Medicaid Expansion in Louisiana United Way of Southeast Louisiana - PowerPoint PPT Presentation

1 Medicaid Expansion in Louisiana United Way of Southeast Louisiana Policy Forum New Orleans, LA February 16, 2016

Governor’s Executive Order - JBE 16-01 2  Signed by Governor John Bel Edwards on January 12, 2016  Directs DHH to adopt Rules and submit State Plan Amendments to expand Medicaid with effective date no later than 7/1/16  Directs DHH and all other executive branch departments to take actions within delegated authority necessary to implement

Why Expand Medicaid in Louisiana? Why Now? 3  Medicaid expansion primarily benefits working people who would otherwise be uninsured  Expansion 7/1 allows us to capitalize on the best federal match rate (100%) immediately; features that would require a Medicaid waiver can be added  Money from expansion helps our urban and rural hospitals and our providers; brings billions of dollars of new income into the state.  Louisiana is the unhealthiest state in the nation and Louisianans can benefit from access to care and improvements in population health

Medicaid Expansion Increases Access to Care 4 Overall access: More individuals will receive all medically necessary care in a given year. ACCESS TO HEALTH CARE Primary care : More individuals will gain a usual source of care. Preventive care : Thousands of additional cholesterol screenings and mammograms will be completed annually. Office visits : Additional physician office visits will be completed each year. Sources: Council of Economic Advisers, “Missed Opportunities: The Consequences of State Decisions Not To Expand Medicaid” (July 2014); Deloitte, “Commonwealth of Kentucky: Medicaid Expansion Report” (February 2015)

Expansion Advances Coverage 5 Uninsurance Rate in Uninsurance Rate in Non-Expansion States Expansion States 25.0% 25.0% 21.6% Decline of 33% 20.0% 20.0% 14.8% 14.4% 15.0% 15.0% Decline of 49% 10.0% 10.0% 7.5% 5.0% 5.0% 0.0% 0.0% Q4 2013 Q1 2015 Q4 2013 Q1 2015 Source: Urban Institute Health Reform Monitoring Survey: http://hrms.urban.org/quicktakes/Trends-in-Uninsurance-and-State-Marketplace-and-Medicaid-Expansion-Decisions.html

Expansion Economics: Impact on State Budgets 6 ACA Newly Eligible FMAP  State Costs 1 Calendar Year FMAP 2016 100% • Coverage for newly eligible adults 2017 95% • Increased administration costs 2018 94% 2019 93% 2 State Savings 2020 and thereafter 90% • Enhanced federal matching funds for some previously enrolled Medicaid beneficiaries now eligible • Some services historically funded with State or local funds could be refinanced with Medicaid funds (such as spending on inpatient hospital costs of inmates) • Redirecting spending on disproportionate share hospital payments (regular match) to new adult spending (with enhanced match)  3 Revenue Gains • Expansion will result in State revenue gains related to existing health plan and/or provider taxes as health plan and provider revenues increase

Expansion Economics: Job Creation 7  Expansion will result in an estimated $1.1 billion gross state product increase, resulting in: – Approximately 15,600 new jobs (70% healthcare, 25% retail, leisure, hospitality and personal services, 5% other) – $1.8 billion in increased economic activity  New jobs equate to new state and local tax revenue of approximately $120 million per year

Expansion Economics: Workers and Employees 8  Coverage will be available for working people in important industries like tourism and construction: – 30,000 restaurant and 15,500 construction workers currently uninsured will be covered by expansion. – Supports small business and their employees when the business cannot provide insurance due to high costs.  Untreated health problems cost Louisiana employers $380 million a year – Lower out of pocket cost allow consumers to spend elsewhere. A healthy, productive workforce benefits the employee, employer and the state

Reductions in Uncompensated Care 9 Hospitals in Louisiana must pay for “uncompensated” care for uninsured individuals. Since implementation of the ACA, hospitals in states that expanded have experienced decreases in their uncompensated care costs. These reductions alleviate strain on hospitals and help ensure their sustainability. Numerous studies document reductions in uncompensated care costs in expansion states:  In Connecticut, hospital uncompensated care was 1/3 lower than what it would have been without Medicaid expansion (2011 – 2013)  The Iowa Hospital Association reported uncompensated care cases declined by 18.5%, saving hospitals approximately $32.5 million (January – June 2014)  Arkansas projects a $1.1 billion reduction in hospital uncompensated care costs from 2017-2021 Sources: State Health Reform Assistance Network Issue Brief, The Impact of Medicaid Expansion on Uncompensated Care Costs: Early Results and Policy Implications for States, June 2015. Health Affairs, Early Medicaid Expansion in Connecticut Stemmed the Growth in Hospital Uncompensated Care, July 2015; Deloitte Kentucky Expansion One Year Report, February 2015

2010 Affordable Care Act & Medicaid for Adults 10  Mandatory changes in eligibility for Medicaid program created in 1974 – No longer a requirement to fit into a “category”, meaning adults with and without dependent child(ren) could qualify – Standardized for all states calculation of countable income; established national income standard of 138% gross income  Effective date of changes was intended to be January 1, 2014  June 2012 Supreme Court decision made Medicaid expansion optional rather than mandatory for states  Changes in method for calculating income for Medicaid eligibility remained mandatory and Louisiana implemented 1/1/14  Current La income limit for parents is 24% of poverty level; most adults with no dependent child in home are ineligible

Louisiana is 32 nd State to Adopt Expansion 11

Louisiana Medicaid Current Timeline and Key Tasks 12  Jan. 12, 2016 – Gov. signs Executive Order JBE 16-01 to expand Medicaid  Feb. 20, 2016 – Notice of Intent published in Louisiana Register  March 2016 – State Plan amendments submitted to CMS  April 2016 – Direct mail, community outreach efforts to new adults begin  May 2016 – DHH accepting applications with expansion criteria  June 2016 – Enrollment in Bayou Health Plans, ID cards mailed  July 1, 2016 – Earliest effective date of coverage (“go live”)

Who Will Be Eligible for Medicaid Expansion? 13  Parents with dependent children and other adults (19-64 years old) with incomes below 138% of the federal poverty line – Maximum eligibility would be $16,242 for a single adult and $27,724 for parents in a three-person household  Cannot be eligible for or enrolled in Medicare Part A or B  Cannot be eligible for full coverage Medicaid – They do not have to be working – They do not have to have children – They do have to meet citizenship requirement

How Many Louisianans Might be Eligible for Expansion? 14  Based on best available data, 300,000 – 450,000 p eople could qualify (not all will enroll). – U.S. Census Bureau: ~ 300,000 Louisianans uninsured & income below 138% FPL expansion limits. Census data is the best nationa l data available but some states have found it understated eligible population – Louisiana Administrative Data: ~ 450,000 people might be eligible. This data also has limitations. For example, it includes people who already have insurance.  DHH’s goal is to be transparent about numbers and costs , using the best data available. We will regularly monitor and report on enrollment trends.

Louisiana Medicaid: Expansion Impact on Eligibility 15 LA Medicaid with Expansion Income as % of the Federal Poverty Level LA Medicaid Today Individuals 160% above the current 140% 138% FPL eligibility level for ABD 120% would qualify as adults or 100% parents under expansion 80% 60% 40% 20% 0% Pregnant Women Aged, Blind and Parents Childless Adults Disabled (SSI) (Except GNOCHC)

Streamlined Enrollment and Application 16  Enrollees with limited Medicaid coverage - GNOCHC and Take Charge Plus - “flipped” to full coverage. No need to apply  All other adults wanting Medicaid will need to apply unless they have: – a pending Medicaid application – active enrollment in full Medicaid coverage.  DHH will use data from SNAP to target new adults eligible for Medicaid (over 99% of people getting SNAP are below 138% FPL)

Medicaid Coverage and Service Delivery for New Adults 17  Expansion population will be eligible for same benefits and services as current full-coverage Medicaid adults  Enrollees will receive services through one of five Bayou Health Plans – Auto enrollment to a Plan when no active choice is made on the application – Option to change plans in the first 90 days – Same provider network and care management as other Bayou Health enrollees – Provider reimbursement will be same as other Bayou Health enrollees  More information on the Health Plans can be found at www.BayouHealth.com or by calling 1-855-BAYOU-4U (1-855-229-6848).