Maryland Health Benefit Exchange Web-Based Entities(WBE) Advisory - - PowerPoint PPT Presentation

A service of Maryland Health Benefit Exchange

Maryland Health Benefit Exchange

Web-Based Entities(WBE) Advisory Committee Consumer Issues & Contracting Meeting August 6, 2013 9:00 am-12:00 pm Department of Health and Mental Hygiene, 201 W. Preston Street, Lobby Level, Conference Room L3, Baltimore, Maryland 21201

Agenda

• Introductions:
• Start Discussion of WBE Value and Consumer Protection:
• Background on the Uninsured in Maryland (Frank Kolb)
• Value of WBEs (John Condrat & Sam Gibbs, discussion on

key areas for value)

• Overview of Consumer Protections for WBEs in Federal

Exchange (Frank Kolb)

• Consumer Protection Issues (Mary Lou Fox & Dr. Patrick

Richard, discussion on key consumer protection topics)

• Break:
• Begin Discussion of Contract Issues:

Topics to be Covered:

• Minimum Requirements vs. Competitive vs. Pilot
• Oversight/Enforcement
• Performance Measures/Data Collection
• Review and Next Steps

2

Introductions

WBE Advisory Committee

• Dr. Joshua Sharfstein, Chair, MHBE Board of Trustees

Jim Bendel, President, Potomac Basin Group Associates Kimberly Cammarata, Director, HEAU John Condrat, Manager, Extend Health Vickie Cosby, Senior Director, Consumer Direct Sales and Training, CareFirst BlueCross Blue Shield Samuel C. Gibbs, III, SVP and President of Government Services, eHealth Mary Lou Fox, Maryland Women’s Coalition for Health Care Reform Melanie C. Green, Health Services Manager, Aetna, Inc. Wesley Mace, Vice President, Kelly & Associates Insurance Group, Inc. Megan Mason, Special Assistant for Health Care Reform, MIA Tara Pellet, Consultant, Allied Resource Management – A TriBridge Partners company

• Dr. Patrick Richard, Community Alliance For Health Care

Coverage & Access WBE Advisory Committee Members:

4

WBE Advisory Committee Frank Kolb, Director of Policy and Government Relations, Maryland Health Connection, 410 547-1838 La Toya Strange, Executive Assistant, Maryland Health Connection, 410 547-1834 Maansi Raswant, JD, Senior Regulatory and Policy Advisor, The Hilltop Institute, 410-455-6859 Staff:

5

Start Discussion of WBE Value and Consumer Protection

Background on the Uninsured in Maryland

Uninsured 13% Insured 87%

1% 5% 12% 12% 13%

Other Public Individual Medicare Medicaid Uninsured Employer

55% 39% 97% Firms Offering Coverage Firms with 50 or less employees Firms with 50 or more employees

Private Sector Coverage

(percent of category that offers coverage)

Source: The Henry J. Kaiser Family Foundation, State Health Facts (2011)

8

57%

Health Insurance Coverage Type

10% 88% 2%

Under 18 years 18 to 64 years 65 years and older

Age Distribution of Uninsured

56% 44%

Male Female

Gender Distribution of Uninsured

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Source: U.S. Census Bureau American Community Survey (2010)

Uninsured 13% Insured 87%

Total Uninsured Demographic Profile

15% 27% 18% 17% 11%

18-24 25-34 35-44 45-54 55-64

56% 44%

Male Female

Uninsured 15% Insured 85%

Gender Age

Source: U.S. Centers for Disease Control, Behavioral Risk Factor Surveillance System Health Care Access/Coverage (2010), U.S. Census Bureau American Community Survey (2011)

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% of Uninsured Population

Adult Uninsured Demographic Profile Statewide

Race/ Ethnicity

Uninsured 15% Insured 85%

Education

Source: U.S. Centers for Disease Control, Behavioral Risk Factor Surveillance System Health Care Access/Coverage (2010), U.S. Census Bureau American Community Survey (2011)

11 24% 32% 25% 18%

Less than high school graduate High school graduate, GED,

• r alternative

Some college or associate's degree Bachelor's degree or higher

47% 33% 7% 13%

White Black or African American Asian Other

% of Uninsured Population

Adult Uninsured Demographic Profile Statewide

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Adult Uninsured Type by MHC Region

28.6% 48.1% 23.3%

Western

Total Uninsured: 84,812

33.1% 48.5% 18.5%

Central

Total Uninsured: 216,587

27.4% 49.7% 22.9%

Capitol

Total Uninsured: 221,914

27.6% 32.5% 20.9%

Southern

Total Uninsured: 30,796

31.9% 48.6% 19.5%

Upper Eastern Shore

Total Uninsured: 50,314

40.5% 46.1% 13.4%

Lower Eastern Shore

Total Uninsured: 23,143 Uninsured <65, Income <138% FPL (Medicaid) Uninsured <65, Income 138-400% FPL (Thru HIX) Uninsured <65, Income >400% FPL (Thru HIX)

Source: MHBE (2012) Data Sheet

7% 6% 16% 14% 10% 47% Children Living with 2 Parents Children Living with ≤ 1 Parent Married Parents Married Non-Parent Adults Single Parent Single Non-Parent Adults The Nonelderly Uninsured by Children/Parent Status

Source: State of Maryland, Maryland Health Care Commission Health Insurance Coverage Report (2011)

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Adult Uninsured Demographic Profile

Adult Uninsured Demographic Profile

Source: State of Maryland, Maryland Health Care Commission Health Insurance Coverage Report (2011)

20% 26% 55% Less than 100% Less than 200% 200% or above

Ratio of Income to Poverty Level of those Uninsured

(over the past 12 months)

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15 16,494 28,148 18,267 27,038 36,608 13,949 72,196 92,286 48,626 88,316 189,177 105,635 2,216 2,240 1,353 634 4,362 1,795 5 10 15 20 25 Below 50% 50% to below 125% 125% to below 150% 150% to below 200% 200% to below 400% 400% and above 0-20 years of age 21-64 years of age 65 and older

Percentage breakdown of Uninsured Individuals in MD by Age and Percentage of Federal Poverty Level. (Total numbers indicated above each bar)

Source: Fakhraei, S. H. (2012). Maryland health care reform simulation model: Detailed analysis and methodology. Baltimore, MD: The Hilltop Institute, UMBC.

Adult Uninsured Demographic Profile

Value of WBEs

Overview of Consumer Protections for WBEs in Federal Exchange

Federal Consumer Protections for All WBEs

Plan Display: All WBEs must: Meet all standards for disclosure and display of QHP information; Display all QHP data provided by the Exchange; and Provide consumers the ability to view all QHPs offered through the Exchange. All FFE WBEs must: Provide quality information on each QHP. Financial Incentives: All WBEs must: Not provide financial incentives, such as rebates and giveaways.

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Consumer Protections for FFE WBEs

Termination of Shopping Experience: All WBEs must: Provide consumers with the ability to withdraw from the process and use the Exchange Website at any time. Record Keeping: All WBEs must: Maintain audit trails and records in an electronic format for a minimum of ten years. Security: All WBEs in the FFE must: Securely transmit and receive QHP, eligibility and enrollment information between the FFE and the WBE; Meet all existing and future HHS privacy and security standards; and Authenticate consumer identification.

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Consumer Protections for FFE WBEs, Contin.

Steering & Conflicts of Interest: All WBEs in the FFE must: Refrain from steering consumers to specific plans; Disclose compensation; and Offer a QHP shopping experience free of non-QHP advertising. Disclosures: All WBEs in the FFE must: Provide all required disclosures; and Prominently display language notifying consumers that their Website is not an FFE Website. Agreements: All WBEs in the FFE must: Enter into agreements with the FFE and agents or brokers using the WBE’s Website indicating the WBE, agents and brokers will comply with federal standards and the WBE will provide to HHS a list of the agents and brokers.

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Consumer Protection Issues

Break

Begin Discussion of Contract Issues

Minimum Requirements vs. Competitive vs. Pilot

Begin Discussion of Contract Issues

Performance Measures/Data Collection

Review and Next Steps