NASHP Briefing February 3, 2011 Beth Osthimer Division of Coverage and Enrollment Office of Health Insurance Programs Paving a Health Coverage Enrollment Superhighway: Bridging the Gap to 2014 and Beyond in New York
New York Health Coverage and Enrollment
May 15, 2015
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NASHP Briefing February 3, 2011
Beth Osthimer Division of Coverage and Enrollment Office of Health Insurance Programs
Paving a Health Coverage Enrollment Superhighway: Bridging the Gap to 2014 and Beyond in New York
Public coverage-‐ 5 million
Employer-‐ based-‐10.5 million
Uninsured-‐ 2.7 million
2
New York Health Coverage and Enrollment: 2011
Increase Medicaid enrollment by about 25%
Add Exchange coverage for over one million more New Yorkers (700,000 subsidized)
3
New York Health Coverage and Enrollment: 2014
30+ year old, mulUple legacy eligibility and enrollment systems encompassing health and human services
Jointly administered by state/ 58 local districts-‐ variaUon, costs
Budget constraints
4
New York : Key Challenges
Technical infrastructure to support a more uniform, automated, consumer-‐friendly administraUon of health coverage programs by 2013
Align and integrate public and Exchange/subsidized opUons
Building the plane while we fly
5
New York : Key Challenges
Leverage Medicaid Enterprise assets, federal funding for technical infrastructure to support integrated health coverage eligibility and enrollment
90/10 match -‐ key
SoluUons have to move us in the right direcUon-‐ 2014 and beyond
6
New York : Strategies to Help Bridge the Gap
Statewide Call Center
Telephone Renewal supported by HEART rules engine
State Medicaid AdministraUon
7
New York : Strategies to Help Bridge the Gap
June 2010-‐ LegislaUon required Commissioner of Health to develop plan to assume Medicaid administraUon from counUes within 5 years.
November 30 2010 Report-‐ first step, strategic direcUon, recommendaUons, many more discussions with stakeholders before final comprehensive plan.
8
State Medicaid Administration: Background
Short term – e.g. consolidaUng health plan contracts for Medicaid and FHPlus (waiver)
Longer term-‐ e.g. centralizing eligibility determinaUons as move forward under ACA
Issues for discussion include transiUon of personnel, local presence to assist consumers-‐parUcularly most vulnerable, personal care services, long term care, financing related to administraUon, etc.
9
State Medicaid Administration: Recommendations
Offers opportunity to improve efficiency, uniformity
Raised frequently during stakeholder engagement process of Medicaid Redesign Team (MRT).
Reasonable to expect that implementaUon of many of the recommendaUons in the November 30 report will become part of broader Medicaid Redesign effort.
10
State Medicaid Administration: Going Forward
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Self declaraUon of income/ residency at renewal
12 month conUnuous enrollment for most adults
No resource test for most Medicaid beneficiaries
No finger imaging requirement
No face-‐to-‐face interview
Automated Eligibility
Elimination of Enrollment Barriers Helps Pave the Way : Key Challenge is Eligibility Systems
Underlying rules are simple and aligned across all public/private(subsidized) opUons
Have resources ,technical infrastructure to support automated processes for eligibility, verificaUon and communicaUon/noUficaUons
ss
12
No High Volume , Consumer Oriented Eligibility and Enrollment Experience Under ACA Unless:
Key rules early in 2011-‐ e.g. MAGI
Same rules to apply across Medicaid, CHP and Exchange/subsidies
Finalize/fund NPRM for new eligibility and enrollment systems (90/10).
13
Federal Actions Needed to Help Bridge the Gap
Align audit requirements (MEQC, PERM) with ACA rules and systems
Establish “federal hub” elements, components, processes for state access
14
Federal Actions Needed to Help Bridge the Gap
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