Medicaid Advisory Committee December 9 th , 2015 Oregon State - - PowerPoint PPT Presentation

Medicaid Advisory Committee

December 9th, 2015

Oregon State Library Salem, Oregon

Time Item Presenter 9:30 Opening Remarks Co-Chairs 9:35 OHA OmbudsAdvisory Council  Recently activities and informational sessions  Client-based initiatives Ellen Pinney, OHA 9:55 Oregon Health Plan (OHP) and Coordinated Care Organizations – OHA update  OHP determination and enrollment 2015  CCO integration Rhonda Busek, OHA 10:15 OHA Legislative Update  2015 implementation update, next steps Brian Nieubuurt, OHA 10:25 OregonONEligibility  Informational update Sarah Miller, OHA 10:50 Break 11:00 Basic Health Program (BHP): HB 2934  Review BHP Stakeholder Group recommendations Staff, OHA 11:15 Public Health Modernization  Informational session Cara Biddlecom, OHA 11:50 Committee Planning for 2016  Review committee’s work in 2015  Identify priority policy areas for 2016  Committee calendar Co-Chairs; staff 12:20 Closing comments Co-Chairs

OHA OmbudsAdvisory Council

Ellen Pinney, OHA Ombudsperson

OHA Update: Oregon Health Plan (OHP) and CCOs

Rhonda Busek Health Systems Division, OHA

OHA Legislative Update 2015

Brian Nieubuurt, OHA

OregonONEligibility MAGI Medicaid System Transfer Project

Sarah Miller, Project Director, OHA

OHA MAGI Medicaid System Transfer Project Oregon Eligibility (ONE)

Overview December 2015

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Project Overview

• Kentucky system exists in production and works correctly
• Minimum necessary system customizations were planned and made
• Policy and business processes will change wherever feasible

Kentucky’s Affordable Care Act-compliant system (called kynect), was transferred and configured to meet Oregon’s MAGI Medicaid/CHIP eligibility determination needs. Oregon’s system is called Oregon Eligibility (ONE) or just ONE.

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Oregon’s Medicaid Eligibility & Enrollment

• Applicants apply for Oregon Health Plan (OHP) coverage via ONE (Medicaid

Eligibility Determination)

• Applicants eligibility information is passed from ONE to MMIS to enroll in OHP and

get a coverage card (Medicaid Enrollment)

• MMIS sends CCO enrollment files to enroll OHP members in particular CCOs

Medicaid eligibility will be completed in the ONE System. The Medicaid enrollment system of record is Oregon’s MMIS.

Oregon MMIS Oregon CCOs

Project Mission and Key Benefits

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Improve Oregonians’ access to health care by providing a simplified process for eligibility determination and enrollment in Oregon Health Plan (OHP)

The Mission

• Better coordination of care for mixed household families because applicants complete a

single application through the HealthCare.gov website or within the ONE system to receive an eligibility determination for MAGI Medicaid/CHIP or private health insurance

• Oregonians can set-up an account, report changes and receive real-time eligibility

determinations via the user-friendly Applicant Portal

• Simplified OHA eligibility workload via automated process that generates tasks for case

management

• Centralized and verified enrollment data available for Coordinated Care Organizations
• Consistent quality data source for reporting CMS-mandated operational statistics

Key Benefits

Median Household Income Key Benefit

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100% 200% 300% 400% QHP APTC OHP

Pregnant Woman Child

APTC QHP OHP QHP APTC OHP

Adult % of FPL

The Median Household Income in Oregon often results in mixed eligibility

• households. A key

benefit of the ONE system will be the ability to track these households and service each member

• f the family.

Median Household Income in Oregon = Between 200-300% FPL

Applicants complete a single application through the HealthCare.gov website or within the ONE system to receive an eligibility determination for MAGI Medicaid/CHIP

190% 138% 305%

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Benefit Programs Capabilities

Applicant Portal & Community Partners

Channels Worker Portal (Mail / Fax / Phone)

Screening MEC Check for Adult

Advanced Premium Tax Credit (APTC) (Disabled)

Continuous Eligibility

MAGI

Account Registration Non-MAGI Referral CAWEM / CAWEM Plus (Emergency Medicaid)

Former Foster Care Children

New Existing

Emergency Medicaid

Federal Healthcare.gov

ONE System Functionality

Check Benefits Document Management Reasonable Compatibility Case Maintenance Verification Real Time Eligibility Manage Tasks Inquiry Hospitalized Inmate Application Bi-directional Account Transfer Correspondence & Reports Renewals Eligibility Override

Public Assistance Reporting Information System Medicaid Management Information System Oregon Employment Dept. Federal Data Services Hub

Interfaces

Qualified Health Plan/ Employee Sponsored Insurance (Disabled)

Project Approach

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Status Phase What We’re Doing

Design

• Finalize requirements
• Define future-state business processes supporting new capabilities
• Capture all changes occurring as a result of the new technology and processes
• Planning to move data from existing systems into the new tool, known as the “cutover

strategy”

• Communicating with staff and stakeholders about the project

Build

• Build technology, integrating and “talking to” current systems not being replaced
• Write scenarios that simulate how the system is used
• Develop detailed training courses
• Communicate specifics about changes and benefits that ONE will bring

Test

• Extensively test the system to confirm it is running correctly and works with other systems

OHA currently uses

• Make final adjustments to technology and processes as necessary, based on the results of

tests

Implement

• Conduct training to help staff and others learn new technology and processes
• “Turn on” the system to perform business processes
• Conduct additional training as needed

Support

• Continuous support with help of “Local Experts”, or staff highly trained on the system
• Encourage continued momentum among staff to use the system, ask questions, and raise

concerns

We are here

ONE System Go-Live Dates

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Worker Portal Go-Live

December 15, 2015

• Used for eligibility determinations
• Read only access for DHS staff as needed to

review status of client applications

Applicant Portal Go-Live

February 6, 2016

• Community Partners/Assisters and public

use for self-servicing new eligibility determinations and enrollments

• Current Medicaid enrollees will need to

have an eligibility determination completed in ONE by a worker before they can use the Applicant Portal

S M T W T F S 1 2 3 4 5 6 7 8 9 10 11 12 13 14 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 December February S M T W T F S 1 2 3 4 5 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

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A Day in the Life of an Eligibility Worker

15 Applicant provides verification documents

Receive Verification Documents

Eligibility Worker Other OHA / DHS System generates correspondence

Request for Information

Data needed to run verification is received and entered

Re-run Verification

Reassign applicant to appropriate queue

Non-MAGI Referral

Applicant is handed off to DHS and processed outside of the ONE system

DHS Dashboard

Pull appropriate task from queue. Manage from your dashboard

Log In

Single Sign On Verification successful?

Verification

Complete Applicant Registration and data collection

Data Entry Authorize Benefits

Authorize the appropriate benefits

Authorize Benefits

Authorize the appropriate benefits Yes No

Report Results

The eligibility results will be reported to the ONE System

Application Lifecycle for Applicants and Workers

General New Applicant — Does not have Medicaid Existing Applicant — Has Medicaid Worker Log In Single Sign On Worker Dashboard Pull appropriate task from cue. Manage from your dashboard Verification successful Verification Applicant Applies Applicant Portal (On-Line) Community Partner Assistance in Applicant Portal Complete Applicant Registration and data collection Data Collection Eligibility Determined Applicant not previously known to the Oregon system has their eligibility determined CCO Selection Applicant or Community Partner selects a preference, MMIS assigns CCO finally Complete Applicant Registration and data collection *Applicant known to Oregon Systems? Data Collection Eligibility Determined Applicant not previously known to the Oregon system has their eligibility determined Verification successful. Verification Yes No

Application Lifecycle for Applicants and Workers

Applicant Applies Completes their application via Paper, Fax, Fillable PDF IRMS Scans the application into the Worker Portal Worker Dashboard Pull appropriate task from cue, Manage from your dashboard Verification successful Verification Worker Log In Single Sign On Applicant without Computer or Access to a Community Partner Complete Applicant Registration and data collection Data Collection Eligibility Determined Applicant not previously known to the Oregon system has their eligibility determined

Project Team Contact Information

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For additional information regarding the OHA MAGI Medicaid System Transfer Project or the ONE System, email the project team:

OHAOregon.Eligibility@state.or.us

BREAK

Basic Health Program (BHP): Oregon Considerations 2013-2015

Basic Health Program (BHP) Overview

• ACA gives states the option to establish a BHP for:

– Individuals between 138-200% FPL who are ineligible for Medicaid or CHIP, and who do not have access to affordable employer coverage. – Individuals below 138% of FPL who are ineligible for Medicaid due to immigration status.

• Federal government gives states 95% of what would have been

spent on tax credits in the marketplace.

• Health plans must include essential health benefits.
• Monthly premiums and cost sharing cannot exceed the amount

the individual would have paid for coverage in the marketplace.

How BHP Fits into ACA Coverage Options in Oregon?

Employer Sponsored Insurance (ESI) BHP 250% Medicaid (Adult Coverage) Cost-Sharing Reductions for Qualified Health Plans Qualified Health Plans (Marketplace) *138% *190% *305% 400%

0% 100% 200% 300% 400%

% Federal Poverty Level *Indicates the 5% across-the-board income disregard in Medicaid and CHIP. (Illustration adapted from the Washington State Health Care Authority.)

Premium Tax Credits for Qualified Health Plans Children (Medicaid/CHIP) Medicaid (Pregnancy Coverage) (Medicaid 5-year bar/COFA pop.)

BHP Timeline in Oregon: 2013-2015

• Oct. 2013 – August 2014: Committee examined BHP

among several policy options to mitigate churn in OHP post ACA

• April – Nov. 2014: HB 4109 required OHA to conduct a

comprehensive study of the financial feasibility of a BHP in Oregon

• May – Nov 2015: HB 2934 required OHA to convene a

stakeholder advisory group to develop operational, policy, and financial recommendations to Oregon Legislature

Committee Considerations for BHP (2013/14)

• BHP eligible enrollees ineligible for QHP subsidies
• New transition point and affordability cliff created at 200%

FPL

• Federal funding may not cover cost of plans; State has

financial exposure

• State fiscal responsibility for start-up and ongoing

administrative costs

• Fewer covered lives in the Marketplace may affect risk

pool, increase QHP premiums

• Providers may receive lower reimbursement rates than in a

QHP

Committee Considerations for BHP (2013/14) (cont.)

• Submitted a comprehensive report with recommendations to Health

Policy Board to reduce, avoid, and mitigate future churn in Medicaid – Aug. 2014

• Committee concluded the following
• BHP deemed not a viable option for 2014 or 2015 due to

implementation costs and administrative complexity.

• Any recommendation regarding BHP from the standpoint of

churn should wait until the feasibility study required by HB 4109 (fall of 2014)

• Identified several issues for future BHP discussions: reasonable

provider reimbursement rates, scope of benefit coverage (OHP

• vs. QHP), feasibility of operating BHP through existing CCOs,

consumer choice, and administrative complexity in establishing an entirely new program.

HB 4109: Study Objectives (2014)

• Fulfill requirements of House Bill 4109

– Directed OHA to commission a study of the costs and impacts of operating a BHP in Oregon

• Identify the following with respect to potential BHP

– BHP eligible and expected enrolled populations – Estimated State fiscal impact for 2016 – BHP consumer impact, including affordability – Marketplace and commercial insurance impact – Preliminary range of State administrative costs – Other considerations

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Key Results: 4109 BHP Study

• An estimated 87,600 people would qualify for BHP in 2016;

61,400-66,300 individuals would enroll. – 55,000 individuals would transition from Marketplace to BHP – Slight decline in overall uninsured (approx. 5,400-9,900) – Consumer savings of approx. $800 - $1,590 per year

• BHP program would marginally impact the individual market

risk pool, carrier interest in the Marketplace, and Marketplace stability.

• No modeled scenario yielded a financial “break even” point

for Oregon. – Projected deficits in 2016 of $1.6 - $119 million.

Requirements of HB 2934 (2015)

• Required OHA to convene a stakeholder group to provide

recommendations to Legislative Assembly concerning the BHP.

• OHA to report recommendations to interim legislative committees no

later than Dec. 1, 2015.

• Recommendations needed to address “the policy, operational,

and financial” preferences of the group in the “design and

• peration” of a BHP.
• Recommendations should further the goals of the Legislative

Assembly of “reducing the cost of health care and ensuring all residents” of Oregon have equal access to health care.

• Increase access to coverage for uninsured, including

those ineligible for Medicaid and Oregon’s COFA population

• Increase affordability of coverage for low-income

Oregonians

• Reduce churn by minimizing and mitigating the

frequency of and impact from coverage transitions, including the benefit cliff, among ACA insurance affordability programs (IAPs)

• Sponsor an accountable care model using a

measurement framework to incentivize quality and population health improvements

Oregon BHP Design Principles

• Promote a sustainable and predictable rate of

growth

• Maintain a healthy and vital Marketplace and spread

the Coordinated Care Model (CCM)

• Exercise stewardship of State resources by

maximizing federal resources available through the ACA

Oregon BHP Design Principles (cont.)

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BHP Design Framework: Hybrid-Marketplace Delivery System CCOs and commercial QHPs compete for BHP enrollees using principles of Oregon’s coordinated care model (CCM) Benefit Coverage Full Medicaid benefit level without adult dental Provider Reimbursement Average of Medicaid and Commercial (~81% of Oregon’s commercial reimbursement rate) Premiums & Cost- sharing <138% FPL, $0; 138-200% FPL graduated cost-sharing through premiums; no deductibles or copays for services Eligibility & Enrollment Marketplace standards; FFM eligibility system (federal hub) Consumer Choice Standard Health Plan (SHP) offerings via Marketplace Administrative Functions Marketplace and carriers (client services, grievances, premium billing) Annual Growth Rate Annualized sustainable rate of growth (e.g. 3.4% OHP, PEBB, OEEB); rate to be determined by Legislature

BHP: Advantages and Disadvantages

Potential Advantages

• Affordability, more low-income individuals able to afford

coverage by reducing premiums and cost sharing for low-income individuals;

• Expand coverage to remaining uninsured 0-200% FPL and

increase access to care for remaining uninsured;

• Reduce churn below 200% by smoothing transitions as incomes

fluctuate at 138% FPL, potentially reduce rate of pregnancy related churn between Medicaid and the Marketplace;

• Offer additional benefit coverage and encourage appropriate use
• f primary and preventive care (e.g. removing additional copays);
• Opportunity to expand Oregon’s coordinated care model

through Oregon’s Marketplace; and

• Sustainable rate of growth, creating potential long-term savings

by controlling annual costs.

BHP: Advantages and Disadvantages (cont.)

Potential Disadvantages

• Federal funding may not cover cost of plans leading to financial

exposure for the State, and

• State funding for start-up and ongoing administrative costs.
• BHP could destabilize

Uncertainty

• BHP could help stabilize Oregon’s individual market, or

destabilize by creating multiple risk pools and low carrier participation

Committee Response to HB 4109/HB 2934

• Based on the work completed in response HB 4109

(2014) and HB 2934 (2015), and ongoing inquiry among committee members, does the committee wish to formally comment on the BHP?

• If so, to what extent, and is additional information needed

before commenting?

PUBLIC HEALTH DIVISION Office of the State Public Health Director

Public Health Modernization

Cara Biddlecom Health System Transformation Lead Medicaid Advisory Committee December 9, 2015

What does governmental public health do?

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Task Force on the Future of Public Health Services

• HB 2348 (2013) called for the creation of a task force to study and

develop recommendations for a public health system for the future.

• Between January and September 2014, the Task Force on the

Future of Public Health Services met to develop a framework for modernizing Oregon’s public health system.

• In September 2014, the Modernizing Oregon’s Public Health System

report was submitted to the legislature with a specific set of recommendations.

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Task Force recommendations

• The Modernizing Oregon’s Public Health System report included the

following recommendations: – The foundational capabilities and programs for governmental public health services should be adopted. – Significant and sustained state funding should be identified for

• perationalization of the foundational capabilities and programs.

– Statewide implementation of the foundational capabilities and programs should occur in waves over time. – Local public health should have the flexibility to operationalize the foundational capabilities and programs through a single county structure; a single county with shared services; or a multi- county jurisdiction. – Improvements and changes in governmental public health should be structured around metrics established and evaluated by the Public Health Advisory Board, which shall report to the Oregon Health Policy Board.

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House Bill 3100 (2015)

• House Bill 3100 operationalizes many of these recommendations
• ver the period of 2015-2017. Specifically, the bill:

– Adopts the foundational capabilities and programs for governmental public health. – Changes the composition and role of the Public Health Advisory Board beginning on January 1, 2016. – Requires the Oregon Health Authority’s Public Health Division and local public health authorities to assess their current capacity to implement the foundational capabilities and programs; and requires a report on these findings be submitted to the legislature by June 2016. – States that local public health authorities shall submit plans for implementing the foundational capabilities and programs no later than December 2023.

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Why modernize Oregon’s public health system?

• Public health has traditionally provided a safety net for individuals

without health insurance, and due to the Affordable Care Act, Oregon’s uninsured rate has greatly decreased.

• Without needing to provide health care for a substantial number of

uninsured individuals, public health can focus on developing policies and programs that can sustain lifelong health for everyone.

• A focus on policies and programs that can help everyone be healthy

will yield cost and time savings for the health care delivery system.

• Investments in public health vary from county to county, leading to

disparities in services.

• Oregon’s public health system relies heavily on federal categorical

grants, which do not always meet the unique needs of our state.

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What does public health modernization mean for my community?

• Modernization of public health means that everyone in Oregon will

be served by a health department that provides for: – Timely and comprehensive data on the health of their population in order to inform community health assessments and community health improvement plans; – Response to emerging health threats like natural disasters and communicable diseases; – Clear and comprehensive communications about important health issues; – Assurance that community members have access to healthy foods and safe places to play and be active.

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What will happen now?

• In order for everyone in Oregon to have access to these

foundational public health protections, between now and June 2016: – A new Public Health Advisory Board, will be appointed by the Governor; – Clear, measurable definitions for the foundational capabilities and programs for public health will be finalized; – State and local health departments will assess the extent to which they currently provide the foundational capabilities and programs and will determine costs to fully implement them; – Health departments will determine the most appropriate governance structure for the jurisdiction they serve; – With communities and partners, state and local health departments will develop plans to implement the foundational capabilities and programs, based on the findings from their assessments.

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Next steps

Activity Timeline Public Health Policy Manual draft complete; modernization assessment tool developed December 2015 New Public Health Advisory Board is appointed by the Governor January 2016 Public Health Division and local public health authorities assess ability to implement foundational capabilities and programs January-March 2016 Administrative rules are filed in accordance with House Bill 3100 May 2016 Assessment findings are reported to the Oregon legislature June 2016 Public Health Division and local public health authorities plan for implementation of the foundational capabilities and programs Beginning July 2016

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Contact information

cara.m.biddlecom@state.or.us (971) 673-2284 www.healthoregon.org/modernization

Looking Ahead to 2016

Committee Input and Guidance 2016

• Review April 2015 charter
• What issues and considerations are most relevant and

important to share with OHA and the Oregon Legislature in 2016? – Consumer perspectives (e.g. CACs) – Benefit coverage, access to services, other? – Physical, oral and behavioral health integration – OHP and health-related supportive services (e.g. housing, transportation, food, other?)

• What are your top 2 priorities and topics for the

committee in 2016?

2016 Meeting Schedule

• Committee will meet on the following months:

– January 27th – February 24th – April 27th – June 22nd – July 27th – Sept. 28th

– Oct. 26th

– Dec. 7th

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• Not scheduled to March, May, August or November

Public Comment or Testimony