Consumer Assistance Presentation to the Faith Leaders Summit May 14, 2013 Leslie Lyles Smith Director of Operations Maryland Health Benefit Exchange A service of Maryland Health Benefit Exchange
Maryland Health Connection
Overview of Maryland Health Connection The Patient Protection and Affordable Care Act requires each state to establish a “health insurance exchange” by 2014 A marketplace where individuals and small businesses explore, compare and enroll in health insurance and public assistance programs as well as access federal tax credits and cost-sharing subsidies States had a choice to establish a state-based exchange, join a partnership or the federally-facilitated exchange; Maryland opted to establish a state-based health insurance exchange Maryland’s exchange is called Maryland Health Connection 3
Why It’s Important to Maryland Expands access to health insurance for 730,000 Marylanders (13% of Maryland) currently without health insurance – Gives individuals access to primary care physicians, preventive services Provides federal subsidies for individuals up to 400% of FPL to pay for health insurance premiums – Infuses $600 million in federal subsidies into the State of Maryland by 2015 NEW funds in health care system Lowers uncompensated care costs in the healthcare system – lower insurance premiums across the state 4
Maryland Health Connection – Individual Marketplace One single entry point for commercial insurance or Medicaid Offers tax subsidies and cost sharing reductions to individuals and families – Only place individuals can access subsidies – Federal government will pay a portion of costs for health insurance for people who earn up to 400% of FPL – Cost sharing reductions are available to individuals under 250% of FPL Open Enrollment Period Begins: Oct. 2013 Coverage Effective: Jan. 2014 5
Maryland Health Connection – SHOP Maryland Health Connection will have a Small Business Health Options Program (SHOP) dedicated portal for small businesses and their employees Small businesses (including non-profits) with up to 50 employees may participate In 2016, the ACA modifies the definition of small group to 100 employees Small businesses can offer coverage to employees in two ways (one of which is new to the market) – Employer Choice / Employee Choice Tax credits available for first two years 6
Online Resources MarylandHealthConnection.gov Sign Up for weekly newsletter Sign Up for Text Updates: Text “Connected” to 69302 Get information on resources available to help find insurance now MarylandHBE.com Meeting Information RFP Announcements Job Information Producer Training & Authorization information 7
The Connector Program
Overview of the Connector Program Formerly called the Navigator Program The Connector Program has two components – Navigator Program: made up of Certified Individual Navigators and Licensed SHOP Navigators – In Person Assistance Program: made up of Assisters who will perform Outreach and Education duties and facilitate eligibility determinations and Non-certified personnel who will provide support services Insurance producers will have the option to be licensed to sell through the exchange, and will be trained on advanced premium tax credits, cost sharing subsidies, Medicaid, and other assistance options MHBE will contract with six Connector Entities in six distinct geographic regions to implement the Connector Program in their regions 9
Navigators and In-Person Assisters Navigators will: – Conduct public education and outreach as required by the Affordable Care Act – Distribute fair and impartial information – Facilitate enrollment in health plans – Provide referrals for grievances, complaints and questions – Provide information in a culturally and linguistically appropriate manner – Maintain expertise in eligibility, enrollment and program specifications – Refer insured small groups and individuals back to producers Assisters will: – Conduct public education and outreach; – Facilitate eligibility determination for subsidies, Medicaid, and MCHP; – Facilitate and provide ongoing support Application Counselors: – Facilitate enrollment in health plans – Act in the best interest of the enrollee – Disclose any potential conflicts – Receive no funding from the MHBE 10
Connector Program Features Connector entities will use the full-service website to help consumers research health coverage options, apply for insurance subsidies and enroll in a health plan. The Consolidated Services Center (CSC or “call center”) will provide a broad range of consumer assistance services, accept and make referrals to navigators, and provide technical assistance to navigators and assisters. The MHBE will develop outreach and education materials for use by connector entities; many of the materials will be customizable and available in multiple languages. The MHBE is developing required navigator and assister training, which will be free to participants. Additional information on training modules and schedules will be available in Spring 2013. 11
Connector Entities 12
Local Partnerships Central Region: Health Care Access Maryland (HCAM) Anne Arundel Medical Center Mental Health Association of Maryland Baltimore City Health Department Mercy Hospital Baltimore Healthy Start Mosaic Community Services Baltimore Medical System Park Heights Community Alliance Charm City Clinic Planned Parenthood Chase Brexton St. Stephens AME Church Chatman, LLC The Coordinating Center Healthcare for the Homeless The Maryland Medical Society (MedChi) Maryland Navigators MSO Independent Marylanders Achieving Growth Through Empowerment, Inc. 13
Local Partnerships Southern Region: Calvert Healthcare Solutions Health Partners, Inc. Walden Sierra Greater Baden Medical Services Upper Eastern Shore Region: Seedco Cecil County Health Department Harford Community Action Agency, Inc. Choptank Community Health Systems, Inc. Harford County Health Department Eastern Store Area Health Education Center Triangle Health Alliance Lower Eastern Shore Region: Worchester County Health Department None identified yet 14
Local Partnerships Western Region: Healthy Howard Door to HealthCARE Tri-State Community Health Center Benefits Data Trust Chase Brexton Allegany Health Department Frederick Community Action Agency Frederick Health Department Washington County Community Action Agency Garrett Health Department Partnership for a Healthier Carroll Capital Region: Montgomery County Department of Health and Human Services Prince George’s County Health Department Benefits Data Trust Prince George’s County Department of Korean Community Service Center of Social Services Greater Washington Interfaith Works, Inc. Family Services, Inc. Community Clinic, Inc. Mary’s Center for Maternal and Child Care, Inc. CASA de Maryland, Inc. 15
Funding Structure Total Funding: $24 Million Connector Entity Funding allocation primarily based on percentage of uninsured of the region Connector Entity Funding also includes a performance incentive 16
Consolidated Service Center Full Service Call Center Inbound Call Center (Toll-Free Hotline) linked from www.MarylandHealthConnection.gov Language Line/Translation Services TTY (Hearing Impaired) Extended Hours During Open Enrollment Coordination with Insurance Carriers and Connector Entities Scheduled Opening: July 2013 (with launch of advertising campaign and social media launch) 17
Questions Inquiries regarding this presentation can be directed to: Leslie Lyles Smith Director, Operations Leslie.LylesSmith@maryland.gov 18
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