ACA Implementation Update Jean Yang Executive Director - - PowerPoint PPT Presentation

ACA Implementation Update

Jean Yang Executive Director Presentation to HFMA Dec 9, 2014

ACA Implementation Status

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Major Components of ACA Where We Are Today Medicaid Expansion

• Completed as of Jan 2014 with establishment of the CarePlus program

(citizens with income up to 133% federal poverty level)

Establishment of the Exchange

• The Health Connector serves as the State-Based Marketplace
• After an initial IT readiness delay, now offering full suite of ACA-compliant

products with applicable federal and state subsidies

Insurance Market Reform

• New ACA rules (Essential Health Benefits, merged market rating rules,

metallic tier structure) in place

• Transitional rating factors for small groups continue through 2017

Premium Stabilization

• State-operated risk adjustment program for merged market in effect 2014
• Federal reinsurance and risk corridor programs in place as of 2014 and will

run through 2016

Individual and Employer Responsibilities

• Reconciled federal and state rules and parameters

 Individual mandate  Employer obligations (repealed Fair Share penalty)  Minimum Creditable Coverage (state) vs. Minimum Essential Coverage (ACA)

Health Connector Overview

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IT system:

Determines eligibility Calculates subsidies Displays plans Completes enrollment/billing Provides reporting Conducts settlement Insurers Customer Service Center and Business Operations Federal Gov Policy Development

Excha hange nge core functi tions

• ns:
• Det

eterm ermin ines es eligibility bility and pro rovid vides es subsidi idies es

• Operat

ates es a mark rketp etplace ace where ere consumer ers can shop p for insurance ce

• Aggreg

regat ates s some back ck- end operatio tions ns (e.g., enro roll llment ent and billing) ng)

• Policy

cy devel elop

• pment

ent (e.g., affor

• rdabil

ability ty sch chedule) edule)

State Gov Plan Management & Certification Consumer Outreach & Assistance

2014 Challenges & Turnaround

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• The Commonwealth’s ACA implementation experienced significant set back in

2014 due to a non-functional IT system

 The new system was intended to perform eligibility determination and enrollment in accordance with ACA rules  Vendor failure  The system was severely lacking in both functionality and performance  Only a small subset of individuals (those not seeking financial subsidies) could use the system to enroll

• The Commonwealth deployed emergency mechanisms to help people preserve
• r access subsidized coverage

 Extended Commonwealth Care and Medical Security Program  Established temporary Medicaid program under federal authority

Notwithstanding the IT challenges, the Commonwealth succeeded in protecting and even expanding its nation-leading insurance coverage.

2014 Challenges & Turnaround (cont’d)

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Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Independent IT review by MITRE New governance structure Engaged Optum as new IT vendor Launched “Dual Track” implementation with Federal Exchange (FFM) as fall back Identified hCentive system as new target IT platform Successfully dropped FFM; focused

• n re-launching state-based system

Decision to deploy integrated Medicaid – Exchange eligibility for Fall 2014 2015 Open Enrollment

New System Powering Mahealthconnector.org

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Participant creates account (Identity Mgt)

• 2. Apply
• 3. Verify

Eligibility QHP[c] Bill Pay

Participant enters through a single Front Door for CCA & MassHealth (hCentive)

• 1. Front Door

Participant completes application (hCentive)

QHP[a] Shop

Application data is verified (Federal Hub) Participant provides verification if necessary Eligibility and MAGI program is determined (hCentive) Participant chooses plan – non state wrap (hCentive) Participant chooses plan – state wrap (hCentive) Participant is invoiced and pays bill (Dell) Participant receives Proof of Coverage Portal or Phone Portal, Phone or Paper

QHP[d] Enroll

Qualified Health Plan

MH [a] Notification

Participant is noticed (from hCentive to MassIT) Non-MAGI manual processing (Excel file to MA-21)

Assessed to be non-MAGI

Medicaid

MH [b] Enrollment

Eligibility information is sent to MMIS for enrollment

QHP[b] Notification

Participant is noticed for QHP (Dell)

Open Enrollment 2015

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Member Transition

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The highest priority for Open Enrollment is to successfully transition current Health Connector and temporary MassHealth members in order to prevent coverage gaps.

Temporary Medicaid

~300K

CommCare

~100K ~ 34k

• Current coverage ends in 3

“waves”: 1/15/15, 1/31/15, 2/15/15

• May be eligible for QHP or

MH; some likely have and will keep ESI

• Have been subject to no

premium and only nominal cost-sharing, which will no longer be the case for many

• Current coverage ends

1/31/2015

• Majority likely eligible for

State Wrap

• Accustomed to the types

and costs of plans they will likely be eligible for

• All coverage ends

12/31/2014

• About 10K enrolled

via “Fast Path” last year New Shoppers seeking coverage through the Marketplace

• r Medicaid

(# unknown)

QHP

Transition Population

A subset will not submit new applications because their circumstances may have changed and they may no loner require coverage through us.

Multi-faceted Outreach Campaign

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Our goal: outreach every single member of the transition population while still targeting the remaining uninsured to bring new people into coverage for the first time.

Foundation

• f strong,

coordinated messaging Centralized member outreach data reporting to track and measure our progress.

DIRECT RECT MEMBE BER CONTACT ACT

• Mailing (Open Enrollment packet, reminder postcards)
• Outbound calls
• Door knocking

COMMUNIT ITY Y ENRO ROLLM LLMENT ENT ASSISTAN STANCE CE

• Navigators & Certified Application Counselors
• Community enrollment fairs
• Collaboration with community partners

MEDIA DIA AND D PUBLIC IC EDUCATI CATION

• Radio, TV, print
• Earned media; corporate sponsorships
• Public events highlighting member transition message

1 2 3

Foundation

• f strong,

coordinated messaging

Health Connector 2015 Programs

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ConnectorCare (Up to 300% FPL; state and federal subsidies) Qualified Health Plans (300%~400% FPL; federal tax credit only) (>400% FPL; unsubsidized) Qualified Dental Plans

ConnectorCare

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Wrap Plans Region A Region B Region C Region D Region E Region F Region G Western MA (010 – 013) Central MA (014 – 016) Metro West (017 - 020) Northeast (017 - 020) Boston/ Greater Boston (021, 022 - 024) Southeast (023 - 027) Cape/Island s (025 – 026) Lowest NWH NHP NWH BMCH NWH NWH BMCH 2nd Lowest BMCH CeliCare BMCH Minuteman BMCH BMCH NWH 3rd Lowest NHP NWH Minuteman NWH Minuteman Minuteman NHP 4th Lowest CeltiCare FCHP Comm. CeltiCare NHP NHP CeltiCare CeltiCare 5th Lowest HNE BMCH NHP CeltiCare CeltiCare NHP

7 participating plans: Tufts Network Health, Boston Medical Center HealthNet Plan, Neighborhood Health Plan, CeltiCare, Fallon Community Health Plan, Health New England, and Minuteman Health.

Subsidized Enrollee Premiums

Qualified Health Plans

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126 QHPs offered by 11 participating plans: the 7 ConnectorCare plans, plus Blue Cross Blue Shields of MA, Harvard Pilgrim Health Care, Tufts Health Plan and United Healthcare.

Qualified Dental Plans

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24 QDPs offered by 5 participating plans: Altus Dental, Blue Cross Blue Shields of MA, Delta Dental of MA, Guardian and Metlife.

Issuers Small group

• nly

Both NG and SG Standardized Plans Non-Standardized Plans All Plans Total Configurations Total Configurations Pedi High Low Pedi High Low Altus Dental √ 3 1 1 1 3 BCBSMA √ 3 1 1 1 1 1 4 Delta Dental of MA √ 7 3 2 2 2 2 9 Guardian √ 3 1 1 1 3 MetLife √ 3 1 1 1 2 1 1 5 Final SoA Small group only 9 3 12 Both NG and SG 10 2 12 Total 19 5 24 Unique Plan Designs 3 5 8

2015 Health Connector Priorities

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• Continue to stabilize and enhance the new IT system

 Continuous development envisioned by 2015 system road map

• Implement ACA-compliant small business program

 Was “put on hold” in 2014 to prioritize non-group system implementation

• Close out legacy programs (Commonwealth Care, Medical Security Program,

temporary Medicaid) and complete member transition to ACA-compliant coverage programs

• Continue to refine Health Connector product shelf with annual Qualified

Health/Dental Plan certification (Seal of Approval 2016)

• Solidify operationalization of new ACA-required essential processes (e.g.,

eligibility verification and appeals; cost-sharing reduction administration, IRS reporting, risk adjustment operation, etc.)