WEL WELCOME COME KANCARE EXPANSION FORUM January 5, 2016 - - PowerPoint PPT Presentation

WEL WELCOME COME

KANCARE EXPANSION FORUM

January 5, 2016

WELCOME

DANA ABRAHAM

President Of Private Wealth Management And Consumer Services Vice Chair, REACH Healthcare Foundation

FORMER SENATE PRESIDENT

DAVE KERR

MEDICAID EXPANSION STATUS

WHAT’S THE COST TO KANSAS HOSPITALS?

• $331 MILLION IN REDUCED MEDICARE

REIMBURSEMENTS THROUGH 2015

• $1.2 BILLION IN ADDITIONAL CUTS FROM 2016

TO 2024

SOURCE: HEALTH ASSOCIATION OF NEW YORK STATE

WHO ARE THE NEWLY ELIGIBLE POPULATION

APPROXIMATELY 138,000 KANSANS

• HAVE INCOMES BELOW 138% OF THE FEDERAL POVERTY LEVEL
• $27,724 FOR A FAMILY OF 3, OR
• 73 HOURS A WEEK, 52 WEEKS A YEAR WITH NO VACATION OR SICK LEAVE AT MINIMUM

WAGE

• 66 HOURS A WEEK, 52 WEEKS A YEAR WITH NO VACATION OR SICK LEAVE AT KANSAS

LOWEST AVERAGE HOURLY WAGE

• AGE 19-64
• STUDENTS
• PARENTS
• GRANDPARENTS
• VETERANS
• HIGH SCHOOL DIPLOMA OR LESS
• DISABLED

WORK STATUS OF THE NEWLY ELIGIBLE

POPULATION

Employed 54%

Unemployed 18% Not in the workforce 28%

43.1% 9.0% 14.5% 33.5%

Total Uninsured under 100% FPL

26 Weeks or More 14 to 26 weeks 13 weeks or less Did Not Work

68.6% 7.1% 6.5% 17.8%

Total Uninsured 100-138% FPL

26 Weeks or More 14 to 26 weeks 13 weeks or less Did Not Work

WORK STATUS OF THE NEWLY ELIGIBLE

POPULATION

WHAT IS KANCARE EXPANSION?

COST OF EXPANSION TO KANSAS

2017 2020

$40.1 $762.1 $0.0 $100.0 $200.0 $300.0 $400.0 $500.0 $600.0 $700.0 $800.0 $900.0 2017 Cost of Expansion

In Millions

SGF Federal Fudns $91.9 $827.5 $0.0 $100.0 $200.0 $300.0 $400.0 $500.0 $600.0 $700.0 $800.0 $900.0 2020 Cost of Expansion

In Millions

SGF Federal Funds

$0.0 $50.0 $100.0 $150.0 $200.0 $250.0 $300.0 2017 State Costs 2017 Cost Savings/Revenues 2020 State Costs 2020 Cost Savings/Revenues

In Millions

SGF Beneficiary Payments Drug Rebate Increases Increased Privilege Fee Revenues Medically Needy Spend Down MediKan SSI Disabled Mental Health Substance Abuse Prisoner Hospitalization Pregnant Women State Revenues from Economic Growth

FINANCING EXPANSION IN KANSAS

$40.1 Million $91.9 million $218.5 Million $239.8 Million

HOW WOULD EXPANSION IMPACT KANSAS JOBS?

2,545 3,601 3,711 3,780 3,830 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500 2017 2018 2019 2020 2021

Jobs Created as a Result of Expansion

Jobs Created

NOW IS THE TIME FOR A KANSAS PLAN WITH KANSAS PRINCIPLES

• A KANSAS PLAN MUST INCLUDE:
• PERSONAL RESPONSIBILITY
• LIMITATION TO US CITIZENS AND LEGAL RESIDENTS
• REQUIREMENT OF KANSAS RESIDENCY
• EMPLOYMENT AS PART OF THE SOLUTION
• SUPPORT FOR KANSAS EMPLOYERS BY SUPPORTING EMPLOYMENT AND EMPLOYER SPONSORED INSURANCE
• FOCUS ON PREVENTIVE CARE
• ACCESS TO ALL FEDERAL DOLLARS
• STATE PORTION FROM BENEFICIARY CONTRIBUTIONS, COST SAVINGS AND NEW REVENUE GENERATED BY THE NEWLY

ELIGIBLE

• WITHDRAWAL OPTION IF THE FEDERAL MATCH GOES BELOW THE 90% LEVEL PROMISED BY THE ACA

WHAT IS THE PATH TO PERSONAL RESPONSIBILITY?

No Insurance

· No accountability or responsibility · Endless access to ER · No management of chronic conditions · Cost of care shifted to private insurance

KanCare

·

“Skin in the Game”

Component to create more responsible consumers · Access to primary care and management of chronic conditions · · Co-pays and premiums to help cover cost

Private Insurance

· Responsible for selecting and purchasing private health care services · Able to access right care at the right time · Cost of care borne by the beneficiary

Business Leadership Panel Terry Dunn, D.D. Ranch Leawood Doug Leonard, President, Indiana Hospital Association Robert Moser, MD, The University of Kansas Hospital Brad Stratton, Chairman, Overland Park Chamber of Commerce

Facilitated by Tom Bell, President/CEO, Kansas Hospital Association

Indiana Coverage Expansion

Healthy Indiana Plan 2.0

16

Hoosier Innovation: Health Savings Account

The Hoosier landscape

• Like Kansas, Indiana is a very conservative state.
• Governor was and remains an outspoken opponent of Obamacare.
• Governor Pence said “Absolutely No” to expanding Medicaid because it is a broken

system, that rewards the wrong behaviors.

• He said that he would consider coverage as long as we could do it in an “Indiana-

way”.

What is the Indiana Way?

The Governor had three important criteria:

• 1. It would build on the already proven success of the Healthy Indiana Plan
• 2. It would require no new general taxes
• 3. It would be built around the concept of personal responsibility

HIP 2.0 Features

• Built on original HIP to cover all earning up to 138% of the poverty level
• Requires POWER Account contributions for enhanced benefits
• No enrollment caps or lifetime/annual limits as in original HIP
• Covers Essential Health Benefits, which include: maternity care, mental health, etc.
• Providers reimbursed at Medicare rates

HIP Plus vs. HIP Basic

HIP Plus

• More affordable
• Predictable monthly

contributions

• More benefits
• Option to earn reductions to

future monthly contributions

HIP Basic

• May be more expensive
• Unpredictable costs
• Fewer benefits
• Potential to reduce future

monthly contributions for HIP Plus enrollment, but these reductions are capped at 50%

POWER Account Contributions

Percentage of federal poverty level Individual monthly income/POWER account contribution Family of 2 income/POWER account contribution amount Family of 4 income/POWER account contribution amount 22 percent $216/$4.32 $292/$5.84 $445/$8.90 50 percent $491/$9.82 $664/$13.28 $1,010/$20.22 75 percent $736/$14.72 $996/$19.92 $1,516/$30.32 100 percent $981/$19.62 $1,328/$26.56 $2,021/$40.42 138 percent $1,369.73/$27.39 $1,853.85/$37.06 $2,822.09/$56.44

HIP Basic Co-pays

Service HIP Basic Co-Pay Amounts <=100% FPL Outpatient Services $4 Inpatient Services $75 Preferred Drugs $4 Non-preferred Drugs $8 Non-emergency ED Visit Up to $25 Alternative co-payment schedule for members below 100% FPL who fail to make POWER account contributions

Funding

• Annual cigarette tax revenues created for HIP 1.0 in 2007 is used first to fund the State’s

program costs

• Starting in 2017, we will recalculate HAF (our provider tax) such that State HAF portion is

sufficient to cover:

• Cost of HIP expansion above the cig tax revenue
• Cost of increasing physician reimbursement in current Medicaid program to 75% of Medicare rates
• We are also adding to the balance of a current trust fund that assures one full year of
• perational costs should the federal government cut the enhanced match.

Status of HIP 2.0

• Gov. Pence announced HIP 2.0 on January 27
• 136,000 former Medicaid patients are enrolled in HIP
• More than 219,000 newly-eligible enrollees since then
• Nearly 1,000 new providers, including 335 physicians have joined the network
• Program is a 3-year waiver and will need renewal

Business Leadership Panel Terry Dunn, D.D. Ranch Leawood Doug Leonard, President, Indiana Hospital Association Robert Moser, MD, The University of Kansas Hospital Brad Stratton, Chairman, Overland Park Chamber of Commerce

Facilitated by Tom Bell, President/CEO, Kansas Hospital Association

Legislative Panel Senator Jim Denning, Overland Park Senator Laura Kelly, Topeka Senator Jeff King, Independence Representative Jerry Henry, Atchison Representative Mark Hutton, Wichita

Facilitated by Ed O’Malley, President/CEO, Kansas Leadership Center

Q & A PANEL

Terry Dunn Doug Leonard Robert Moser Brad Stratton Tom Bell Senator Jim Denning Senator Laura Kelly Senator Jeff King Representative Jerry Henry Representative Mark Hutton

Facilitated by Ed O’Malley, President/CEO, Kansas Leadership Center

CLOSING REMARKS

CARRIE SAIA, CEO HOLTON COMMUNITY HOSPITAL

Thank you for your participation!