~ ~ ~ ~ ~ ~ Full Expansion Medicare Healthcare Reform - - PDF document

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~ ~ ~ ~ ~ ~ Full Expansion Medicare Healthcare Reform - - PDF document

Dec 13, 2022 366 likes •440 views

Medicaid and ACA Populations 400% 200% Exchange Subsidies ~ ~ ~ ~ ~ ~ Full Expansion Medicare Healthcare Reform Mandatory 150% Prop 204 Expanded Coverage State Expanded Coverage (Non- Medicaid Moving Forward 100% 100% Prop 204)

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Medicaid Moving Forward

23rd Annual SEEDS Conference October 1, 2014

0% 50% 100% 150% 200% Infants (0-1) Children (1-5) Children (6-19) Pregnant Women Parents Aged, Blind and Disabled Childless Adults*

Exchange Subsidies Full Expansion Healthcare Reform Mandatory Prop 204 Expanded Coverage State Expanded Coverage (Non- Prop 204) *Currently frozen

~ ~ ~ ~ ~ ~

Medicaid and ACA Populations

67% 67% 67% 67% 67% 67% 85% 100% 100%

Medicare 400%

100-133% FPL Estimated 57,000 to enroll Percentage of costs paid by federal government

Reaching across Arizona to provide comprehensive quality health care for those in need 2

Journey to Restoration

  • In State of the State, Gov. Brewer called for restoration of
  • Prop. 204 childless adult coverage (240,000 Arizonans 0-

100% FPL) and new adult coverage (57,000 Arizonans between 100-133% FPL).

  • Because Arizona expanded early, the State was not

eligible for 100% federal funding for childless adults.

  • ACA included transitional enhanced FMAP for expansion

states, but Arizona could only access that higher match if it “expanded” to include adults from 100-133% FPL.

  • The State could not afford restoration without expansion.
  • Arizona’s “expansion” debate was over 57,000 new adults.

Reaching across Arizona to provide comprehensive quality health care for those in need 3

Relatively Minor Tweak to Populations Already Covered by Arizona Voters

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  • 200,000

400,000 600,000 800,000 1,000,000 1,200,000 1,400,000

Difference- 57,000 People Prop 204 Population Full Expansion to 133%

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2013 Coverage Policy Options

Options Lives covered GF Impact (FY 14-16) Federal $ available Prop 204 Vote Honored Governor’s Proposal 300,000 $(100) m savings $4.1 billion Yes Continued Freeze (assume state only) 63,000 and shrinking $850 m plus cost $0 No Terminate Coverage 1-1-14 (63,000 lose coverage) $0 $0 No

Reaching across Arizona to provide comprehensive quality health care for those in need 5 6

Total AHCCCS Acute

Reaching across Arizona to provide comprehensive quality health care for those in need

  • 200,000

400,000 600,000 800,000 1,000,000 1,200,000 1,400,000 1,600,000 1,800,000 Actual Forecast

Hospital Assessment & Litigation

  • Hospital Assessment
  • Collaborating with hospital industry; no negative impact to hospital

systems

  • Assessed: $75M in FY14; $233M in FY15
  • Litigation: Biggs v. Brewer and Betlach
  • Goldwater Institute files lawsuit representing 36 legislators
  • Claim hospital assessment required 2/3 supermajority.
  • 2/3 does not apply to “fees and assessments that are authorized by

statute, but are not prescribed by formula, amount or limit, and are set by a state officer or agency.” Agencies given fee authority over 80 times in the past 5 years.

  • February: Judge grants State motion to dismiss on standing.
  • April 23, Court of Appeals reverses Superior Court ruling.
  • November 6 State Supreme Court arguments

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Moving Forward

Implementation

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Medicaid Restoration

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12/1/2013 9/1/2014 Change Prop 204 Restoration 67,770 258,169 190,399 Adult Expansion 28,477 28,477 KidsCare 46,761 1,966

  • 44,795

Family Planning 5,105

  • 5,105

AHCCCS for Families & Children (1931) 672,135 744,029 71,894 All Other 505,379 589,031 83,652 Total Enrollment 1,297,150 1,621,672 324,522

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Total AHCCCS Acute

Reaching across Arizona to provide comprehensive quality health care for those in need

  • 200,000

400,000 600,000 800,000 1,000,000 1,200,000 1,400,000 1,600,000 1,800,000 Actual Forecast

KidsCare Update – changes for 2-1

  • KidsCare I (covers 133% - 200% FPL)
  • 7,000 Kids
  • roughly 4,500 to Medicaid
  • 2,300 stay in KidsCare
  • KidsCare II (expired 1-1-14)
  • 37,000 Kids
  • 23,000 Medicaid
  • 14,000 to FFM - Marketplace

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Essential Health Benefits

  • EHBs required for Marketplace Coverage
  • In Medicaid EHBs apply to New Adult Group Only.
  • Medicaid rules allow Aligning to Medicaid package

– Arizona’s path

  • Added HPV vaccine for adults (21-26) – 1/1/14
  • Restored well visits – 10/1/13
  • Allowing separate 15 visit PT limit for acquiring
  • r maintaining a skill or function
  • 25-day IP limit going away 10/1/14

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Health

  • e-

Arizona AHCCCS’ ACE DES’ AZTECS

New Application and Eligibility System

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Health-e-Arizona Plus

Reaching across Arizona to provide comprehensive quality health care for those in need

Expanding the Public/Private Partnership

  • AHCCCS partners with over 100 organizations and providers

to offer local application assistance to consumers.

  • AHCCCS has trained nearly 2,000 subscriber employees

known as “community assistors” to assist applicants.

  • Many new organizations are signing up to become subscribers

to HEAplus.

  • Many organizations can be HEAplus partners. Hospitals.
  • Clinics. Faith-based groups. Community organizations.
  • Counties. Courts/Probation Departments.
  • Making Eligibility Local. Provide personalized support to your

customers in their own community.

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Justice Transition Initiatives

  • 18,000 + released DOC annually
  • 100,000 + released county jails annually
  • Estimated over half of those released require

treatment for mental health/substance abuse

  • DOC Spends $150 m annually
  • Counties spend approx $90 m
  • 60-70% for Both is BH/SA
  • In 2011 AHCCCS spent $187 m on members

incarcerated at some point during the year

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Justice Transition Initiatives

  • AHCCCS has processes in place to:
  • Cover Inpatient costs for DOC and most county

jails

  • Data interfaces to suspend and reinstate

enrollment rather than terminate and require reapplication

  • Manual process for care coordination –

enrollment for high cost cases

  • Pursuing other opportunities

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Moving Forward

Medicaid vs. Marketplace

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Federal Marketplace

Premium Tax Credits Cost Sharing Reductions Qualified Health Plan enrollment Navigators/Certified Application Counselors

Arizona

AHCCCS (Medicaid) KidsCare (CHIP) Health-e-Arizona Plus

Reaching across Arizona to provide comprehensive quality health care for those in need

Medicaid vs. Marketplace

  • What if a HEAplus applicant is over income for AHCCCS?
  • HEAplus will tell you if you are over income for

AHCCCS and that your information is being transferred to the Marketplace.

  • For people not AHCCCS eligible, HEAplus will

automatically transfer the application to the Marketplace for review.

  • AHCCCS has transferred approximately 146,000

accounts to FFM (as of April 1, 2014).

  • Applicants will need to go to www.healthcare.gov

to open an account in the Marketplace.

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Medicaid vs. Marketplace

  • What happens if an applicant applies for coverage through the

Marketplace but is screened as AHCCCS eligible?

  • FFM will not make AHCCCS eligibility determinations.
  • If Marketplace screens applicants as AHCCCS eligible based on

income, Marketplace transfers that account to AHCCCS without the person having to do anything.

  • AHCCCS will then complete your eligibility determination.
  • FFM transferred 88,000+ accounts starting in mid-February.
  • Initially, there were multiple errors in the data transfer.
  • AHCCCS has since processed all FFM account transfers.
  • Federal changes to that process may occur and may require

changes in HEAplus. We will know more soon.

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Medicaid vs. Marketplace

  • Are any of the federal Marketplace website issues

impacting HEAplus?

  • HEAplus relies on a federal data hub to access certain

information.

  • That system is sometimes taken down for

maintenance.

  • This means that HEAplus will not be able to verify

certain information like citizenship during those off hours.

  • Any unscheduled problems with the federal data hub

will also cause delays for HEAplus.

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Questions?

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