Kentucky Health Benefit Exchange SnapshotKentucky Health Benefit Exchange Snapshot
KMAKMA Presentation Winter Update Kentucky Health Benefit Exchange
Kentucky Health Benefit Exchange
Disclaimer
KMAKMA Presentation Winter Update Kentucky Health Benefit Exchange
Current Current State of ExchangesState of Exchanges
(Kaiser) (Kaiser)
Kentucky Health Benefit Exchange
Cabinet for Health and Family Services(CHFS)
Kentucky Health Benefit Exchange
Letters of Intent•Anthem •Bluegrass Family Health•Humana X*•United Health Care•KY CO-OP
Coventry CaresHumana CareSourcePassportWellCare Others – Anthem, etc.
*regional plan
Large Employers
2015
Expansion Expansion 308,000 uninsured may gain Medicaid and will include:
Adults 19-64 with income under 138% of the FPL and not covered under current Medicaid eligibility criteria
Former foster care children up to age 26
Request for Proposal (RFP) for Medicaid expansion must be submitted by July 22, 2013
Bids will be for new vendors and will exclude Region Three MCOs currently under contract outside of Region Three (WellCare and
Coventry) will have an opportunity to amend their current contract.
In place – January 1, 2014
Medicaid
Household Size/FPLHousehold Size/FPL100%100% 138%138%1 $11, 4901 $11, 490 $15,856$15,8562 $15,4102 $15,410 $21,404$21,4043 $19, 5303 $19, 530 $26, 951$26, 9514 $23, 5504 $23, 550 $32, 449$32, 449
Kentucky Health Benefit Exchange
MAGI Premium Cost
Proposed Rule:Eligibility evaluations for premium tax credits and Medicaid eligibility will be based on the “honor system” and will be performed manually by the state exchanges rather than being based on IRS data provided to the exchanges through the new federal data hub.
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Kentucky Health Benefit Exchange
50 or less
FTE
Kentucky Health Benefit Exchange
10
Kentucky Health Benefit Exchange
More than 50 FTE
Delayed - 2015
Cabinet for Health and Family Services(CHFS)
Kentucky Health Benefit Exchange
Kentucky Health Benefit Exchange
Kentucky Health Benefit Exchange Level Percentage of Medical
Expenses
Bronze 60%
Silver 70%
Gold 80%
Platinum 90%
Kentucky Health Benefit ExchangeBenefit Benefit
Ambulatory patient services Emergency services
Hospitalization Maternity and newborn care
Mental health and substance use disorder services, behavioral health
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services including oral and vision care
*KCHIP
Kentucky Health Benefit Exchange
Navigators - Individuals or Entities that:Navigators - Individuals or Entities that:
•May include: Community/consumer-focused nonprofit groups, Chambers of commerce, resource partners of Small Business Administration, Health Care Providers, etc.
•Maintain expertise in eligibility, enrollment and programs;Provide information/services in fair, accurate, impartial way;Facilitate selection of Qualified Health Plans (QHPs); and
•Provide referrals to any applicable office, health insurance consumer assistance or ombudsman, or State agency for grievances, complaints, or questions about health plan.
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Kentucky Health Benefit Exchange
ACA – Affordable Care Act
CHFS – Children and Family Services
E&E – Eligibility and Enrollment
EHB – Essential Health Benefits
KHBE – Kentucky Health Benefit Exchange
IT – Information Technology
MAGI – Modified Adjusted Gross Income
MCO – Managed Care Organization
QHP – Qualified Health Plan
SHOP – Small Business Health Option Program
Kentucky Health Benefit Exchange
http://healthbenefitexchange.ky.gov/
www.kyma.org
Kentucky Health Benefit Exchange
www.glms.org
Kentucky Medical AssociationLindy Lady, CPC, CPCOManager, Medical Business Advocacy4965 US Highway 42Suite 2000Louisville, KY 40222-6301502 426-6200/Extension [email protected]
Questions?
Kentucky Health Benefit Exchange
Kentucky Health Benefit Exchange