UNIVERSAL ACCESS TO CARE WORK GROUP 2018 1 LPRO : L EGISLATIVE P - - PowerPoint PPT Presentation

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UNIVERSAL ACCESS TO CARE WORK GROUP 2018 1 LPRO : L EGISLATIVE P - - PowerPoint PPT Presentation

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July 19, 2018 LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE UNIVERSAL ACCESS TO CARE WORK GROUP 2018 1 LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE AGENDA Welcome, Opening Remarks

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UNIVERSAL ACCESS TO CARE WORK GROUP 2018

LPRO: LEGISLATIVE POLICY AND RESEARCH OFFICE

July 19, 2018

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AGENDA

Welcome, Opening Remarks ……………………..……………………………………8:30—8:35am

  • Representative Salinas, Chair, Workgroup

Oregon Health Insurance Marketplace..……………………………………………8:35—9:15am

  • Chiqui Flowers, Administrator, Health Insurance Marketplace
  • Elizabeth Cronen, Communications & Legislative Manager

Medicaid Buy-in, State Options………………….…………………………………..9:15—10:00am

  • Staff

House Resolution 6097………………….……………………………………………10:00—10:15am

  • Workgroup Members

Public Testimony………………………………………………………………………..10:15—10:30am Adjourn……………………………………………………………………………………………………..10:30 am

LPRO: LEGISLATIVE POLICY AND RESEARCH OFFICE

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Today’s Objectives

➢ Learn about Oregon’s Health Insurance Marketplace including coverage, enrollment, activities and operations ➢ Marketplace landscape 2018/19 ➢ Explore the concept of a Medicaid buy-in option in Oregon; identify key questions and next steps ➢ Brainstorm potential policy goals ➢ Identify initial design considerations ➢ Discuss next steps – August/September ➢ Understand House Resolution 6097 (115th Congress)

LPRO: LEGISLATIVE POLICY AND RESEARCH OFFICE

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The Marketplace’s practical functions and policy roles

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  • Increase the quality, reliability and

availability of health insurance for all Oregonians and lower or contain the cost of health insurance so that health insurance is affordable to everyone

  • Be accountable to the public, and promote

the public interest and the benefit of those

  • btaining health insurance through the

exchange

  • Empower Oregonians through information

and tools for making health insurance choices

Legislative intent for the Marketplace (ORS 741.001)

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  • Improve health care quality and public

health, mitigate health disparities, control costs and ensure access to affordable, equitable and high-quality health care

  • Encourage the development of new

health insurance products with innovative benefit packages, care delivery, and payment mechanisms

Legislative intent for the Marketplace (ORS 741.001)

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Marketplace framework:

  • Division of the Dept. of Consumer and

Business Services

  • State-based Marketplace using the federal

platform

  • State-level partner to HealthCare.gov,

helping Oregonians get health insurance and financial assistance

Functions of the Marketplace

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Oregon has more authority than most other states using the federal platform. The Marketplace:

  • Assesses a fee on insurance companies

selling plans in Oregon through HealthCare.gov

  • Funds and manages a community partner

(navigator) program

  • Certifies plans offered here through

HealthCare.gov

Practical functions of the Marketplace

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  • Fields an ad campaign for open

enrollment

  • Conducts outreach and assistance,

including a call center

  • Works closely with Oregon’s insurance

regulator on design of standard plans

Practical functions of the Marketplace

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Advertising and marketing

The Marketplace’s most visible work

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Outreach, education, and assistance

The Marketplace’s most visible work

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  • Any Oregonian who wants coverage or to

learn about insurance (no wrong door)

  • 156,105 Oregonians enrolled in private

plans through HealthCare.gov for 2018

  • 115,889 enrollees qualified for premium

subsidies

  • A total of 268,588 Oregonians are

estimated to qualify for premium subsidies

The Marketplace landscape: our audience

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  • People with incomes under 400 percent
  • f the poverty level usually qualify for

premium subsidies

  • Less than $48,000 for one person
  • Less than $98,400 for a family of four

Subsidies through the Marketplace

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  • Average subsidized premium was $138
  • Premium subsidies are designed so that

no one with income under 400 FPL pays more than 9.56 percent of income for a midrange plan

  • People with lower incomes pay less, e.g.

about 4 percent at 150 FPL, about 8 percent at 250 FPL

Subsidies through the Marketplace

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  • People with incomes under 250 percent
  • f FPL may qualify for lower costs when

they get care

  • Less than $30,150 for one person
  • Less than $61,500 for a family of four
  • This year, 55,231 people got lower costs

when getting care

  • The subsidies continue even though the

federal govt. stopped paying to support them

Subsidies through the Marketplace

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  • Plans are available on HealthCare.gov for

every county in Oregon

  • Choices vary around the state, with the

Portland metro area having the most

  • ptions (5 insurance companies, 31 plans)
  • Lincoln and Douglas counties have the

fewest (1 insurance company, 3 plans)

The Marketplace landscape: 2018 plan choices

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The Marketplace landscape: 2018 plan choices

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  • Expect plans on HealthCare.gov for every

Oregon county

  • Once again, choice will vary around the

state, with the Portland metro area having the most options (5 insurance companies, 39 plans)

  • Lincoln and Douglas counties have the

fewest (1 insurance company, 4 plans)

The Marketplace landscape: 2019 plan choices

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The Marketplace landscape: 2019 plan choices

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  • Final rate decisions will be announced July 20
  • Final specific rate information will be

available by August 20

  • Preliminary 2019 Silver Standard Plan

premiums for a 40-year-old in Portland range from $414 to $486 a month

  • Subsidy calculation will expect 9.86 percent
  • f income from consumer at 400 percent FPL
  • 400 FPL will go up to $100,400 for 4 people

The Marketplace landscape: 2019 costs for consumers

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MEDICAID BUY-IN: OREGON CONSIDERATIONS

LPRO: LEGISLATIVE POLICY AND RESEARCH OFFICE

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Medicaid Buy-In: Defined

  • A state proposal to provide healthcare coverage to individuals with

incomes above the current state Medicaid eligibility level by leveraging Medicaid in some way – such as using the following to

  • ffer a more affordable or accessible coverage option in the state:
  • Medicaid provider network
  • Medicaid reimbursement
  • Medicaid infrastructure
  • Medicaid-like benefits

State Health and Value Strategies | 22

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State Goals for Medicaid Buy-In

Access and Competition Affordability Market Alignment Between Medicaid and Marketplace Single Payer Glide Path

  • States may have a range of goals,

some of which might be in conflict

  • Meeting multiple goals—even

when goals do not directly conflict— can be a challenge: prioritization is key

  • State policymakers will need to

understand and account for divergent stakeholder perspectives (e.g., advocates, insurers,providers)

A state may need to obtain a 1332 waiver depending on its goals and Medicaid buy-in design

State Health and Value Strategies | 23

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Primary Models for Medicaid Buy-In

State Health and Value Strategies | 24

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Model 1: State-Sponsored Product on the Marketplace

State Health and Value Strategies | 10

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Key Model 1 Features

State may set the provider rates as part of product design State aligns eligibility with Marketplace coverage State designs a product to meet Marketplace standards and qualify for advance premium tax credits (APTCs) State procures the product through its Medicaid managed care plans

State Health and Value Strategies | 26

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Model 1: Operational Considerations and Implementation Authority

  • 1332 Waiver Considerations
  • Obtaining a 1332 waiver may not be necessary to implement this model if the

state’s plan meets all the requirements to be certified as a qualified health plan (QHP) in order to receive APTCs

  • If a state wants to “stand in the shoes of the issuer,” or receive tax credits

directly, a 1332 waiver may be necessary; risk adjustment is an additional complexity if the state-sponsored product is not a certified QHP

  • Agency collaboration between the state Medicaid agency and state

insurance department is essential for successful implementation

State Health and Value Strategies | 27

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Model 2: Medicaid Buy-In Outside of the Marketplace

State Health and Value Strategies | 28

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Key Model 2 Features

A state would create a Medicaid buy-in product outside the Marketplace for people with incomes above Medicaid eligibility levels Benefits in this buy-in model could be similar to Medicaid or Marketplace, but with rates, premiums and cost-sharing set by the state Structured to allow consumers to use their APTCs to purchase the buy-in product The product would not be subject to private insurance rating requirements and would not be considered individual insurance coverage Eligibility levels above Medicaid and could mirror Marketplace eligibility

State Health and Value Strategies | 29

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Model 2: Operational Considerations and Implementation Authority

  • Impact on Marketplace Coverage
  • The buy-in may result in Marketplace destabilization if enrollees leave the

Marketplace and insurers increase premiums in response

  • Mitigation strategies are available, including limiting enrollment to certain

populations

  • Impact on Marketplace Risk Pool is Complex
  • If the buy-in attracts a sicker population, it improves the individual market risk

pool (and lowers premiums in the individual market), but it could put the state at financial risk to care for a sicker population

  • If the buy-in attracts a healthier population, the state might achieve more

savings, but it could negatively impact the individual market risk and premiums

  • Requires a 1332 waiver to allow individuals to use APTCs to purchase a

non-QHP product

State Health and Value Strategies | 30

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State Initiatives

Massachusetts Legislation passed the state Senate in November 2017 to provide a new coverage option for all residents, including those with employer-sponsoredinsurance Minnesota In April 2018, legislation was reintroduced to allow individuals with incomes above 201% FPL to purchase a MinnesotaCare-like product on the Marketplace A plan to allow residents to purchase Nevada Care Plan with APTC and CSRs was vetoed by the Governor in June 2017. A work group has been formed to explore additionaloptions NewMexico The legislature authorized a study on a Medicaid buy-in proposal to lower costs and expand coverage for residents, including those earning less than 200%FPL Hawaii In October 2017, the State Public Option Act was introduced by Senators Schatz and Lujan tocreate a Medicaid buy-in is designated as a QHP, treated as the second-lowest-cost silver plan, and eligible for APTCs. No further action has been taken Nevada Federal

State Health and Value Strategies | 31

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Discussion Questions

  • What policy goals might be achieved in Oregon with a Medicaid buy-in

program?

  • What questions do you have about designing a Medicaid buy-in

program in Oregon?

  • What stakeholder perspectives (e.g., advocates, CCOs, insurers,

providers) do you want to hear from about this concept?

  • Does Medicaid buy-in offer a transitional policy to universal coverage

in Oregon? LPRO: LEGISLATIVE POLICY AND RESEARCH OFFICE

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