ACA Implementation Update Jean Yang Executive Director Presentation to HFMA Dec 9, 2014
ACA Implementation Status Major Components of ACA Where We Are Today • Completed as of Jan 2014 with establishment of the CarePlus program Medicaid Expansion (citizens with income up to 133% federal poverty level) • Establishment of the The Health Connector serves as the State-Based Marketplace Exchange • After an initial IT readiness delay, now offering full suite of ACA-compliant products with applicable federal and state subsidies • New ACA rules (Essential Health Benefits, merged market rating rules, Insurance Market Reform metallic tier structure) in place • Transitional rating factors for small groups continue through 2017 • Premium Stabilization State-operated risk adjustment program for merged market in effect 2014 • Federal reinsurance and risk corridor programs in place as of 2014 and will run through 2016 • Individual and Employer Reconciled federal and state rules and parameters Responsibilities Individual mandate Employer obligations (repealed Fair Share penalty) Minimum Creditable Coverage (state) vs. Minimum Essential Coverage (ACA) 2
Health Connector Overview Excha hange nge core functi tions ons: • Det eterm ermin ines es eligibility bility and IT system : pro rovid vides es subsidi idies es Federal Determines eligibility Gov Calculates subsidies State Gov • Operat ates es a mark rketp etplace ace Displays plans where ere consumer ers can Completes enrollment/billing Provides reporting shop p for insurance ce Conducts settlement Insurers • Aggreg regat ates s some back ck- Customer Service Center end operatio tions ns (e.g., and Business Operations enro roll llment ent and billing) ng) • Policy cy devel elop opment ent (e.g., Policy Plan Consumer Development Management & Outreach & affor ordabil ability ty sch chedule) edule) Certification Assistance 3
2014 Challenges & Turnaround Notwithstanding the IT challenges, the Commonwealth succeeded in protecting and even expanding its nation-leading insurance coverage. • The Commonwealth’s ACA implementation experienced significant set back in 2014 due to a non-functional IT system The new system was intended to perform eligibility determination and enrollment in accordance with ACA rules Vendor failure The system was severely lacking in both functionality and performance Only a small subset of individuals (those not seeking financial subsidies) could use the system to enroll • The Commonwealth deployed emergency mechanisms to help people preserve or access subsidized coverage Extended Commonwealth Care and Medical Security Program Established temporary Medicaid program under federal authority 4
2014 Challenges & Turnaround (cont’d) Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Independent IT review by MITRE New governance structure Engaged Optum as new IT vendor Identified hCentive system as new target IT platform Launched “Dual Track” implementation with Federal Exchange (FFM) as fall back Successfully dropped FFM; focused on re-launching state-based system Decision to deploy integrated Medicaid – Exchange eligibility for Fall 2014 2015 Open Enrollment 5
New System Powering Mahealthconnector.org Qualified Health Plan QHP[c] Bill Pay QHP[a] 1. Front Door Shop Portal or Phone Participant chooses plan – non state wrap Participant is (hCentive) invoiced and 3. Verify pays bill Participant chooses (Dell) Eligibility plan – state wrap (hCentive) Participant QHP[d] Enroll Participant enters receives QHP[b] Notification through a single Proof of Front Door for CCA Coverage & MassHealth Participant provides Participant is noticed (hCentive) verification if for QHP (Dell) necessary 2. Apply Eligibility and Application data is MAGI program verified is determined Portal, Medicaid (hCentive) (Federal Hub) Phone or Paper MH [a] Notification MH [b] Enrollment Participant Participant Assessed to be non-MAGI creates completes Participant is noticed Eligibility information (from hCentive to is sent to MMIS for account application (Identity Mgt) (hCentive) MassIT) enrollment Non-MAGI manual processing (Excel file to MA-21) 6
Open Enrollment 2015 7
Member Transition The highest priority for Open Enrollment is to successfully transition current Health Connector and temporary MassHealth members in order to prevent coverage gaps. Transition Population A subset will not submit new applications because their circumstances may have changed and they may no loner require coverage through us. New Shoppers Temporary seeking Medicaid coverage through the Marketplace or Medicaid ~300K QHP CommCare (# unknown) ~100K ~ 34k • Current coverage ends in 3 • Current coverage ends • All coverage ends “waves”: 1/15/15, 1/31/15, 1/31/2015 12/31/2014 2/15/15 • Majority likely eligible for • About 10K enrolled • May be eligible for QHP or via “Fast Path” last State Wrap MH; some likely have and will year • Accustomed to the types keep ESI and costs of plans they • Have been subject to no will likely be eligible for premium and only nominal cost-sharing, which will no longer be the case for many 8
Multi-faceted Outreach Campaign Our goal: outreach every single member of the transition population while still targeting the remaining uninsured to bring new people into coverage for the first time. DIRECT RECT MEMBE BER CONTACT ACT 1 • Mailing (Open Enrollment packet, reminder postcards) • Outbound calls Door knocking • COMMUNIT ITY Y ENRO ROLLM LLMENT ENT ASSISTAN STANCE CE Foundation Foundation 2 of strong, of strong, • Navigators & Certified Application Counselors coordinated coordinated • Community enrollment fairs messaging messaging • Collaboration with community partners MEDIA DIA AND D PUBLIC IC EDUCATI CATION 3 • Radio, TV, print • Earned media; corporate sponsorships • Public events highlighting member transition message Centralized member outreach data reporting to track and measure our progress. 9
Health Connector 2015 Programs ConnectorCare (Up to 300% FPL; state and federal subsidies) Qualified Health Plans (300%~400% FPL; federal tax credit only) (>400% FPL; unsubsidized) Qualified Dental Plans 10
ConnectorCare 7 participating plans: Tufts Network Health, Boston Medical Center HealthNet Plan, Neighborhood Health Plan, CeltiCare, Fallon Community Health Plan, Health New England, and Minuteman Health. Region A Region B Region C Region D Region E Region F Region G Boston/ Wrap Greater Cape/Island Plans Western MA Central MA Metro West Northeast Southeast Subsidized Enrollee Premiums Boston s (010 – 013) (014 – 016) (017 - 020) (017 - 020) (023 - 027) (025 – 026) (021, 022 - 024) NWH NHP NWH BMCH NWH NWH BMCH Lowest 2 nd BMCH CeliCare BMCH Minuteman BMCH BMCH NWH Lowest 3 rd NHP NWH Minuteman NWH Minuteman Minuteman NHP Lowest 4 th FCHP CeltiCare CeltiCare NHP NHP CeltiCare CeltiCare Comm. Lowest 5 th HNE BMCH NHP CeltiCare CeltiCare NHP Lowest 11
Qualified Health Plans 126 QHPs offered by 11 participating plans: the 7 ConnectorCare plans, plus Blue Cross Blue Shields of MA, Harvard Pilgrim Health Care, Tufts Health Plan and United Healthcare. 12
Qualified Dental Plans 24 QDPs offered by 5 participating plans: Altus Dental, Blue Cross Blue Shields of MA, Delta Dental of MA, Guardian and Metlife. Standardized Plans Non-Standardized Plans Small Both NG Issuers group All Plans Configurations Configurations and SG Total Total only Pedi High Low Pedi High Low √ Altus Dental 3 1 1 1 3 √ BCBSMA 3 1 1 1 1 1 4 √ Delta Dental of MA 7 3 2 2 2 2 9 √ Guardian 3 1 1 1 3 √ MetLife 3 1 1 1 2 1 1 5 Small group only 9 3 12 Both NG and SG 10 2 12 Final SoA Total 19 5 24 Unique Plan 3 5 8 Designs 13
2015 Health Connector Priorities • Continue to stabilize and enhance the new IT system Continuous development envisioned by 2015 system road map • Implement ACA-compliant small business program Was “put on hold” in 2014 to prioritize non -group system implementation • Close out legacy programs (Commonwealth Care, Medical Security Program, temporary Medicaid) and complete member transition to ACA-compliant coverage programs • Continue to refine Health Connector product shelf with annual Qualified Health/Dental Plan certification (Seal of Approval 2016) • Solidify operationalization of new ACA-required essential processes ( e.g. , eligibility verification and appeals; cost-sharing reduction administration, IRS reporting, risk adjustment operation, etc.) 14
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