Connect For Coverage: Community Outreach Summit Tuesday, May 14, 2013 A service of Maryland Health Benefit Exchange
Connecting Marylanders with Coverage
Carolyn Quattrocki, Executive Director Governor’s Office of Health Care Reform
Health Reform in Maryland Overarching Goal of Healthcare Reform BETTER HEALTH FOR ALL MARYLANDERS Maryland’s Collaborative Approach State Agencies, Local Jurisdictions, Non- Profits and Private Sector 4
4 Pillars of ACA Stronger, Non- Expanded Access to discriminatory Health Insurance and Insurance Coverage Health Care More Affordable Cost Control and Insurance Coverage Quality Improvement 5
Pillar I: Stronger, Non-Discriminatory Coverage – Patients’ Bill of Rights Young adults can stay on parents’ insurance plan until age 26; 52,000 in MD; 2.5 million nationwide. No children denied coverage because of pre-existing condition. No lifetime limits on benefits and harder to rescind policies when people get sick; 2.25 million Marylanders benefiting, including over one half million children. Women no longer paying higher premiums because they are women. Preventive services like mammograms and flu shots; 1.2 million Marylanders covered with no cost-sharing; 554,000 on Medicare have received at no cost; 797,185 eligible. In 2014 , no exclusions for pre-existing conditions or annual limits on benefits. 6
Pillar III: More Affordable Coverage Closing the Donut Hole: Prescription Drug Savings to Maryland Seniors 55,107 Maryland seniors received $250 rebate in 2010. 49,000 saved $37.5 million in 2012. Overall savings to Maryland seniors to date: $84.1 million. Projected savings through 2020: $400 million. 7
Pillar IV: Cost Control and Quality Improvement: Save Money While Making People Healthier Keeping People Healthy: Investments in Wellness and Prevention Higher Quality and More Efficient Care Delivery Models: Pilots and Demonstration Projects with Leadership from Health Care Providers Health Information Technology: Support ongoing efforts to develop Health Information Exchange and meaningful use of Electronic Health Records 8
ESSENTIAL HEALTH BENEFITS: SELECTION OF STATE’S BENCHMARK FEDERAL GUIDANCE – AFFORDABLE CARE ACT Beginning in January, 2014, all plans offered in small group and individual markets inside and outside exchanges must cover “essential health benefits.” Ambulatory Patient Services; Emergency Services; Hospitalization; Maternity and Newborn Care; Mental Health and Substance Use Disorder Services Prescription Drugs Rehabilitative and Habilitative Services Laboratory Services Preventive/Wellness Services & Chronic Disease Management Pediatric Services, including Oral and Vision Care 9
Rebecca Pearce, Executive Director Maryland Health Connection
What is the Maryland Health Connection? Maryland Health Connection is the name for Maryland’s health insurance exchange. Maryland Health Connection is a marketplace where individuals, families and small businesses can: – Compare health insurance options – Calculate total out-of-pocket costs based on eligible subsidies or tax credits – Enroll in the health plan that’s best suited for their needs Open Enrollment is from October 1, 2013 – March 31, 2013 11
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 12
Federal Subsidies for Individuals Maryland Health Connection offers tax subsidies and cost sharing reductions to individuals and families who do not have access to affordable healthcare insurance Single Person Annual Maximum Enrollee FPL % Income Premium Monthly Share (as % of Income) 133% FPL $ 15,281.70 2.00% $ 25.47 150% FPL $ 17,235.00 4.00% $ 57.45 200% FPL $ 22,980.00 6.30% $ 120.65 250% FPL $ 28,725.00 8.05% $ 192.70 300% FPL $ 34,470.00 9.50% $ 272.89 400% FPL $ 45,960.00 9.50% $ 363.85 13
Stakeholder Engagement Stakeholder engagement: – Core tenant of the MHBE process – Open meetings – Diverse, statewide representation Advisory Committees – Navigator Advisory Committee (2011 and 2012) – Operating and Market Rules Advisory Committee – Finance and Sustainability Advisory Committee – Continuity of Care Advisory – Small Business Health Options Program (SHOP) – Implementation Advisory Committee (EIAC) – Plan Management Advisory Committee Producer Advisory Council 14
Chuck Milligan, Deputy Secretary Health Care Financing
Medicaid Expansion in Maryland All citizens at or below 138% of the federal poverty level (FPL) will qualify for Medicaid The Primary Adult Care (PAC) program will convert to full Medicaid benefits on January 1, 2014, helping 75,000 people now on PAC, and creating an immediate outreach opportunity Children who age out of foster care will be able to retain Medicaid to age 26 The total size of the expansion is estimated to be nearly 110,000 people in 2014, and to grow to 190,000 by 2020 (including the former PAC population) 16
New Medicaid Eligibility Rules Most Medicaid eligibility will be based on the “modified adjusted gross income” (MAGI) standard Important features of MAGI: • Identical standard in all states • Medicaid and the Exchange will use the same standard • Based on income tax rules about household composition and income & deductions Paradigm shift for Medicaid: Assumption is that all citizens qualify for health care . The issue isn’t preventing erroneous eligibility. Instead, the issue is: in which program does the person qualify ? 17
2013 Poverty Level Guidelines 18
Bishop Douglas Miles Organizer, Koinonia Baptist Church
“Of all the forms of inequality, injustice in health care is the most shocking and inhumane” – Martin Luther King, Jr. in a speech to the Medical Committee for Human Rights, 1966 20
A Kairos moment for people of faith and “no faith” As a result of health reform, nearly 300,000 Marylanders will gain access to quality, affordable, health insurance coverage in the coming months, reducing the number of uninsured Marylanders by 50% 21
A Call and Challenge to Faith Leaders Why Us? It’s the morally right thing to do It’s a health issue that affects us It’s a social justice issue We have the most people, on the most consistent basis, of any institution 22
The Mandate is Clear: “Write the vision, make it plain on tablets, so that a runner may read it. For there is a vision for the appointed time;…If it seems to tarry, wait for it; it will surely come, it will not delay.” Habakkuk 2:3 23
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