North Dakota Medicaid North Dakota Medicaid ExpansionExpansion

Julie Schwab, MNA, MMGTDirector of Medical Services

North Dakota Department of Human Services

North Dakota North Dakota Medicaid ExpansionMedicaid Expansion

Beginning in January 2014, North Dakota is expanding access to Medicaid to cover more individuals.

Enrollment will begin soon There is no limited enrollment period to

apply for Medicaid and expansion coverage will begin January 1, 2014

Why is North Dakota Why is North Dakota Medicaid Expanding? Medicaid Expanding?

In early 2013, North Dakota passed legislation to expand the Medicaid program in our state in response to the passage and signing of the 2010 Affordable Care Act by Congress and the President

The decision to expand Medicaid programs in the U.S. was left up to each state

Approximately 66,000 North Approximately 66,000 North Dakotans are currently Dakotans are currently

covered by Medicaidcovered by Medicaid

Estimates say that an additional 20,000 – 32,000 individuals may qualify for the N.D. Medicaid expansion

Who does North Dakota Who does North Dakota Medicaid cover TODAY? Medicaid cover TODAY?

Children up to age 21Pregnant womenCaretakers of deprived childrenLow-income Medicare beneficiariesWorkers with disabilitiesOther blind and disabled individuals of all agesLow-income individuals over the age of 65Certain individuals in active breast or cervical cancer

treatment

Who qualifies for Medicaid Who qualifies for Medicaid under the new expansion? under the new expansion?

Individuals between the ages of 19 and 65 who meet the income requirements of the federal Poverty Level of 138% will be eligible for Medicaid expansion

For a single person, that is an annual income of about $15,856

For a family of four, that is an annual income of about $32,499

Who qualifies for Medicaid under Who qualifies for Medicaid under the new expansion? the new expansion?

Low-income adults without dependents will now be able to receive coverage through the Medicaid program

Individuals must be U.S. citizens, not be incarcerated, and not be entitled to Medicare

Those who may have Those who may have been turned down for been turned down for Medicaid in the past Medicaid in the past MAY NOW QUALIFYMAY NOW QUALIFY

Who benefits from Who benefits from Medicaid expansion? Medicaid expansion?

The expansion is making Medicaid available to more of our N.D. residents who previously may not have qualified

The expansion gives more individuals the opportunity to get affordable coverage, preventive services, and economic security against accidents and illness

Who benefits from Who benefits from Medicaid expansion? Medicaid expansion?

With more low-income adults qualifying for Medicaid, uncompensated care should decrease

How will North Dakota How will North Dakota residents know if they qualify residents know if they qualify for the expanded Medicaid? for the expanded Medicaid?

Medicaid expansion eligibility will be determined using a simpler standard that will be based on a person’s modified adjusted gross income (MAGI) from their most recent federal income tax filings

Income is measured by the household’s taxable income

Assets and other resources are not considered

Will people who are covered Will people who are covered under the expansion have to under the expansion have to pay for services they receive?pay for services they receive?

Some individuals may be required to pay co-payments for services receivedServices not covered under the plan will be

the responsibility of the recipient.

Medicaid Expansion will be Medicaid Expansion will be covered through a managed covered through a managed

care organizationcare organizationThe Request for Proposal for the healthcare

coverage for the Medicaid expansion population was issued August 5, 2013

Proposals are due October 8, 2013The contract is expected to be awarded mid-OctoberThe plan will cover Essential Health Benefits, but

may have other requirements as well.The benchmark is the Sanford Health Plan along

with other requirements.

What are essential What are essential health benefits? health benefits?

Ambulatory patient services

Emergency servicesHospitalizationMaternity and newborn

careMental health and

substance use disorder services

Prescription drugsRehabilitative and

habilitative services and devices

Laboratory servicesPreventive and wellness

and chronic disease management

Pediatric services, including oral and vision care

How is the State preparing How is the State preparing for the expansion? for the expansion?

Training county eligibility staff, informing them of the changes resulting from the Affordable Care Act

Various state workgroupsCommunity meetings planned this fall

throughout the state to continue training and disseminating information

When can residents who When can residents who believe they are eligible for believe they are eligible for Medicaid expansion apply Medicaid expansion apply

electronically? electronically?

The online application system to be used for the new Medicaid expansion population will be ready to accept applications in November

Coverage for the Medicaid expansion begins no sooner than January 1, 2014

Applying for Medicaid expansionApplying for Medicaid expansion

OnlineWith telephone assistancePaper application

Who is paying for Medicaid Who is paying for Medicaid expansion in North Dakota?expansion in North Dakota?

The federal government is covering 100% of the cost of The healthcare coverage for the Medicaid expansion through 2016

After 2016, there will be a tiered approach to the federal governments share in coverage.

Additional information about Additional information about the Medicaid expansion the Medicaid expansion is online at:is online at: www.nd.gov/dhs/medicaidexpansiowww.nd.gov/dhs/medicaidexpansionn

Questions? Questions?

NORTH DAKOTA NORTH DAKOTA MEDICAID MEDICAID

Updates

2013 – 2015 2013 – 2015 Budget Budget

$2.94 Billion

Provider IncreasesProvider Increases

House Bill 1012 and other bills with appropriations resulted in a total 2013-2015 general budget of $2.94 billion.

Together these bills provided a general fund increase of $229 million, which is a 24.32% increase from the previous biennium.

Provider Provider IncreasesIncreases

91.5 million increase for inflationary increases, wage pass-throughs, and fee increases to long-term care and long-term service providers.◦ Includes a 3% inflationary increase each year of the biennium for

nursing homes, basic care facilities, developmental disability services providers, and qualified service providers who provide in-home caregiving services for department clients

◦ Includes a $1 per hour wage pass-through to staff of nursing homes, basic care facilities, and developmentally disabled service providers

◦ Includes a $1 per hour fee increase to qualified service providers

Provider IncreasesProvider Increases

$32 million increase to provide a 4% inflationary increase each year of the biennium for all other providers who receive payment from the Department for services such as physicians, dental, ambulance, foster care and adoption

Medical ServicesMedical Services

Includes $1.3 million to continue cost-based reimbursements to critical access hospitals for outpatient laboratory and care provided by certified registered nurse anesthetists

Includes $1.4 million to rebase rural health clinics to Medicare rates