A State-Based Marketplace for Maine MDF Policy Leaders Academy - PowerPoint PPT Presentation

A State-Based Marketplace for Maine MDF Policy Leaders Academy January 23, 2020 Jeanne Lambrew, PhD Commissioner

Context: Coverage for People Without Affordable Employer Health Plans Affordable Care Act: Uninsured Rate • Health Insurance Marketplace – New way to buy insurance 18% • Insurance Reforms (in LD1) 16% – Guaranteed access – no denials based 14% on pre-existing conditions 12% – Essential health benefits – Set levels of coverage: Bronze, Silver, 10% Gold, and Platinum 8% • Premium Tax Credits: 6% – Limit premiums paid for people with 4% income from 100 to 400% of the federal 2% poverty level • Medicaid expansion 0% 2010 2011 2012 2013 2014 2015 2016 2017 2018 – For people with income < 138% of FPL US ME – Optional due to 2012 Supreme Court Maine Department of Health and Human Services 2

The Remaining Uninsured in Maine Income Distribution of 106,000 Uninsured: Uninsured, 2018 • 36,000 eligible for Above 400% FPL MaineCare 17% Below • 51,000 eligible for 138% FPL 34% Marketplace subsidies • 82% are in working 250-400% families FPL • Adults in rural counties are 21% more likely to be 138-250% uninsured FPL 27% Sources: https://www.cbpp.org/research/health/fact-sheet-who-are-the-remaining-uninsured#states;23 https://www.census.gov/library/stories/2019/04/health-insurance-rural-america.html Maine Department of Health and Human Services 3

MaineCare Expansion in 2019 Maine Department of Health and Human Services 4

Fall 2019 Outreach and Enrollment Open Enrollment: • People can sign up for Marketplace coverage from November 1 to December 15 – Prevents people from waiting until they are sick to buy coverage • New CoverME effort: – MaineCare applications up > 70% compared to last year – 62,013 people signed up for Marketplace Coverage • Problems with Federally- facilitated Marketplace – Support for ME cut by 80% – Website problems on first / last day of open enrollment Maine Department of Health and Human Services 5

What Is a Health Insurance Marketplace • The “Marketplace” is a shopping and enrollment service for medical insurance created by the Affordable Care Act in 2010. • In most states, the federal government runs the Marketplace (sometimes known as the “exchange”) for individuals and families. On the web, it's found at HealthCare.gov. • Some states run their own Marketplaces at different websites. • People can shop for and enroll in affordable medical insurance online, by phone, or with in-person help from a trained assister or an agent or broker. • People can fill out a Marketplace application and to find out if they qualify for lower monthly premiums or savings on out-of- pocket costs based on income. They may also find out of they qualify for MaineCare . Maine Department of Health and Human Services 6 Source: HealthCare.gov glossary

Marketplace Model Options State conducts State runs online State conducts marketing, platform, call States using each Model plan outreach, and center, conducts model management consumer eligibility and assistance enrollment Federally-Facilitated 17 Marketplace (FFM) State Partnership 15 Marketplace State-Based Marketplace – Federal 6 Platform (FP) State-Based 13 Marketplace (SMB) Adapted from: https://www.commonwealthfund.org/blog/2019/states-looking-to-run-their-own-health-insurance-marketplace- see-opportunity Maine Department of Health and Human Services 7

Marketplace Landscape Transitioning to State-based Marketplace Maine Department of Health and Human Services 8

Why Move to a State-run Model? ✓ Opportunity to tailor marketing and outreach for Maine ✓ Additional flexibility (e.g., longer open enrollment periods) ✓ Potentially a better consumer experience ✓ Protection from uncertainty at the Federal level Maine Department of Health and Human Services 9 Charts: National Academy for State Health Policy, https://nashp.org/wp-content/uploads/2019/04/SBM-FFM-Comparison-Data_4_1_2019.pdf

Funding a State-Based Marketplace Current model: FFM Gross Individual Federal 3.0% Market Premiums Government SBM-FP Federal 2.5% Government Gross Individual Market Premiums Maine’s 0.5% Marketplace SBM Maine’s Gross Individual 3.0% Market Premiums Marketplace Maine Department of Health and Human Services 10

What Will Change: SBM-FP Landing Page Marketing & Outreach Navigator Oversight Hotline Maine Department of Health and Human Services 11

Timeline SBM-FP CoverME Fall 2020: State SBM-FP responsible Fall 2019: Open for Navigators, landing page, Enrollment includes hotline, outreach and marketing new support for outreach, marketing, January 2021 and beyond: SBM-FP is and advertising officially operational 2019 2020 2021 2022 Determine feasibility, January 2022: Earliest Apply, develop possible start for a full cost of becoming a website, other full SMB functions SBM SBM Maine Department of Health and Human Services 12