ROBIN LUNGE DIRECTOR OF HEALTH CARE REFORM NOVEMBER 18, 2011 Integration of Medicaid and the Exchange
Dec 14, 2015
ROBIN LUNGEDIRECTOR OF HEALTH CARE REFORM
NOVEMBER 18 , 2011
Integration of Medicaid and the Exchange
Purpose & Agenda
Overview of issues & options for how to integrate Medicaid and the Exchange
Summary of analysis underwayYour thoughts and input!
Goals
Universal coverage (for low and moderate income Vermonters)
Comprehensive High Quality Benefits / Innovative services to meet individuals’ needs
Focus on Better Consumer ExperienceProvider Access and QualityPayment ReformSimplified AdministrationControlling Health Care Costs
STAGE 3:
Vermont Single Payer (2017 and
beyond – 2014 if ACA waiver date
changed in
federal law)
Two financing plans
developed for
universal
coverage under: 1.
Green Mountain Care (single payer) and 2.
Exchange –
report back to legislatu
re in 2013
STAGE 2:
Vermont Health Benefit Exchan
ge become
s operatio
nal (2014)
Integration Plan Developed for
“Single Payer
Exchange” – report back to legislature in 2012
STAGE 1:
Vermont Health Benefit Exchange and Vermont Health Reform Board
(established
2011)
Stages of Vermont Health Reforms
Medicaid Changes in 2014
Medicaid income eligibility increases to 133% FPL $1226/month
Income calculation changes for some people “MAGI” – modified adjusted gross income from tax
returnMore verification done electronically
Reduction in paperwork, we hope!!Web-based enrollment
Can still do phone & in person
Health Benefits Exchange in 2014
Individuals without employer-sponsored insurance
Small businesses & their employeesFederal tax subsidies for people with incomes
under 400% FPL $3684/month
Medicaid & the Exchange in 20147
What happens to VHAP, Catamount Health, and employer-sponsored insurance assistance? Individuals with incomes under 133% move to Medicaid Individuals with incomes over this amount – either
Basic Health Plan (option – next slide more details) Health Benefit Exchange with subsidies
Very much like Catamount Health & ESIA
What happens to coverage for individuals with disabilities and seniors? This coverage need not change Anticipate filing Medicaid waiver request to continue
coverage for certain populations currently covered
Children <19
SSI (Aged, Blind and Disabled)
Parents and Caretaker Relatives
Pregnant Women
Und
rinsurdM
edicaid
UninsuredC
HIP
Adults ≥19 but < 65 Medically Needy
QHP without Subsidy
Medicare
PIL
SSI Income Level
AFDC
QHP with Tax Credits Only
300%
400%
225%
Vermont Health Benefit Programs
Options Under Consideration
QHP with Tax Credits and Cost-Sharing
250%
200%
133%
Exchange with federal subsidies
100% federal funds In process of creating complete financial model
Premiums are lower than VHAP/CHAP for very low income & for 2 person families
Premiums are a bit higher at upper income levels of CHAP
Exchange with federal subsidies12
Cost-sharing (deductibles, co-payments, co-insurance) Higher in Exchange than for VHAP
Approx. 70-80% of people in VHAP move to Medicaid VHAP has no deductible or co-insurance, limited co-pays
Hard to compare CHAP & Catamount Need detailed benefit designs to compare deductibles,
etc Out of pocket maximums (total you MIGHT have to pay)
higher in the Exchange w/ subsidy than Catamount Health
Provider rates – by insurer
Possible solutions to cost-sharing issues
State subsidy “wrap” in addition to federal subsidy Similar to wrap for employer-sponsored insurance
program now Could provide additional assistance so people don’t
have dramatic increases In process of costing this out
Flexibility in income phase-out 60-40 if included in new Medicaid waiver request
Basic Health Plan (see next slides)
Basic Health Plan
95% federal funds that would have been received in Exchange
More protective of consumers financially More chance of people losing coverage due to
transitionsImpacts on Exchange financial sustainability
& viabilityProvider rates uncertain at this point
Could be Medicaid; could be Catamount Health level; could be private insurance level