Maryland Health Benefit Exchange Web-Based Entities(WBE) Advisory - PowerPoint PPT Presentation

Maryland Health Benefit Exchange Web-Based Entities(WBE) Advisory Committee Consumer Issues & Contracting Meeting August 6, 2013 9:00 am-12:00 pm Department of Health and Mental Hygiene, 201 W. Preston Street, Lobby Level, Conference Room L3, Baltimore, Maryland 21201 A service of Maryland Health Benefit Exchange

Agenda • Introductions: • Start Discussion of WBE Value and Consumer Protection: • Background on the Uninsured in Maryland (Frank Kolb) • Value of WBEs (John Condrat & Sam Gibbs, discussion on key areas for value) • Overview of Consumer Protections for WBEs in Federal Exchange (Frank Kolb) • Consumer Protection Issues (Mary Lou Fox & Dr. Patrick Richard, discussion on key consumer protection topics) • Break: • Begin Discussion of Contract Issues: Topics to be Covered: • Minimum Requirements vs. Competitive vs. Pilot • Oversight/Enforcement • Performance Measures/Data Collection • Review and Next Steps 2

Introductions

WBE Advisory Committee WBE Advisory Committee Members: Dr. Joshua Sharfstein, Chair, MHBE Board of Trustees Jim Bendel, President, Potomac Basin Group Associates Kimberly Cammarata, Director, HEAU John Condrat, Manager, Extend Health Vickie Cosby, Senior Director, Consumer Direct Sales and Training, CareFirst BlueCross Blue Shield Samuel C. Gibbs, III, SVP and President of Government Services, eHealth Mary Lou Fox, Maryland Women’s Coalition for Health Care Reform Melanie C. Green, Health Services Manager, Aetna, Inc. Wesley Mace, Vice President, Kelly & Associates Insurance Group, Inc. Megan Mason, Special Assistant for Health Care Reform, MIA Tara Pellet, Consultant, Allied Resource Management – A TriBridge Partners company Dr. Patrick Richard, Community Alliance For Health Care Coverage & Access 4

WBE Advisory Committee Staff: Frank Kolb, Director of Policy and Government Relations, Maryland Health Connection, 410 547-1838 La Toya Strange, Executive Assistant, Maryland Health Connection, 410 547-1834 Maansi Raswant, JD, Senior Regulatory and Policy Advisor, The Hilltop Institute, 410-455-6859 5

Start Discussion of WBE Value and Consumer Protection

Background on the Uninsured in Maryland

Health Insurance Coverage Type Employer 57% Uninsured 13% Medicaid 12% Medicare 12% Individual 5% Insured Uninsured Other Public 1% 87% 13% Private Sector Coverage (percent of category that offers coverage) 97% 55% 39% Firms Offering Firms with 50 or less Firms with 50 or more Coverage employees employees 8 Source: The Henry J. Kaiser Family Foundation, State Health Facts (2011)

Total Uninsured Demographic Profile Age Distribution of Uninsured 88% 10% 2% Under 18 years 18 to 64 years 65 years and older Insured Uninsured 87% 13% Gender Distribution of Uninsured 56% 44% Male Female 9 Source: U.S. Census Bureau American Community Survey (2010)

Adult Uninsured Demographic Profile Statewide % of Uninsured Population Male 56% Gender Uninsured 44% Female 15% 18-24 15% 25-34 27% Insured 85% Age 35-44 18% 45-54 17% 11% 55-64 10 Source: U.S. Centers for Disease Control, Behavioral Risk Factor Surveillance System Health Care Access/Coverage (2010), U.S. Census Bureau American Community Survey (2011)

Adult Uninsured Demographic Profile Statewide % of Uninsured Population 47% White Uninsured 33% Black or African American Race/ 15% Ethnicity Asian 7% Other 13% Insured 85% Less than high school 24% graduate High school graduate, GED, 32% or alternative Education Some college or associate's 25% degree Bachelor's degree or higher 18% 11 Source: U.S. Centers for Disease Control, Behavioral Risk Factor Surveillance System Health Care Access/Coverage (2010), U.S. Census Bureau American Community Survey (2011)

Adult Uninsured Type by MHC Region Western Central Capitol Total Uninsured: 84,812 Total Uninsured: 216,587 Total Uninsured: 221,914 18.5% 23.3% 22.9% 27.4% 28.6% 33.1% Uninsured <65, Income <138% FPL 48.5% 48.1% 49.7% (Medicaid) Uninsured <65, Income 138-400% FPL (Thru HIX) Lower Eastern Shore Uninsured <65, Southern Upper Eastern Shore Income >400% FPL Total Uninsured: 23,143 Total Uninsured: 30,796 Total Uninsured: 50,314 (Thru HIX) 13.4% 19.5% 20.9% 31.9% 27.6% 40.5% 46.1% 48.6% 32.5% 12 Source: MHBE (2012) Data Sheet

Adult Uninsured Demographic Profile The Nonelderly Uninsured by Children/Parent Status Single Non-Parent Adults 47% Single Parent 10% Married Non-Parent Adults 14% Married Parents 16% Children Living with ≤ 1 Parent 6% Children Living with 2 Parents 7% 13 Source: State of Maryland, Maryland Health Care Commission Health Insurance Coverage Report (2011)

Adult Uninsured Demographic Profile Ratio of Income to Poverty Level of those Uninsured (over the past 12 months) 55% 26% 20% Less than 100% Less than 200% 200% or above 14 Source: State of Maryland, Maryland Health Care Commission Health Insurance Coverage Report (2011)

Adult Uninsured Demographic Profile Percentage breakdown of Uninsured Individuals in MD by Age and Percentage of Federal Poverty Level. (Total numbers indicated above each bar) 189,177 25 20 105,635 15 92,286 88,316 72,196 10 48,626 36,608 5 28,148 27,038 18,267 16,494 13,949 4,362 2,216 2,240 1,353 1,795 634 0 Below 50% 50% to below 125% 125% to below 150% to below 200% to below 400% and above 150% 200% 400% 0-20 years of age 21-64 years of age 65 and older 15 Source: Fakhraei, S. H. (2012). Maryland health care reform simulation model: Detailed analysis and methodology. Baltimore, MD: The Hilltop Institute, UMBC .

Value of WBEs

Overview of Consumer Protections for WBEs in Federal Exchange

Federal Consumer Protections for All WBEs Plan Display: All WBEs must: Meet all standards for disclosure and display of QHP information; Display all QHP data provided by the Exchange; and Provide consumers the ability to view all QHPs offered through the Exchange. All FFE WBEs must: Provide quality information on each QHP. Financial Incentives: All WBEs must: Not provide financial incentives, such as rebates and giveaways. 18

Consumer Protections for FFE WBEs Termination of Shopping Experience: All WBEs must: Provide consumers with the ability to withdraw from the process and use the Exchange Website at any time. Record Keeping: All WBEs must: Maintain audit trails and records in an electronic format for a minimum of ten years. Security: All WBEs in the FFE must: Securely transmit and receive QHP, eligibility and enrollment information between the FFE and the WBE; Meet all existing and future HHS privacy and security standards; and Authenticate consumer identification. 19

Consumer Protections for FFE WBEs, Contin. Steering & Conflicts of Interest: All WBEs in the FFE must: Refrain from steering consumers to specific plans; Disclose compensation; and Offer a QHP shopping experience free of non-QHP advertising. Disclosures: All WBEs in the FFE must: Provide all required disclosures; and Prominently display language notifying consumers that their Website is not an FFE Website. Agreements: All WBEs in the FFE must: Enter into agreements with the FFE and agents or brokers using the WBE’s Website indicating the WBE, agents and brokers will comply with federal standards and the WBE will provide to HHS a list of the agents and brokers. 20

Consumer Protection Issues

Break

Begin Discussion of Contract Issues

Minimum Requirements vs. Competitive vs. Pilot

Begin Discussion of Contract Issues

Performance Measures/Data Collection

Review and Next Steps