Childrens Health Insurance Program (CHIP) Advisory Council Meeting - - PowerPoint PPT Presentation

Children’s Health Insurance Program (CHIP) Advisory Council Meeting

April 15, 2020

Agenda

• Welcome and Introductions
• COVID-19 CHIP Coverage and Guidance
• State Based Exchange
• CHIP by the Numbers
• Marketing Updates
• Policy Update
• Quality Assurance Updates
• Closing and Wrap-Up

2

Welcome and Introductions

3

COVID-19 and CHIP

Achievements to Date

• Waive copays for testing and treatment for COVID-

19.

• Issued direction that families are not losing

coverage.

– Data fix to ensure continuation of coverage. – Policy guidance 2020-05.

4

COVID-19 and CHIP

Achievements to Date

• Application Processing

– CHIP is continuing to process applications. – Reporting income changes and reassessment.

• CHIP Call Center

– The CHIP Call center is responding to consumer inquiries. – Callers should not experience a difference in their customer service experience.

5

COVID-19 CHIP Coverage and Guidance

• CHIP Disaster Relief State Plan Amendment

– What is the Disaster Relief State Plan Amendment – Flexibility descriptions

• COVID-19 copay waiver
• Premium payment delays
• Renewal Due Date extension
• Self-Attestation

6

COVID-19 CHIP Coverage and Guidance

Guidance to Date

• Continuation of Coverage
• MCOs are not terminating enrollees for failure to provide

renewal information, failure to pay premiums, failure to provide information regarding disability, or whereabouts unknown.

• Families are still responsible for premium payments.
• Families who experience financial hardship during this

time should be assessed to see if income changes lower their premium payment or are appropriate for transfer to MA.

• MCOs are to work with families on payment plans for

premiums

7

COVID-19 CHIP Coverage and Guidance

Guidance to Date

• Waiver of COVID-19 Copays
• MCOs are waiving copays related to the testing, screening

and treatment of COVID-19

• Waiver of Prior Authorizations
• MCOs are waiving prior authorizations related to the

testing, screening and treatment of COVID-19

• Early Refills Available
• MCOs are authorizing enrollees to receive early refills of

non-opioid prescriptions

• Member Services
• MCOs continue to serve members and take member

inquires during this time

8

COVID-19 CHIP Coverage and Guidance

Guidance to Date

• Self-Attestation
• Applicants may utilize self-attestation of eligibility

information if they cannot provide documentation

• MCOs and CHIP will continue to review available

electronic databases to verify eligibility information at application and renewal

• Applications and renewals must be signed to utilize self-

attestation

• Enrollment prior to first premium payment
• Children are being enrolled in CHIP at eligibility
• Premium payments still apply but may be collected after

initial enrollment

9

State Based Exchange

Zachary Sherman

Executive Director, Health Insurance Exchange Authority

Pennsylvania Health Insurance Exchange Authority

Pennsylvania Health Insurance Exchange Authority

Executive Director Zachary Sherman

April 15, 2020

Meeting Agenda

1. Exchange Authority Overview and Critical Milestones 2. Uninsured Data

Exchange Authority | 12

Pennsylvania Health Insurance Exchange Authority

Overview of the Exchange Authority

13

• 2014: HealthCare.Gov (FFE) and state-based exchanges (SBE) launched to varying degrees
• f success
• Initial availability of federal grant funding and enhanced matching funds for Medicaid programs led to

large system integration approaches in many states

• A few states failed to go-live effectively and transitioned back to the FFE
• Many states, including PA, assessed the implementation risk as too high and deferred operational

management to the federal government

• 2015 - 2018: States slowly began to transition from the FFE to SBE or a hybrid approach using

the federal platform (SBE-FP)

• Idaho successfully transitioned to a SBE from the FFE in 2015, declining to integrate with Medicaid or
• perate a small business exchange
• AK, NM, NV and OR became SBM-FPs
• 2019 - 2020: Led by Nevada, more states decided to begin transitioning to SBEs
• NV procured a vendor solution for technology and customer service and went live for Open Enrollment

in November 2019

• NJ, NM, OR and PA are transitioning to a SBE and taking similar approaches to NV with their

procurements

History of State-Based Exchanges

The evolution of State-Based Exchanges over time

Exchange Authority | 14

The mission of the Pennsylvania Health Insurance Exchange Authority is to improve the accessibility and affordability of individual market health coverage for Pennsylvanians.

Our goal is to serve Pennsylvania’s individual health insurance market customers without disruption, operate a state-based exchange and support the needs of consumers purchasing health insurance while ensuring the stability and affordability of the health and dental offerings available through the Exchange Authority.

Who is the Exchange Authority?

Exchange Authority | 15

A seamless transition

• A vendor solution that will stand up fully-functioning exchange technology

platform and customer service center on-time and on-budget

• Successful conversion of existing customers to the state exchange system
• Limited technical and operational disruption and change to community and

insurer partners as well as the Department of Human Services

Higher quality access and customer service

• Accountability to Pennsylvanians looking to access subsidized and unsubsidized

individual market health insurance

• Data reporting that is accurate and timely, and can respond to all stakeholder

needs

• Flexibility to accommodate changing operational and customer needs
• Ability to better serve PA families churning between individual market and

Medicaid

Lower costs and lower premiums

• Operation of the exchange at a significantly lower cost than current

Healthcare.Gov price-tag

• Reduction of individual market premiums in 2021 by 5-10% through reinsurance

Strategic Goals

PHIEA | 16

Successful Implementation and Operations Measures of Success Strategic Goals

To date we have:

• Been working diligently with our technology platform and customer service vendor
• Begun testing the enrollment and eligibility system design
• Engaged stakeholders – consumer advocates, producers, medical and dental insurers,

legislators, business and community groups, Exchange Assister, etc.

• Begun developing our brand
• Established much of the infrastructure necessary to operate a new, self-sustaining entity

Progress against Goals

Where we are today

Exchange Authority | 17

Critical Milestones

Exchange Authority | 18

JAN DEC NOV OCT SEP AUG JUL JUN MAY APR MAR FEB 2020 JAN

Call Center Representative Training Begins

OEP Begins!

Call Center Operational Exchange Assisters and Broker Training 2021 Plans Loading Public Brand Launch Customers are Auto-Renewed Insurer Integration Starts 2/14 Launch of Outreach & Education Workgroup and Broker Workgroup Medicaid Integration Complete 6/30 2021 Coverage Begins Stakeholder and Customer Outreach Platform Call Center/training Stakeholder Engagement continues

Pennsylvania Health Insurance Exchange Authority

Overview of Pennsylvania’s Uninsured Population

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• There are over 12.5 million residents in the Commonwealth of Pennsylvania in 2018
• Insured: 11.9 million (Through employer or government programs)
• Uninsured: Nearly 700,000 (5.5% of the state’s population)
• Adjusted to exclude uninsured undocumented immigrants and uninsured individuals with PA

German ancestry, there are an estimated 607,000 uninsured residents, 4.8% of the population

• Characteristics of the 607,000 uninsured and likely to be eligible and interested in enrolling

Income

• 28% are below 138% of the federal poverty level (FPL)
• 53% are between 138-400% of FPL
• 19% are at or above 400% of FPL

Demographics

• 67% identify as White alone (not Hispanic or Latinx)
• 14% identify as Hispanic or Latinx, nearly twice percent of population (7.6%)
• 14% identify as Black or African American, disproportionately higher than percent of population (11%)

Overview of the Uninsured in PA

Exchange Authority | 20

Source: SHADAC analysis of the United States Census Bureau's American Community Survey (ACS).

52.0% 6.2% 15.4% 17.5% 8.9% 54.6% 5.6% 14.6% 19.7% 5.5% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% Employer Sponsored Individual Market Medicaid/CHIP Medicare Uninsured

Health Insurance by Coverage Type

United States Pennsylvania

Current Health Coverage Landscape

The vast majority (94.5%) of PA residents had health insurance; over 60% through commercial insurance and ~34% through government programs

Exchange Authority | 21

Source: SHADAC analysis of the United States Census Bureau's American Community Survey (ACS).

64,000 28,000 10,000 20,000 30,000 40,000 50,000 60,000 70,000

Number Uninsured by Group

Undocumented Immigrants German Ancestry

Uninsured and Unlikely to Enroll

Undocumented immigrants are ineligible for exchange coverage; Amish and Mennonite populations have historically not enrolled in exchange coverage

Exchange Authority | 22 34.9% 19.4% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0%

Uninsured as a Percentage of Population

Undocumented Immigrants German Ancestry

Source: SHADAC analysis of the United States Census Bureau's American Community Survey (ACS).

699,000 607,000 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000

Number Uninsured Unadjusted vs. Adjusted

Uninsured Adjusted Uninsured

Uninsured and Likely Eligible

Adjusted to exclude undocumented immigrants and residents with German ancestry, the likely eligible uninsured rate is 4.8%

Exchange Authority | 23 5.5% 4.8% 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0%

Percent Uninsured Unadjusted vs. Adjusted

Uninsured Adjusted Uninsured

Source: SHADAC analysis of the United States Census Bureau's American Community Survey (ACS).

167,000 317,000 113,000 50,000 100,000 150,000 200,000 250,000 300,000 350,000

<138% of the poverty threshold 138% to 399%

• f the poverty

threshold At or above 400% of the poverty threshold

Total Uninsured by Income

Uninsured By Income

The majority (53%) of the uninsured are eligible for subsidized coverage through the Exchange; uninsured rate is highest for Medicaid eligible; kids in low-income households are 1.5x likelier to be uninsured

Exchange Authority | 24 7.4% 6.4% 2.2% 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0%

<138% of the poverty threshold 138% to 399% of the poverty threshold At or above 400% of the poverty threshold

Uninsured as a Percentage Total Population by Income

Notes: Uninsured has been adjusted to exclude uninsured undocumented immigrants (likely ineligible for ACA coverage) and uninsured individuals who indicate Pennsylvania German ancestry. Civilian noninstitutionalized population. Sources: SHADAC analysis of the United States Census Bureau's American Community Survey (ACS). Pennsylvania Partnerships for Children, State of Children’s Health Care – October 2019

Emphasis on Financial Assistance

Individuals between 100-400% of the Federal Poverty Level (FPL) are eligible for advance premium tax credits (APTC) through the exchange

Exchange Authority | 25

Source: ASPE – Coverage year 2020

Salary

317,000 uninsured individuals are eligible for financial assistance.

$17,236 $23,336 $29,435 $35,535 $49,960 $67,640 $85,320 $103,000 $0 $20,000 $40,000 $60,000 $80,000 $100,000 $120,000 Single 2 3 4 100% FPL 138% FPL 400% FPL

Household Income by FPL

5.0% 4.1% 8.8% 10.4% 8.4% 6.4% 4.7% 0.4% 0.3%

20,000 40,000 60,000 80,000 100,000 120,000 140,000 160,000 180,000 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0%

Under 6 years 6 to 18 years 19 to 25 years 26 to 34 years 35 to 44 years 45 to 54 years 55 to 64 years 65 to 74 years 75 years and older

PA Uninsured by Number and Percentage

Uninsured Percentage Uninsured Number

Age Demographics of the Uninsured

Five percent of children under six years of age are uninsured; Approximately 124,000 children under 19 are uninsured statewide

Exchange Authority | 26

Source: SHADAC analysis of the United States Census Bureau's American Community Survey (ACS).

40 Percent of Pennsylvania’s Uninsured Kids Live in Five Counties

Lancaster, Allegheny, Berks, Chester and Philadelphia counties have the highest uninsured rate for children

Exchange Authority | 27

Source: Pennsylvania Partnerships for Children, State of Children’s Health Care – October 2019

Where do the uninsured live?

Five counties (Chester, Delaware, Lancaster, Montgomery and Philadelphia) in the southeast make up 36.6% of the uninsured

Exchange Authority | 28

Notes: Uninsured has been adjusted to exclude uninsured undocumented immigrants (likely ineligible for ACA coverage) and uninsured individuals who indicate Pennsylvania German ancestry. Civilian noninstitutionalized population. Source: SHADAC analysis of the United States Census Bureau's American Community Survey (ACS).

WAY 2,433 WYO 1,065 LAC 7,958 ELK 814 VEN 2,909 FOR 94 CAME 114 PIK 2,549 LYC 5,372 SUL 409 MER 5,827 CLI 2,437 CLA 2,593 LUZ 12,778 JEF 2,648 COL 2,273 CEN 6,767 CLE 3,528 MONROE 9,062 NORTHUMBERLAND 3,996 BUT 5,623 ARM 2,667 MONTOUR 749 UNI 3,457 CAR 2,381 LAW 3,810 NORTHAMPTON 11,655 SCH 6,219 IND 6,071 SNY 3,871 BEA 6,327 MIF 4,458 LEH 16,924 BLA 5,373 HUN 1,795 CAMB 4,991 JUN 1,989 BER 19,483 WES 11,221 ALL 43,514 DAU 12,106 PER 3,334 BUC 18,851 LEB 10,296 WAS 6,992 MONTG 21,022 BED 2,932 CUM 10,993 LAN 52,785 FRA 12,027 SOM 4,305 CHE 20,651 YOR 19,802 FUL 858 FAY 5,860 PHI 104,860 ADA 4,569 DEL 22,836 GRE 1,568 ERI 12,149 BRA 3,442 TIO 2,682 WAR 1,744 SUS 2,451 MCK 1,592 POT 1,023 CRA 6,693

<5k 5-10k 10-20k 20-50k

>50k Legend

Where are the highest uninsured rates?

Lancaster County’s uninsured rate is the highest; several Central PA counties have higher than average rates

Exchange Authority | 29

Notes: Uninsured has been adjusted to exclude uninsured undocumented immigrants (likely ineligible for ACA coverage) and uninsured individuals who indicate Pennsylvania German ancestry. Civilian noninstitutionalized population. Source: SHADAC analysis of the United States Census Bureau's American Community Survey (ACS).

WAY 5.1 WYO 3.9 LAC 3.8 ELK 2.7 VEN 5.6 FOR 2.9 CAME 2.4 PIK 4.6 LYC 4.8 SUL 6.8 MER 5.4 CLI 6.3 CLA 6.7 LUZ 4.1 JEF 6.1 COL 3.5 CEN 4.3 CLE 4.7 MONROE 5.4 NORTHUMBERLAND 4.5 BUT 3.0 ARM 4.1 MONTOUR 4.2 UNI 8.7 CAR 3.8 LAW 4.4 NORTHAMPTON 3.9 SCH 4.6 IND 7.2 SNY 9.6 BEA 3.8 MIF 9.7 LEH 4.7 BLA 4.4 HUN 4.3 CAMB 3.8 JUN 8.2 BER 4.7 WES 3.2 ALL 3.6 DAU 4.5 PER 7.3 BUC 3.0 LEB 7.5 WAS 3.4 MONTG 2.6 BED 6.1 CUM 4.6 LAN 9.9 FRA 7.9 SOM 6.1 CHE 4.0 YOR 4.5 FUL 5.9 FAY 4.5 PHI 6.7 ADA 4.5 DEL 4.1 GRE 4.5 ERI 4.5 BRA 5.7 TIO 6.6 WAR 4.4 SUS 6.0 MCK 4.0 POT 6.1 CRA 7.9

<3% 3-5% 5-7% 7-8% >9%

Legend

Pennsylvania Health Insurance Exchange Authority

Questions?

30

THANK YOU

zsherman@pa.gov

Exchange Authority | 31

CHIP by the Numbers

CHIP Enrollment

33

178,000 179,000 180,000 181,000 182,000 183,000 184,000 185,000 186,000 187,000 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 180,970 181,385 182,971 183,564 183,431 184,333 184,812 183,072 184,912 185,553 185,959 186,093 186,191

CHIP Enrollment

MG18C Children

CHIP Enrollment Ages 0 to 4 TOTAL July 2019 27,957 August 2019 28,121 September 2019 28,191 October 2019 27,939 November 2019 28,076 December 2019 28,069 January 2020 28,130 February 2020 28,250

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MG18C Children TOTAL July 2019 1,430 August 2019 1,558 September 2019 1,339 October 2019 1,742 November 2019 1,314 December 2019 1,575 January 2020 977 February 2020 1,040

• MG18C refers to MA Children age 0-4 that remain in MA until their renewal date when

their family is over the MA income limits.

CHIP Successful Renewals

35

84% 94% 97% 94% 95% 52% 72% 73% 75% 85% 49% 65% 69% 73% 83% 48% 66% 70% 75% 84% 0% 20% 40% 60% 80% 100% 120% Free Sub1 Sub2 Sub3 At Cost

CHIP Successful Renewals

Dec-19 Jan-20 Feb-20 Mar-20

Processing Times for CHIP Applications

36

Customer Calls to the CHIP Call Center

37

1-800-986-KIDS Calls Received

4,485 4,525 3,888 4,571 5,377 4,227 1000 2000 3000 4000 5000 6000 7000 September 2019 October 2019 November 2019 December 2019 January 2020 February 2020

38

CHIP Call Center Metrics (continued)

38

Apply Over the Phone: Completed Applications

567 543 518 432 447 518 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 320 340 360 380 400 420 440 460 480 500 520 540 560 580 August 2019 September 2019 October 2019 November 2019 December 2019 January 2020

Policy Updates

Policy Updates

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Quality Assurance Updates

• Encounter Data Validation
• EQR Technical Reports

42

Quality Assurance (QA) Updates

Questions?

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Closing and Wrap Up

• Topics of discussion for next meeting?
• Next Advisory Council meetings:
• Wednesday, October 14, 2020

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