Medicaid Advisory Committee September 23, 2015 General Services - PowerPoint PPT Presentation

Medicaid Advisory Committee September 23, 2015 General Services Building Salem, Oregon

Time Item Presenter 9:00 Opening Remarks Co-Chairs Oregon Health Plan (OHP) and Coordinated Care Organizations – OHA update Rhonda Busek, Janna Starr, 9:05  OHP enrollment and determination dashboard OHA  OHP quarterly report; 2 nd quarter 2015 Oral Health and OHP – OHA Dental Director  9:25 Oral health and OHP Dr. Austin, OHA  2015 legislative priorities and OHA initiatives on oral health 9:55 InterCommunity Health Network CCO Community Advisory Rebekah Fowler, CAC Council (CAC) Coordinator • IHN’s CAC membership and community engagement activities • Council priority areas and implementation activities outlined in the CHIP 10:25 Break Medicaid 12 Month Continuous Eligibility 10:30 Co-Chairs; staff • Review draft recommendations; finalize. Darren Coffman, Jason 11:20 Health Evidence Review Commission (HERC) Gingerich, OHA 11:50 Closing comments Co-Chairs

OHA Update: Oregon Health Plan (OHP) and CCOs Rhonda Busek and Janna Starr Health Systems Division, OHA

Oral Health and OHP Bruce Austin, OHA Dental Director

C ommunity A dvisory C ouncil Rebekah Fowler , PhD CAC Coordinator

Presentation Overview 1. Describe CAC structure & representation 2. Provide overview of CHIP and its impact 3. Discuss current CAC CHIP work 4. Give 3 CHIP activity examples 5. Discuss community engagement activities 6. Provide my contact information 7. Answer questions

Community Representation  Regional CAC Structure • 12 IHN-CCO members (63%) • 3 county staff • 3 community members • 1 Chair  Three Local Advisory Committees • 6 CAC Representatives plus county & community partners • Provide broader, deeper level of community involvement

CHIP: Community Health Improvement Plan  CHIP Focus Areas • Access to healthcare • Behavioral health • Chronic disease • Maternal & Child health  Strategic Planning • The CHIP focus areas are used to prioritize transformation pilot projects

Current CHIP Work in Progress  The CCO will use Outcomes and Indicators to further prioritize pilot project proposals • Outcome example: IHN-CCO members will receive appropriate care at the appropriate time and place • Indicators are measures of progress toward achieving outcomes such as length of time to receive an appointment or Emergency Department use.

Sample Initiatives  Health Disparities Workgroup will : • Identify areas of health disparities • Identify root causes of disparities • Develop strategic plan to create equity  Traditional Health Workers (THW) • Inventoried region’s use of THWs • Developed learning collaborative for THW alternative payment method pilot projects • Embedded THWs into patient centered primary care homes and schools

Community Engagement: A Work in Progress  Community Conversations  Pros & Cons comments outreach  Strategic Planning Retreat will focus on identifying 2-5 questions the CAC wants to ask of the community

Challenges  Data availability  Community engagement – lessons learned  Differences in work styles  While the CAC has always maintained an IHN-CCO member majority, more members are needed.

Contact Information Rebekah Fowler, PhD CAC Coordinator rfowlerconsulting@gmail.com (541)768-7699

BREAK

12-Month Continuous Eligibility for OHP Adults

12-Month Continuous Eligibility Problem: Low and moderate-income parents and childless adults experience substantial income volatility throughout the year, which affects eligibility and can cause churning on and off Medicaid Policy: 12-Month Continuous Eligibility Allows beneficiaries to maintain coverage for up to one full year, even if individuals/families experience a change in income or family status – Option for children since 1997; 32 states have adopted policy in their Medicaid or CHIP programs; 23 states have in both programs – Federal policy has been an option for Medicaid adults since 2013  To date, only New York state had has implemented the policy for their adult populations, likely due to financing barriers Impact : Promotes coverage continuity for eligible individuals, despite fluctuations in income or other eligibility criteria, but also creates additional costs for a state 54

Method for Determining Costs of 12-Month Continuous Eligibility for OHP Adults, 2017-19 Biennium Estimate Estimate budget Forecast Calculate Develop annual impact for 12- OHP federal/state continuity program month continuous enrollment program costs for of coverage expenditures eligibility for for 17-19 current and new ratios for 17-19 income-eligible biennium eligibility policy biennium OHP adults

Continuity Ratio • Used similar approach to the Medicaid “continuity ratio” developed by researchers at George Washington University (GWU) in 2009 _______ Average Member Months ________ = Continuity Ratio Total # of Unduplicated Enrollees that Year 100% Continuity Ratio = Everyone Was Enrolled for the Entire Year Table 2. Continuity Ratios, 2017-19 Biennium Current New Policy Eligibility Categories Difference Policy (%) (%) Medicaid Expansion Adults 68.2 78.7 +10.5 Aid to the Blind and Aid to the 83.8 87.3 +3.5 Disabled (AB/AD) Parent/Caretaker Relative 61.9 77.7 +15.8 Sources: George Washington’s analysis of Medicaid Statistical Information System Datamart for FY 2006-11; DHS/OHA Integrated Client Services data warehouse, 2008-2012 18

Federal Financial Participation • Federal funding for the AB/AD and Parent/Caretaker Relative adult groups for the 2017-19 biennium is estimated at 62.47% • Federal funding for the Medicaid expansion population gradually decreases from 100% in 2016 to 90% in years 2020 and beyond – 2014 CMS guidance indicated that states would not receive the full-enhanced match rate for their Medicaid expansion population under 12-month continuous eligibility Table 4. Federal Participation for Oregon’s Medicaid Expansion Population with New Policy (i.e. 12-Month Continuous Eligibility), 2017-19 Biennium SFY Year Estimated ACA 12-Month CE FMAP Reduction Enhanced FMAP FMAP for Adults 17-19 Biennium 2018 94.50% 93.68% -0.82% 2019 93.50% 92.68% 19

Results Table 8. Combined Estimated Cost for OHP Adult Populations, 2017-19 Biennium Change 17-19 Current Policy New Policy Biennium Total Member Months of 11.8 million 13.5 million 1.7 million Coverage PMPM Cost $770 $759 N/A Federal Share $7.64 billion $8.66 billion $1.01 billion FMAP 83.81% 83.58% -0.22% State Share $1.47 billion $1.7 billion $223 million Total Program Cost 2017-19 $9.1 billion $10.3 billion $1.2 billion Biennium † †The change in combined program expenditure from “current policy” to “new policy” reflects a change in the ratio of clients due to changes in the continuity ratio for the respective adult populations resulting from the implementation of 12-month continuous eligibility. Because each eligibility group has a different program expenditure (PMPM), the combined weighted average PMPM is different when the ratio of member months changes. 20

Summary of Results If a 12-month continuous eligibility policy were implemented for OHP adults for the 17-19 biennium: • Coverage Continuity: estimated to increase total member months of coverage by nearly 15% over the biennium, resulting in 1,734,346 additional member months of coverage. – Continuity ratios are estimated to increase on average by nearly 10 percent for the three OHP adult populations. • Program Costs: estimated to increase total program spending by $1.23 billion  Additional federal revenue of $1.01 billion  Additional state spending of $223 million  $58 million due to decrease in ACA Expansion FMAP 21

Recommendations Committee’s Task: • Prepare and submit recommendations to OHA regarding the feasibility of 12-month continuous eligibility for adults in OHP in the 2017-19 biennium. • Outline the potential fiscal impact on the state budget in the next biennium. Potential Recommendations: • Recommend to OHA to request the Legislature to fund 12- month continuous eligibility for 17-19 biennium • Don’t recommend 12 -month continuous eligibility • Alternative options/considerations: see draft memo

Preliminary Recommendations (July 2015) Request policy as part of Oregon’s 1115 Waiver renewal: Propose to the Centers for Medicare and Medicaid Services (CMS) that 12-month continuous eligibility for OHP income-eligible adults be incorporated into Oregon’s 1115 waiver in 2017, including waiving the reduction in FMAP for this policy, reducing the overall state investment to $165 million. Monitor OHP program performance: Implement data collection procedures to monitor changes in the fiscal, quality and health outcomes that result from churn in OHP:  Adopt transparent OHP eligibility, enrollment and redetermination performance indicators.  Complete annual assessment of administrative costs that result from churn and potential savings to the Medicaid program, CCOs, and health providers if this policy were adopted. Conduct longitudinal cost-benefit study: estimate potential financial benefits that could result from changes in health care utilization associated with increases in coverage continuity (i.e. stable Medicaid coverage).

Public Comment or Testimony