Preserving Mission in a Changing Environment. Payment Reform Coverage Expansion Delivery System...
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Transcript of Preserving Mission in a Changing Environment. Payment Reform Coverage Expansion Delivery System...
Preserving Mission in a Changing Environment
Payment Reform
Coverage Expansion
Delivery System
Redesign
Regulation Reform
Affordable Care Act (ACA)Healthcare Reform Fundamentals
A Tangled Safety
Net
Medical
EducationalSocial
What happens to the uninsured in Texas?
% of Federal Poverty Level
Unsubsidized – In or Out of Exchange
Sliding Scale Health Insurance
Subsidies, through Exchange400% FPL
CHIP CHIP200% FPL
CHIP200% FPL
CHIP
Current Medicaid185% FPL
Current Medicaid133% FPL Current
Medicaid100% FPL
Current Medicaid185% FPL
Current Medicaid74% FPL
12% FPL
NEW OptionalMedicaid133% FPL
NEW Optional Medicaid133% FPL
Old CHIPNEW Medicaid
133%, (Really 138% due to use of Modified Adjusted Gross Income)
Health Insurance Exchange,
Sliding Scale Subsidies
Available for 100%-
400% FPL
Health Insurance Exchange,
Sliding Scale Subsidies
Available for 100%-
400% FPL
Health Insurance Exchange,
Sliding Scale Subsidies
Available for 100%-
400% FPL
Health Insurance Exchange,
Sliding Scale Subsidies
Available for 100%-
400% FPL
Health Insurance Exchange,
Sliding Scale Subsidies
Available for 100%-
400% FPL
Health Insurance Exchange,
Sliding Scale Subsidies
Available for 100%-
400% FPL
Unsubsidized – In or Out of
Exchange
Unsubsidized – In or Out of
Exchange
Unsubsidized – In or Out of
Exchange
Unsubsidized – In or Out of
Exchange
Unsubsidized – In or Out of
Exchange
Unsubsidized – In or Out of
Exchange
Unsubsidized – In or Out of
Exchange
Health Insurance Exchange,
Sliding Scale Subsidies
Available for 100%-
400% FPL
Healthcare CoveragePost ACA Implementation
FPL Level Individual Family of 3
12% $1,340 $8,265
100% $11,170 $19,090
133% $14,856 $25,390
400% $44,610 $76,360
Marketplace No Subsidy10%
Marketplace Subsidy40%
Undocumented14%
Medicaid Expansion Required or Remain
Uninsured23%
Medicaid Eligible but Unenrolled
13%
Percent of Texas UninsuredWhat happens to the 6 million uninsured Texans?
Source: Texas Health and Human Services, March 8, 2013.
What does insurance coverage look like in Texas in January 2014?
Where to Find Insurance
Who Will Find Insurance
Federal Marketplace
Small Group, Individual
Medicaid Poor Pregnant Women, Poor Children, SSI
Commercial Insurance
Employer Coverage
61% Americans
unaware of the Marketplace
Federal Marketplace
Mental health and substance use benefits are essential benefits
Limits on mental health and substance abuse must meet parity requirements
Preventive services include behavioral health
Federal Marketplace
46 plans in Harris County
Platinum, Gold, Silver, Bronze
“Silver” Plan premiums range from $122 to $428 per month, based on age
Texas is one of 25 states not expanding Medicaid.
Anticipate greater number of children in the program due to eligible but not enrolled.STAR Health
The platform for Medicaid in Texas is Managed Care.
If you bill Medicaid, it will be through contracts with health plans.STAR Health
Commercial Insurance
Eliminated in 2014: pre-existing condition exclusions for adults; annual limits and waiting periods more than 90 days.
Job-based insurance qualifies as minimum essential coverage
Many ACA changes in effect prior to 2014 including parity and preventive services
What does it mean for your organization?
Who do you serve that will become eligible under the Marketplace?
Who do you serve that will become Medicaid if an expansion does occur in the future?
Are your services reimbursable under the Benchmark Plan or Medicaid?
How well do you conduct third party contracting and billing?
What’s the Impact
to Your Organization?
How do organizations in your community support each other during this transition?
Where does the needed expertise lie among your partners?
Where do you need to bring in outside expertise for technical assistance?
What is the role of the
collaborative?
What does it mean for people we care about?
CoverageIntegrationParityFinancial SecurityHealth
https://www.healthcare.gov
Melissa RowanHealthcare Policy DirectorTexas Council of Community [email protected] ext 109
