Healthy michigan plan update april 2015 fcom

The Healthy Michigan Plan

Spring 2015 Update

Advocacy: How the Healthy Michigan Plan Got Started Opportunity to extend coverage to roughly

half a million Michiganders Better physical and mental health for

Michigan residents, and lower medical debt 100% federal funding for the expansion until

2017, 90% in 2020 and beyond $1.1billion in net state budget savings in the

first ten years Reductions in the profound burden of

uncompensated care on the healthcare system, businesses, insurers and consumers

So, how are things going so far? Enrollment Plan Selection Health Risk Assessment Utilization

Enrollment As of April 20th, 2015 there were 589,490

individuals enrolled in HMP By all accounts, enrollment to-date has been

unexpectedly high and much faster than anticipated

Roughly 83% of HMP beneficiaries are below the federal poverty level, 17% are above

Enrollment by gender has been relatively equal at 51.9% female and 48.1% male

Enrollment

200,000

250,000

300,000

350,000

400,000

450,000

500,000

550,000

600,000

650,000

Enrollment The age diversity of HMP enrollees has

improved greatly since early enrollment efforts began

Plan Selection 447,404 HMP beneficiaries were enrolled

in a health plan as of April 1st, 2015 73.5% of those health plan enrollees chose

their plan, 26.5% were auto-assigned Enrollment is concentrated in a handful of

health plans, in fact the five largest HMP plans represent just over 70% of total plan enrollment

Plan SelectionHealth Plan Percentage of EnrolleesBlue Cross Complete 7.9%CoventryCares of MI 1.9%HAP Midwest Health Plan 5.9%Harbor Health Plan 0.8%HealthPlus Partners 5.8%McLaren Health Plan 11.6%Meridian Health Plan of Michigan 26.9%Molina Healthcare of Michigan 11.5%Priority Health Choice 7.1%Sparrow PHP 1.1%Total Health Care 3.7%UnitedHealthcare Community Plan 12.9%Upper Peninsula Health Plan 3.0%

Health Risk Assessment A sizable number of beneficiaries are

completing the Health Risk Assessment process, in fact many are completing the first section during plan selection

Health Risk Assessment

Utilization Utilization statistics released to-date don’t

provide a comprehensive perspective, but we have seen is encouraging

What should we be paying attention to now? Known Eligibility Challenges Post-Application Education and Support Redetermination / Renewal DCH + DHS = DHHS Medicaid Health Plan Re-Bid Approval and Characteristics of the

Second CMS Waiver Medicaid Modernization

Known Eligibility Challenges Plan First! and Spenddown

Enrollment in another Medicaid program can interfere with HMP eligibility, even when it shouldn’t

Emergency Services Only Some applicants have been incorrectly assigned

to ESO, especially when citizenship questions were skipped or not verifiable on an application

5% Disregard Some applicants between 133-138% FPL did not

have the income disregard applied correctly and were not approved

Retroactivity Most approved applicants should be eligible for 3

months of retroactive coverage , but retroactive coverage has not always been granted

Known Eligibility Challenges Counting Self-Employment Income

Some applicants had an incorrect 25% cap on deductions applied in reference to self-employment income

Other applicants have had additional problems related to self-employment income

No Correspondence Some applicants received a HMP eligibility

determination through MI Bridges but didn’t receive a follow-up letter or enrollment packet

Pregnant Women (especially MOMS) Non-citizen pregnant women applied but only

received ESO instead of ESO + MOMS

Following Up on Eligibility Challenges DHHS will only speak to a client or their authorized

representative about an individual’s case Most assisters are not authorized representatives, so

making contact together is essential Making contact with a client’s assigned caseworker

is the best first step If the caseworker contact is not successful,

advancing to a supervisor/manager or Director is the next step

When problems cannot be resolved with local DHHS staff, utilizing the appeals/hearing process may be warranted

The appeals process is also appropriate for applicants who believe they have been denied coverage inappropriately

Post-Application Education and Support Applying for coverage and getting an

eligibility determination only represent a third of the steps involved in the HMP process.

Missing the steps beyond an eligibility determination will leave new enrollees not fully able to engage in their health and healthcare.

And, the ultimate goal of HMP is to improve health… not just enroll an individual in coverage.

Resources to Support After Sign-Up Activities MICoverage.org

An interactive, web-based resource that delivers customized content on important coverage concepts and downloadable worksheets to document and save key information

Downloadable Worksheet

Web-Based Guide

Redetermination / Renewal On April 13th DHHS reported a drop in the HMP

enrollment total to 581,769 beneficiaries, almost 22,000 less people than the reported number of HMP beneficiaries on March 30th

Enrollment is growing again (as of April 20th) but the drop in early April illustrates the need for significant investment in renewal supports and strategies

micoverage.org resources now include a renewal worksheet similar to those used for enrollment to support those assisting clients

DCH + DHS = DHHS The merger of Michigan’s former health (DCH)

and human services (DHS) departments is in the early stages of implementation

We don’t yet know the full range of implications, but we do know that changes are in the works

Medicaid Health Plan Re-Bid The State of Michigan competitively procures

the services of Medicaid managed care organization (health plans) through a bid process

The current bid for Medicaid health plans in Michigan will be released next month with responses due in August and new health plan contracts effective January 1, 2016

Michigan's Prosperity Regions will be used for the bid, meaning all counties within a region that is being bid on must be included in a plan’s requested service area Regions 2 and 3 in northern lower Michigan must

be bid together

Approval and Characteristics of the Second CMS Waiver

(20) By September 1, 2015, in addition to the waiver requested in subsection (1), the department of community health shall seek an additional waiver from the United States department of health and human services that requires individuals who are between 100% and 133% of the federal poverty guidelines and who have had medical assistance coverage for 48 cumulative months beginning on the date of their enrollment into the program described in subsection (1) to choose 1 of the following options:

(a) Change their medical assistance program eligibility status, in accordance with federal law, to be considered eligible for federal advance premium tax credit and cost-sharing subsidies from the federal government to purchase private insurance coverage through an American health benefit exchangewithout financial penalty to the state.

(b) Remain in the medical assistance program but increase cost-sharing requirements up to 7% of income. Required contributions shall be deposited into an account used to pay for incurred health expenses for covered benefits and shall be 3.5% of income but may be reduced as provided in subsection (1)(e). The department of community health may reduce co-pays as provided in subsection (1)(e), but not until annual accumulated co-pays reach 3% of income.

Approval and Characteristics of the Second CMS Waiver CMS has previously rejected proposals from Iowa,

Indiana and Pennsylvania which included “Premiums exceeding 2% of income for individuals with incomes over FPL”

We are not currently able to find a find a circumstance where CMS has approved or rejected beneficiary cost-sharing up to 7% of income

State officials have heard from the federal government that it will be “very difficult” for Michigan to get a crucial second waiver for its Medicaid expansion program without going back and changing the law

Medicaid Modernization There’s been some public recognition

from DHHS that the Department is now considering a significant overhaul of Medicaid systems, especially the IT side of things

This process of “modernizing” and improving Medicaid systems could be a very positive experience for beneficiaries, assisters and providers

Questions? Discussion!