Commonwealth of Kentucky All information based on Kentucky HEALTH Waiver proposal. Overview of Kentucky HEALTH Information is subject to change.
DRAFT Kentucky Health Program Overview Kentucky HEALTH is the Commonwealth’s new program for certain low -income adults and their families. The program gets its name from its mission. H E A L T H Helping to Engage & Achieve Long Term Health This innovative program brings together existing state agencies and programs, and leverages federal funding to improve member access to health , educational, financial, and professional development resources that can help families and communities grow and thrive over the long-term . 2
DRAFT Challenges Facing Kentucky Nationally, Kentucky is ranked close to last in many crucial areas. The state’s unemployment rate, poverty rate, workforce participation rate and wages are all significantly below the national average. Over the past decade, the Kentucky is among the worst opioid epidemic has wreaked nationally in several key havoc on our families, population health metrics. • 1 st in the nation for cancer communities and economy. deaths, 2 nd highest in the • Overdose deaths have climbed to more than 1,000 per year. nation for smoking. • Kentucky’s rate of babies born • Nearly 1/3 of Kentuckians are obese (12 th highest rate in the drug-addicted is twice the national average. nation). • Drug abuse has negative • There are 6.8 infant deaths impacts on daily life and work per 1,000 live births (17 th functions, and is weakening highest rate in the nation). people’s employability • 8 of 13 counties in the nation (attendance, teamwork, and with largest declines in life productivity). expectancy since the 1980s • All of these factors cause are in Kentucky. higher unemployment. 3
DRAFT DRAFT Unsustainable Growth High poverty & high Medicaid enrollment • Workforce participation is 59.4%, 45 th in the nation • 19% of Kentuckians live in poverty • 47 th in the nation for median household income • Nearly 1/3 of total state population is enrolled in Medicaid • Poor health outcomes despite high spending • 1 out of 3 Kentuckians are obese • Ranks 2 nd highest in the nation for smoking • Ranks 1 st highest in the nation for cancer deaths • No long term financing plan • Kentucky is projected to spend approximately $1.2 billion over the next five years • on expanded Medicaid benefits (SFY 2017-2021) The cost growth in Medicaid expansion threatens funding for traditional Medicaid coverage for the aged, blind, disabled, pregnant women, & children. 4
DRAFT DRAFT What Determines Health? Clinical Care (20 %) Healthy Behaviors (30%) Social & Economic Factors (40%) Access to healthcare alone will NOT dramatically improve the health of Kentuckians. 5
DRAFT DRAFT Kentucky HEALTH Covered Populations Medicaid Populations Not Included in Kentucky Medicaid Populations Included in Kentucky HEALTH HEALTH Traditional Medicaid (Aged, Blind & Disabled) and Non-Disabled Adults & Children Former Foster Youth up to age 26 (Individuals covered before expansion, pregnant women, children, & adult expansion population) T raditional Medicaid Medicaid Expansion Home and Model Waiver II – Community Based 1915(c) Adults Eligible Prior Adults Waiver - 1915(c) to Expansion Premiums or Copays • No Change No Change Premiums or Copays • State Employee Benefits • No Change in Benefits • Vision and Dental • (continue to get vision Michelle P Waiver – Supports for available through My and dental through MCO) 1915(c) Community Living – Rewards Account 1915(c) Community Engagement • Community Engagement • required, unless primary required, unless primary No Change No Change caretaker of dependent caretaker of dependent Acquired Brain Injury Acquired Brain Injury, Pregnant Women & Medically Frail Adults – 1915(c) Long Term Care – Children (T raditional Optional Premiums (for • 1915(c) Medicaid and KCHIP) access to My Rewards) No Change No Change No Premiums • No Change in Benefits • No Change in Benefits • Community Engagement • Nursing Facility and Qualified Medicare initiative not required Community Engagement • ICF/MR Residents Beneficiaries initiative not required No Change No Change 6
DRAFT Key Components of Kentucky HEALTH Deductible Account The deductible account empowers individuals Cost Sharing to make cost-conscious healthcare decisions. Cost sharing introduces members to critical My Rewards Account commercial market My Rewards Account features, including making provides incentives for timely monthly premiums, members to improve their tracking deductibles, and health, engage in their managing a healthcare communities, and improve account a way of investing their job skills. in own health. Kentucky PATH Program HEALTH Research shows an important link between some sort of community engagement (like volunteer work, public service, and employment) and an Premium individual’s overall health and well-being. This Assistance program is a unique Establishes a path for the Education and community engagement state to pay member’s and employment initiative Training premium if employer for Kentucky HEALTH sponsored insurance is The Health and Financial members designed to build available. Literacy classes allow and strengthen Kentucky’s Kentuckians to gain skills workforce. for long-term independence and success. 7
DRAFT DRAFT Benefit Overview 2 Kentucky HEALTH Medicaid State Plan/CHIP • Current benefits available to individuals outside of the Adult Group o Includes Medically Frail 1 Kentucky HEALTH Alternative Benefit Plan • Kentucky State Employee Benefit Model o Same benefits and limitations as this plan o The following benefits are moved to My Rewards Account : ▪ Vision ▪ Dental ▪ The following benefits are added to My Rewards Account : ▪ Gym membership & fitness activities 8
DRAFT DRAFT Benefits by Population Population Benefit Package Adult Group Kentucky HEALTH Alternative Benefit Plan Medically Frail Adults No change in benefits (Medicaid State Plan) • Pregnant Adults No change in benefits (Medicaid State Plan) • Parents and Caretakers & TMA No change in benefits (Medicaid State Plan) Pregnancy Category No change in benefits (Medicaid State Plan) Children No change in benefits (Medicaid State Plan) Note : Vision and dental coverage will continue to be covered by the MCOs (not the My Rewards Account) for all members with access to Medicaid State Plan benefits. 9
DRAFT DRAFT Kentucky HEALTH Cost Sharing • Expansion Adult and Parent/Caretakers • Budget predictability for members • Access to My Rewards Account for Premium Plan enhanced benefits • Expansion Adult and Parent/Caretakers • Non-payment penalty plan available to Copay Plan those under 100% FPL • No My Rewards Account access Cost-Share • Medically Frail ( Premium optional for Exempt access to My Rewards Account ) • Pregnant Women • Children 10
DRAFT INTEGRATED APPROACH TO IMPROVING OUTCOMES Personal Proactive Finance Health Services Kentucky HEALTH takes a holistic approach to improving health Skills by integrating key Development components of a Community person’s Engagement wellbeing. Financial Rewards & Advancement 11
DRAFT DRAFT My Rewards Account Earned Incentives Education and Training Community Engagement Register with career center and complete goal Complete health risk assessment with MCO needs assessment Complete diabetes, cardiovascular, or other Participate in qualifying community service chronic disease management, or weight activity (including services) management course Complete job skills training or training with "Complete HANDS Program" career coach Participate in Moving Beyond Depression Job Search Activities (MBD) Participate in Special Supplemental Nutrition Employment - related education or GED - prep Program for Woman, Infants, and Children classes (WIC) Complete a My Rewards Course Passing the GED exam Prevention Healthy Living Health Screenings, including: Mammograms, Sign non-smoking pledge and participate in Pap Smears, Prostrate Screenings, smoking cessation activity Colonoscopy, & Flu Shots Annual Physical including Biometric screening Sign drug-free pledge and participate in drug addiction counseling service (including alcohol) Complete well-child, preventative dental exam or vision screening for the Dependent Complete First Step Program child One Adult Preventative Dental Exam Avoid inappropriate Emergency Room Visits Follow-up Visits with Primary Care Physician One Adult Preventative Vision Exam after ER Visit 12
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