Washington Health Benefit Exchange

State of ReformSpokane, WA September 2015

Phil DyerBoard Member

DISCLAIMER;The views and information expressed are my personal opinions and perspectives and do not represent the official position of the State of Washington or the Washington Health Benefit Exchange Board or Staff.

Exchange Value – Specific Functions

3

I. Issuers of QHPs

II. Health Care Market

III. Public and State

• Marketing & Outreach• Eligibility Determination for tax

credits• Enrollment

• Easy plan comparison and purchase of health insurance

• Reporting of cost/quality metrics

• Awareness of need for health insurance

• Appeals of eligibility determinations and individual responsibility

• Information on health insurance carriers

• Customer Service• Enrollment reconciliation with

HHS• New Membership opportunity –

previously uninsured

• Supporting use of innovative product designs and payment methodologies

• Expanded access to health insurance coverage

• Reduced charity care

• Trustworthy source of health care reform information

• Broad-based Public Information • Other impacts of ACA

Georgetown University's Center for Health Insurance Reforms, with funding from the Robert Wood Johnson Foundation (RWJF) and the Urban Institute, studied six states to identify effective strategies to improve the HIX enrollment process.

HBE Board 2015 Strategic Priorities

▪ Optimize Customer Experience▪ Define key customer base and determine value proposition▪ Map and identify improvements in customer experience for key

customer base▪ Remediate current customer account issues

▪ Steward Resources▪ Define and enforce 2015 core competencies▪ Retain essential staff▪ Evaluate and reduce contractors footprint▪ Constant vigilance on budget/cost benefits▪ Improve Board processes▪ Improve Governance process

HBE Board 2015 Strategic Priorities

▪ Maximize Enrollment▪ Develop plan for growth to include enrollment projections and

strategies for growth in individual and SHOP QHP’s.▪ Maximize use of “Special Enrollment” periods (SEP’s) for the

2015 plan year.▪ Evaluate and enhance the “Sales Force”▪ Evaluate additional sources of revenue▪ Fix Auto-Enrollment

▪ Stabilize and Enhance HPF ▪ Remove Premium Aggregation▪ Stabilize the system▪ Limit enhancements to Customer Centric and Enrollment Growth

improvements.

Current WHPF Enrollments(As of 6/15)

7

Enrollment0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

MedicaidQHP

2016 Enrollment

▪ Wakely estimated individual market medical and dental enrollment through 2018. The base enrollment scenario (used in assessment calculation) for CY2016 assumes growth of up to $164,262 QHP enrollees in March 2016.

ANNUAL MEMBER MONTHS

Year Medical Plans Dental Plans

2015 1,660,432 61,794

2016 1,727,713 65,108

2017 1,830,579 69,823

2018 1,857,898 70,862

Adopted Biennial Budget Summary

▪ Total Biennial Budget of $ 110,000,000

▪ FY 2016 $56,900,000.

▪ FY 2017 $53,100,000.

▪ Budget Provisos proscribe required spending minimums in the following areas;▪ Customer Service Call Center $ 9,800,000 [$26m]▪ In – person Assisters $ 6,400,000 [$8m]▪ Exchange IT Systems $ 9,600,000(Provisos account for nearly 25% of the appropriated budget)

Carrier Assessment for Calendar Year 2016

▪ With the completion of the legislative budget process, WHPF has rescinded the ‘placeholder’ carrier assessment of $13.66 per member/per month.

▪ The carrier assessment issued for calendar year 2016 will be $7.46 per member per month for Medical Plans.

▪ Dental Plan assessments will be $ 0.33 per member per month.

(Primary estimate components; CY2016 enrollment (as projected by Wakely); 2015 premium revenue (as projected by Milliman); budgeted expenses for CY2016 and the Medicaid cost reimbursement)

CY 2016 Budgeted Expenses and Expected Revenue

▪ Funding for CY2016 will be from premium tax revenues received in 2016, Medicaid reimbursements received in 2016, the assessments collected in 2016, and $2.3 million of the projected 2015 assessment receipts.

Exchange Revenue Sources

Year Exchange Expenses

Medicaid Cost Reimbursemen

ts

Premium Tax Receipts

Assessment Receipts

2016 $54,810,000 $25,437,971 $14,153,275 $12,918,754

Questions