Health Reform and Its Impact on You and Those You Serve

Arizona Coalition to End Homelessness

October 29, 2013

Why Is Reform Needed?

• Nearly 1-in-5 Arizonans lack health coverage

• Medical debt significant cause of financial insecurity

• Growth in healthcare costs are unsustainable, crowding out other public spending, personal income

Why Is Reform Needed?

• Americans are getting far too little bang for our healthcare dollar

• We have a sick care system, not a healthcare system

• Status quo is unacceptable

Health Reform and the Homeless• Seventy percent of those experiencing homelessness are

uninsured

• Those who are homeless often experience chronic health conditions, including behavioral health issues

• Medicaid coverage has been limited for many among the homeless population in recent years

• People who are homeless are often high medical care utilizers, driving up healthcare costs for us all

Health Reform

5

• Access and Coverage

• Quality

• Cost

Principles for Reform• Encouraging healthy behaviors

• Improving access to early, preventive care

• Changing how healthcare is delivered

• Managing the care of high utilizers

• Changing the incentives

• Eliminating waste

Coverage Expansion

Employer-based coverage Medicaid

The “Exchange”

7

Medicaid Expansion

• Over 300,000 Arizonans could benefit

• Supported by the Governor, passed by the Legislature

• Approximately 60 percent of voters support restoration or expansion

• Restores coverage to childless adults

Medicaid Expansion

• Increases eligibility up to 133 percent of the federal poverty level (approximately 15,000/year for an individual)

• Eligibility screening began October 1st

• Coverage begins on January 1, 2014

Health E Arizona Plus

• Online application for AHCCCS as well as programs such as TANF and SNAP

• Began mid-October, 2013

• Consolidation, update of existing state eligibility systems

Health E Arizona Plus

• Access to federal data hub, making eligibility determinations easier

• Renewals less frequent, easier

• More affordable options for community providers to participate

• Connection to Marketplace

Improvements to Coverage

• Requires many health plans to offer ten essential health benefits

• Provides broader access to behavioral health and substance abuse services

• Prohibits many insurance plans from charging cost sharing for preventive services

Improvements to Coverage

• Prevents discrimination in pricing based on pre-existing conditions

• Those who have self-insured or grandfathered plans will not benefit from essential benefits, elimination of cost-sharing

• Those on traditional Medicaid may not benefit from essential benefits in some instances

Essential Benefits• Emergency services • Hospitalization• Maternity and newborn care• Mental health and substance use disorder services• Prescription drugs;• Rehabilitative and habilitative services and devices • Laboratory services• Preventive and wellness services• Chronic disease management• Pediatric services, including oral and vision care

Essential Benefits

• Arizona picked state employee plan, administered by United Health Care, as benchmark

• www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/arizona-ehb-benchmark-plan.pdf

The Marketplace

• Online site for individuals and small businesses to compare and purchase health coverage

• Intended to simplify and structure health insurance choices for individuals, families and small businesses

• Exclusive mechanism for receiving federal subsidies and plans with cost-sharing limits

The Marketplace

• Open enrollment began October 1

• Open enrollment will occur through the end of March

• 1.3 million Arizonans predicted to eventually receive coverage through the marketplace

Plan Levels of CoverageLevel of Coverage Plan Pays on Average Enrollees Pay on Average

(In addition to the monthly plan premiums)

Bronze 60% 40%

Silver 70% 30%

Gold 80% 20%

Platinum 90% 10%

Premium Subsidies

• Tax credit is advanceable or refundable• Eligibility is based on – Projected household income and family size– 100 – 400% FPL ($23,550 -$94,200 for a family of four

in 2013)– Obtaining qualified coverage through the marketplace– Ineligible for government-sponsored coverage,

affordable-sponsored insurance, or certain other minimum essential coverage

Cost Sharing Reduction

• Eligibility for reduced cost sharing is based onincomes at or below 250% of FPL ($58,875 annually for a family of four in 2013)

– Receiving the new premium tax credit– Enrolling in a marketplace silver-level plan– No cost sharing for members of Tribes

Individual Mandate

• Beginning in 2014, most people must have health coverage or pay a fee when you file your tax return

• Some people may qualify for an exemption

Cover Arizona

• Builds off of the successful outreach efforts for the Pre-Existing Conditions Insurance Pool

• More than 600 members

• Two goals:

– Maximize enrollment of individuals and families in the new insurance marketplace and Medicaid

– Identify and assess outreach efforts so that we can build on our successes

How Cover Arizona is Organizing

• By Demographics

• By Geography

• By Strategy

Enrollment Assistance

• Navigators

• Certified Application Counselors

• Brokers

• Health E Arizona Plus Assisters

Resources

• healthcare.gov• www.cuidadodesalud.gov • marketplace.cms.gov• 1-800-318-2596 (open 24/7, 150+ languages)

• www.healthearizonaplus.gov• 1 855 HEA-plus

• coveraz.org

Optimizing Coverage Among Those Experiencing Homelessness

• Having staff dedicated to outreach, education, and enrollment assistance

• Building community partnerships to assist with outreach and enrollment activities

• Educating individuals about the specific benefits of coverage and the overall enrollment process

Optimizing Coverage Among Those Experiencing Homelessness

• Providing direct hands-on, one-on-one assistance through each step of the enrollment process

• Assisting in obtaining documentation by helping to fill out paperwork, going with or providing transportation to the offices, and covering the cost of replacing documents

• Storing copies or originals of documents in client file to keep them safe and secure

Optimizing Coverage Among Those Experiencing Homelessness

• Providing transportation and accompanying individuals on visits to the eligibility office

• Maintaining contact over time to assist in the renewal of coverage

• Engaging providers to remind individuals about steps needed to complete enrollment during patient visits

• Educating consumers about how to use their benefits, access health care

Improving Quality, Lowering Costs

Opportunities to move forward on:

• Coordination of care, integration• Community-based care• Chronic disease management• Primary care• Prevention• Incentivizing value-based health care

Changes in Care Delivery

• Accountable Care Organizations and other models aimed at rewarding outcomes

• Penalties for inappropriate hospital readmissions

• Movement towards medical home model where care is coordinated

• Integration of acute care and behavioral healthcare

Opportunities• To serve an essential community provider for a health plan

• To partner in helping hospitals manage inappropriate hospital readmissions

• To become a member of a provider networks for those caring for persons with behavioral health needs

• To partner with a federally qualified health clinic to provide care coordination

www.slhi.org