Overview Presentation February 16, 2015 State of the Uninsured in - PowerPoint PPT Presentation

Overview Presentation February 16, 2015

State of the Uninsured in Indiana Uninsured Hoosiers, 2010 1 50,713 6% 348,900 215,214 40% 24% Under 100% FPL 100-138% FPL Coverage Gap 139-200% FPL 201-399% FPL 400%+ FPL 160,998 105,466 18% 12% TOTAL UNINSURED = 881,291 (13.6%) 2 1. SHADAC Health Insurance Analysis. (2011). American Community Survey data. Retrieved from www.nationalhealthcare.in.gov.

Healthy Indiana Plan  True Medicaid Reform  First Medicaid plan with strong consumer- directed features (2008) • HDHP • POWER Account • Consumer choice + Provider engagement  Proven Results  High Member and Provider Satisfaction • Enhanced coverage • Enhanced provider reimbursement 3

Why is Indiana using a consumer- directed model?  The State of Indiana has a long history of success with the consumer-directed health care model.  Indiana ranks highly among states in consumers covered by high deductible health plans attached to Health Savings Accounts.  Studies show that employer adoption of the consumer- directed model considerably decreases total health care spending.  Consumer-directed plans are also popular among employees.  Consumer-directed plans lower unnecessary healthcare 4

HIP Success HIP improves HIP promotes HIP results in high member health care personal satisfaction utilization responsibility 93% of members Lowers inappropriate make required emergency room 96% of enrollees use by 7% compared satisfied with HIP POWER account to traditional coverage contributions on Medicaid time 60% of HIP members 30% of members ask 83% of HIP enrollees receive preventive prefer the HIP design their healthcare care - similar to to co-payments in provider about the commercial traditional Medicaid cost of services populations 80% of HIP members choose generic 98% would enroll drugs, compared to again 65% of commercial 5 populations

Medicaid Reimbursement Rate Increases • In Medicaid (Hoosier Healthwise/pregnancy/kids and aged, blind and disabled) • INCREASED rates by an average of 25 percent • Behavorial Health= 85% of Medicare • Prenatal/Maternity = 100% of Medicare 6

Medicare Reimbursement Rates HIP Different Process Reimbursement for Conversion Rates Populations Inpatient claims for Low Income Parents, Caretakers Medicare Rates and 19 and 20 year olds are reimbursed at the Hoosier Healthwise rate, and then HAF adjustment will be made later. 130% of Medicaid rate if no Medicare rate exists 7

Maintaining Financial Sustainability HIP 2.0 will continue to utilize HIP Trust Fund HIP 2.0 dollars will be sustainable HAF - Indiana hospitals will help support & will not costs to expand HIP 2.0 starting in 2017 increase taxes for Waiver specifies HIP 2.0 continuity requires: Hoosiers -Enhanced federal funding -Hospital assessment program approval 8

HIP 2.0: Basics Who is • Indiana residents • Age 19 to 64 eligible for • Income under 138% of the federal poverty level (FPL) • Not eligible for Medicare or other Medicaid categories HIP 2.0? • Also includes all non-disabled adults currently enrolled in Medicaid Monthly Income Limits for HIP 2.0 Plans 2014 FPL # in household HIP Basic HIP Plus Income up to 100% FPL Income up to ~138% FPL** 1 $973 $1,358.10 2 $1,311 $1,830.58 3 $1,650 $2,303.06 4 $1,988 $2,775.54 9

HIP 2.0: Closing the Coverage Gap Federal Premium Tax Credit 250% SCHIP Expansion 200% Federal Poverty Level 185% Medicare SCHIP 150% Pregnancy Services 138% 133% HIP 2.0 100% HIP 2.0 70% - 80%* Disabled/ Standard Medicaid Medicare/ Medicaid Dual Eligible 23% Disabled Parents & Single Adults Age <1 1-5 6-18 *65+ Pregnant* Blind Caretakers 19 - 64 10 *Maternity services are added to HIP 2.0, so pregnant women may choose to stay in HIP FPL is recalibrated annually and dependent on household size. In 2014, the FPL (100%) for a family of four is $23,850 of annual income .

HIP 2.0 Plan Structure Covered Services • Comprehensive essential health benefits Essential • Maternity benefits provided Health Benefits • Enhanced benefits for HIP Plus • Enhanced benefits in members including vision and HIP Plus dental benefits • Minimum Essential • Benefits meeting all minimum Coverage in HIP Basic requirements for HIP Basic POWER Account members • No annual or lifetime dollar limits $2,500 account Holds State and Member contributions Covers initial health expenses* Preventive Care Provided outside of POWER account. 11 *Covered benefits beyond $2,500 paid by member’s health plan

HIP 2.0: Plan Options • Initial plan selection for all members • Benefits : Enhanced benefits: vision, dental, bariatric, pharmacy • Cost sharing : HIP Plus • Monthly POWER account contribution required. Contribution is 2% of income with a minimum of $1 per month. • Employers & not-for-profits may pay up to 100% of member contributions • ER copayments only • Fall-back for members <100% FPL that do not make POWER account contribution HIP Basic • Benefits : Minimum coverage, no vision or dental coverage • Cost sharing : • Must pay copayment ranging from $4 to $75 for doctor visits, hospital stays, and prescriptions • More information coming soon! HIP Link • Enhanced POWER account to pay for premiums, deductibles and copays in employer sponsored plans • Provider reimbursement at commercial rates 12

HIP Plus: POWER Account Contribution (PAC) POWER account contributions are approximately 2% of member income  Minimum contribution is $1 per month • Maximum contribution is $100 per month • Employers & not-for-profits may assist with contributions  Employers and not-for-profits may pay up to 100% of member PAC • Payments made directly to member’s selected managed care entity • Spouses split the monthly PAC amount  Maximum Monthly HIP 2.0 POWER account contributions (PAC) Maximum Monthly Maximum Monthly Maximum Maximum Monthly Income, Monthly PAC*, Monthly Income, Monthly PAC, Monthly Income, Monthly Income, Maximum Monthly Maximum Monthly FPL FPL FPL PAC*, Single PAC*, Single Monthly Income, Monthly Income, Single Individual Single Individual Household of 2 Spouses** Single Individual Single Individual PAC, Spouses** PAC, Spouses** Individual Individual Household of 2 Household of 2 <22% Less than $214 <$4.28 Less than $289 <$2.89 each <22% <22% Less than $214 Less than $214 $4.28 $4.28 Less than $289 Less than $289 $2.89 each $2.89 each 23%-50% $214.01 to $487 $4.29 to $9.74 $289.01 to $656 $2.90 to $6.56 each $214.01 to $487 $214.01 to $487 $9.74 $9.74 $289.01 to $656 $289.01 to $656 $6.56 each $6.56 each 23%-50% 23%-50% 51%-75% $487.01 to $730 $9.74 to $14.60 $656.01 to $984 $.6.57 to $9.84 each 51%-75% 51%-75% $487.01 to $730 $487.01 to $730 $14.60 $14.60 $656.01 to $984 $656.01 to $984 $9.84 each $9.84 each 76%-100% $14.61 to $19.63 $984.01 to $1,311 $9.85 to $13.11 each $730.01 to $973 76%-100% 76%-100% $730.01 to $973 $730.01 to $973 $19.46 $19.46 $984.01 to $1,311 $984.01 to $1,311 $13.11 each $13.11 each $1,311.01 to $13.12 to $18.31 $973.01 to 101%-138% $19.64 to $27.17 $973.01 to $973.01 to $1,311.01 to $1,311.01 to $1,358.70 $1,831.20 each 101%-138% 101%-138% $27.17 $27.17 $18.31 each $18.31 each $1,831.20 $1,831.20 $1,358.70 $1,358.70 13 *Amounts can be reduced by other Medicaid or CHIP premium costs **To receive the split contribution for spouses, both spouses must be enrolled in HIP

Ways to Pay the POWER Account Contribution  Regardless of health plan, members can pay by: Credit or debit card (including prepaid cards) • o Over the phone o Online Check or money order • Automatic bank draft • Electronic funds transfer • Payroll deduction • Cash, at one of the following locations: • Anthem MHS MDwise Pay at any Wal-Mart Pay by Western Union Pay at a Fifth Third Coming soon: Pay at Bank any Wal-Mart Coming soon: Pay at any Wal-Mart

Non-Payment Penalties  Members remain enrolled in HIP Plus as long as they make POWER account contributions (PACs) and are otherwise eligible  Penalties for members not making the PAC contribution: ≤100% >100% FPL FPL Dis-enrolled Moved from HIP from HIP* Plus to HIP Basic Locked out for Copays for all six months** services *EXCEPTION: Individuals who are medically frail. **EXCEPTIONS: Individuals who are 1) medically frail, 2) living in a domestic violence shelter, and/or 3) in a state-declared disaster area. 15 If an individual locked out of HIP becomes medically frail, he/she should report the change to his/her former health plan to possibly qualify to return to HIP early.

HIP Plus vs. HIP Basic for Members with Income Less than or equal to 100% FPL HIP Plus HIP Basic • More affordable • May be more • Predictable monthly expensive • Unpredictable costs contributions • More benefits • Fewer benefits • Option to earn • Potential to reduce reductions to future future monthly monthly contributions contributions for HIP • May reduce future Plus enrollment, but these reductions are contributions by up capped at 50% to 100% 16