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

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) 100% 100-133% FPL Estimated 57,000 to enroll 23 rd Annual SEEDS 67% 67% 67% 67% 67% 67% 85% Percentage of costs paid 50% Conference by federal government October 1, 2014 0% Infants Children Children Pregnant Parents Aged, Blind Childless (0-1) (1-5) (6-19) Women and Disabled Adults* *Currently frozen Reaching across Arizona to provide comprehensive 2 quality health care for those in need Relatively Minor Tweak to Populations Journey to Restoration Already Covered by Arizona Voters • In State of the State, Gov. Brewer called for restoration of Prop. 204 childless adult coverage (240,000 Arizonans 0- 1,400,000 100% FPL) and new adult coverage (57,000 Arizonans Full Expansion to 133% Difference- 57,000 People 1,200,000 between 100-133% FPL). Prop 204 Population 1,000,000 • Because Arizona expanded early, the State was not 800,000 eligible for 100% federal funding for childless adults. 600,000 • ACA included transitional enhanced FMAP for expansion 400,000 states, but Arizona could only access that higher match if it “expanded” to include adults from 100 -133% FPL. 200,000 - • The State could not afford restoration without expansion. • Arizona’s “expansion” debate was over 57,000 new adults. Reaching across Arizona to provide comprehensive Reaching across Arizona to provide comprehensive 3 4 quality health care for those in need quality health care for those in need 1

2013 Coverage Policy Options Total AHCCCS Acute 1,800,000 Options Lives covered GF Impact Federal Prop 204 1,600,000 (FY 14-16) $ available Vote Honored 1,400,000 Governor’s 300,000 $(100) m savings $4.1 billion Yes 1,200,000 Proposal 1,000,000 800,000 Continued Freeze 63,000 and $850 m plus cost $0 No (assume state only) shrinking 600,000 400,000 Terminate 0 $0 $0 No 200,000 Coverage 1-1-14 (63,000 lose coverage) - Actual Forecast Reaching across Arizona to provide comprehensive Reaching across Arizona to provide comprehensive 5 6 quality health care for those in need quality health care for those in need Hospital Assessment & Litigation • Hospital Assessment o Collaborating with hospital industry; no negative impact to hospital systems o Assessed: $75M in FY14; $233M in FY15 • Litigation: Biggs v. Brewer and Betlach Moving Forward o Goldwater Institute files lawsuit representing 36 legislators o Claim hospital assessment required 2/3 supermajority. o 2/3 does not apply to “fees and assessments that are authorized by Implementation 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. o February: Judge grants State motion to dismiss on standing. o April 23, Court of Appeals reverses Superior Court ruling . o November 6 State Supreme Court arguments Reaching across Arizona to provide comprehensive Reaching across Arizona to provide comprehensive 7 8 quality health care for those in need quality health care for those in need 2

Medicaid Restoration Total AHCCCS Acute 1,800,000 12/1/2013 9/1/2014 Change 1,600,000 Prop 204 Restoration 67,770 258,169 190,399 1,400,000 1,200,000 Adult Expansion 0 28,477 28,477 1,000,000 KidsCare 46,761 1,966 -44,795 800,000 Family Planning 5,105 0 -5,105 600,000 AHCCCS for Families & 672,135 744,029 71,894 400,000 Children (1931) 200,000 All Other 505,379 589,031 83,652 - Total Enrollment 1,297,150 1,621,672 324,522 Actual Forecast Reaching across Arizona to provide comprehensive Reaching across Arizona to provide comprehensive 9 10 quality health care for those in need quality health care for those in need KidsCare Update – changes for 2-1 Essential Health Benefits • KidsCare I (covers 133% - 200% FPL) • EHBs required for Marketplace Coverage • In Medicaid EHBs apply to New Adult Group Only. o 7,000 Kids  roughly 4,500 to Medicaid • Medicaid rules allow Aligning to Medicaid package  2,300 stay in KidsCare – Arizona’s path • KidsCare II (expired 1-1-14) o Added HPV vaccine for adults (21-26) – 1/1/14 o 37,000 Kids o Restored well visits – 10/1/13  23,000 Medicaid o Allowing separate 15 visit PT limit for acquiring  14,000 to FFM - Marketplace or maintaining a skill or function o 25-day IP limit going away 10/1/14 Reaching across Arizona to provide comprehensive Reaching across Arizona to provide comprehensive 11 12 quality health care for those in need quality health care for those in need 3

Expanding the Public/Private Partnership New Application and Eligibility System AHCCCS partners with over 100 organizations and providers • to offer local application assistance to consumers. DES ’ AHCCCS ’ • AHCCCS has trained nearly 2,000 subscriber employees AZTECS ACE known as “community assistors” to assist applicants. Many new organizations are signing up to become subscribers • Health -e- to HEAplus. Arizona 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 • Health-e-Arizona Plus customers in their own community. Reaching across Arizona to provide comprehensive Reaching across Arizona to provide comprehensive 13 14 quality health care for those in need quality health care for those in need Justice Transition Initiatives Justice Transition Initiatives • 18,000 + released DOC annually • AHCCCS has processes in place to: • 100,000 + released county jails annually o Cover Inpatient costs for DOC and most county jails • Estimated over half of those released require treatment for mental health/substance abuse o Data interfaces to suspend and reinstate • DOC Spends $150 m annually enrollment rather than terminate and require reapplication • Counties spend approx $90 m o Manual process for care coordination – • 60-70% for Both is BH/SA enrollment for high cost cases • In 2011 AHCCCS spent $187 m on members o Pursuing other opportunities incarcerated at some point during the year Reaching across Arizona to provide comprehensive Reaching across Arizona to provide comprehensive 15 16 quality health care for those in need quality health care for those in need 4

Federal Marketplace Arizona AHCCCS Premium Tax Credits (Medicaid) Moving Forward Cost Sharing Reductions KidsCare (CHIP) Medicaid vs. Marketplace Qualified Health Plan enrollment Navigators/Certified Health-e-Arizona Plus Application Counselors Reaching across Arizona to provide comprehensive Reaching across Arizona to provide comprehensive 17 18 quality health care for those in need quality health care for those in need Medicaid vs. Marketplace Medicaid vs. Marketplace • What if a HEAplus applicant is over income for AHCCCS? • What happens if an applicant applies for coverage through the Marketplace but is screened as AHCCCS eligible? o HEAplus will tell you if you are over income for o FFM will not make AHCCCS eligibility determinations. AHCCCS and that your information is being o If Marketplace screens applicants as AHCCCS eligible based on transferred to the Marketplace. income, Marketplace transfers that account to AHCCCS without o For people not AHCCCS eligible, HEAplus will the person having to do anything. automatically transfer the application to the o AHCCCS will then complete your eligibility determination. Marketplace for review. o FFM transferred 88,000+ accounts starting in mid-February. o Initially, there were multiple errors in the data transfer. o AHCCCS has transferred approximately 146,000 o AHCCCS has since processed all FFM account transfers. accounts to FFM (as of April 1, 2014). o Federal changes to that process may occur and may require o Applicants will need to go to www.healthcare.gov changes in HEAplus. We will know more soon. to open an account in the Marketplace. Reaching across Arizona to provide comprehensive Reaching across Arizona to provide comprehensive 19 20 quality health care for those in need quality health care for those in need 5

Medicaid vs. Marketplace • Are any of the federal Marketplace website issues impacting HEAplus? o HEAplus relies on a federal data hub to access certain information. Questions? o That system is sometimes taken down for maintenance. o This means that HEAplus will not be able to verify certain information like citizenship during those off hours. o Any unscheduled problems with the federal data hub will also cause delays for HEAplus. Reaching across Arizona to provide comprehensive Reaching across Arizona to provide comprehensive 21 22 quality health care for those in need quality health care for those in need Reaching across Arizona to provide comprehensive 23 quality health care for those in need 6