focused on high-risk, high-need enrollees

• To influence Exchange policies and Medicaid program changes

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King County Health Reform Planning Team

• Co-convened by Public Health and Department of Community & Human Services

• Adoption of Framework for an Accountable, Integrated System of Care

• Identification of priority areas of focus

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King County Health Reform Planning Team Vision (Framework)Create a Transformed System of Care with a Single Point of Accountability for Low-

Income ResidentsThrough person-centered medical home, intensive care management, comprehensive

community hubs, and prevention and wellness.

Priority Areas of Focus for Achieving Vision:

AccessEnsure residents obtain coverage

CapacityEnsure system

of care can provide the

right care at the right time in the

right setting

Delivery System

IntegrationPromote

systems of care that effectively

integrate clinical care, community

prevention, and human services

ResourcesSufficient

resources to achieve the Framework

vision and meet residents’ health and

human service needs

EducationEnsure the safety-net

consumer and provider

community understands how health reform will

impact them

Key Changes Still to ComeHow Will We Get to Expanded Coverage?

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Medicaid Program

Coverage (up to133% FPL)

Federal Basic Health Option ?

133% - 200% FPL

Employer-sponsored coverage

Exchange(Tax credits & cost sharing subsidies

for those 100-400% FPL)

Individual mandate

FPL = Federal Poverty Level. 133% of FPL is about $15,000 for an individual.9

• Providing input on development of Health Benefit Exchange

• Influencing shape of Essential Health Benefits package

• Developing community-wide enrollment strategy

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Access

Ensure residents

obtain coverage

Access and Outreach Efforts

Managed Care in King County

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Health Home Models of Care

• Comprehensive care management including– Intensive/chronic disease management– Transitions management/readmission reduction– Self-management support/patient education– Linkages to community/social support services

• Health Assessment• Coordinated Health Action Plans• Use of Health Information Technology

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Health Home Structure

• Network of organizations that provide health home services

• Each network has an identified “lead entity” that is responsible for administrative functions

• Bridges all service domains including medical, mental health, chemical dependency, long term services and supports

• May include health plans, community based organizations, clinics, etc.

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Timeframe/Next Steps

• State will “qualify” health home networks– King County exploring creating a Health Home

Network including PHSKC, DCHS, and AAA• Implementation being phased in regionally• King County implementation November 1,

2013

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Health Reform and the Housing System

Key areas of opportunity and planning for the Housing System and health reform: 1. Enhanced roles in helping people get enrolled

in and retain health coverage.2. Care coordination & care transition

partnerships with Medicaid managed care organizations.

3. Potential for reimbursement of certain services under Medicaid

1. Enhanced roles in helping individuals get enrolled in and retain health coverage

• Community-wide strategy to assure people get enrolled in Medicaid expansion & Exchange will be crafted.

• Potential for longer-term payoff for housing providers→ greater access to earlier medical & behavioral health care.

2. Care coordination & care transition partnerships for those on Medicaid

• Significant numbers of formerly homeless clients will be on Medicaid and in a managed care plan.

• Over time housing providers will need to cultivate working relationships with all 5 Managed Care Organizations (MCOs).

• Many may be involved in a health home and receiving care coordination & care transition functions • Housing providers will play a critical role as essential

partners in health home networks 

3. Potential for reimbursement

• Medicaid Expansion provides a potential source of revenue for people in supportive housing who have clinical service needs

• Health Home Networks provide an opportunity to serve people with the highest needs more efficiently

• Opportunities for WA to propose new ways of approaching healthcare through different state “authorities” or “waivers”

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Corporation For Supportive Housing

• Develop a “cost case” for supportive housing that demonstrates that housing is healthcare

• Develop a crosswalk of the services provided in supportive housing with one or two possible state waivers

• Keep housing and other stakeholders involved

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Health Reform Challenges

• Can’t underestimate the work needed to get and keep people covered

• Some will remain uninsured (including undocumented); others will fall off and on

• Lack of capacity in the safety net health system to serve increase in people

• Historic challenges of managed care in providing quality services for individuals with significant behavioral health issues

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Staying Engaged

• WA State Health Benefit Exchange– http://www.hca.wa.gov/hcr/exchange

• WA Medicaid Expansion– http://www.hca.wa.gov/hcr/me

• WA State Health Care Authority listserv– http://www.hca.wa.gov/

• King County Health Reform Planning Team– http://

www.kingcounty.gov/healthservices/health/partnerships/HealthReform.aspx

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Questions

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