September 20, 2018 LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE UNIVERSAL ACCESS TO CARE WORK GROUP 2018 1
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE AGENDA Welcome, Opening Remarks ……………………..…………………………………………….8:00—8:05am Representative Salinas, Chair, Work Group Public Comment…………………………………………………………………………………….8:05—8:20am Representative Salinas, Chair Medicaid Buy-in: Policy Priorities and Approaches…………….............................8:20—8:50am Tim Sweeney, OHA; Jesse O’Brien, DCBS; Oliver Droppers, LPRO Discussion: Medicaid Buy-in, Oregon Considerations………............................8:50—10:00am Representative Salinas, Chair Premium Assistance – Project Access NOW.…………………………………………...10:00—10:40am Janet Hamilton, Project Access NOW Work Group – Next Steps (Oct. & Nov. Meetings) ………………………………….10:40—11:00am Representative Salinas, Chair, Work Group Adjourn……………………………………………………………………………………………………….11:00 am 2
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE Today’s Objectives Consider Medicaid buy-in option in Oregon; preliminary design considerations (cont. from August 23 rd meeting) Identify and confirm preferred list of policy goals • Review and discuss straw proposals – * disc scussi ssion purpose ses o s only * • Learn about a premium assistance program operated by Project Access NOW Review next steps, discuss work group product and priorities for remaining meetings (Oct.-Dec.) 3
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE 2. What problems are the work group being task to solve in Oregon? • Policy pathway to universal coverage • Better care, more people, less money • Access issues (rural/urban, income disparities) • Affordability • Address unmet health care needs • Address cost drivers; administrative burden, system complexity, & financial accountability * Information from the April 19 th workgroup meeting 4
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE Member Observations - August Learned about approaches to Medicaid Buy-in: 1) marketplace option to compete with commercial carriers 2) provide coverage for target population(s) with certain eligibility 3) public option to minimize churn Members raised the following issues and questions: (1) smoothing coverage transitions between OHP/Marketplace plans (2) increasing competition on the Marketplace (3) establishing provider reimbursement rates (4) scalability – pilot vs. statewide (5) transition from fee-for-service to value-based payment models (6) provider participation (7) voluntary vs. mandatory approach (8) coverage of behavioral health services 5
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE Medicaid Buy-in Design Considerations 1. What is the overall policy goal? Is it to increase coverage? Improve affordability? Increase competition by creating another marketplace option? Leverage delivery system reform through Oregon’s Medicaid program? 2. How many individuals would gain new coverage or shift existing coverage? What is the target population? What’s the income level? Exclude individuals eligible for employer-based coverage? 3. Would the buy-in program be administered as an extension of the ACA Medicaid program (low-income individuals and families), or as a stand alone program? Managed care or fee-for-service? 4. What benefits would be covered? OHP benefits or 10 essential health benefits? Long-term services, adult dental benefits, non-emergency transportation 6
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE Medicaid Buy-in Design Considerations (cont.) 5. What is the appropriate level of out-of-pocket costs? How would cost sharing be structured: co-pays, premiums, deductibles? Similar to Marketplace, Medicaid, in between, other? 6. How would premiums be set and corresponding premium assistance determined? Would premiums be set by the state (similar to Medicaid), or would rates be developed by carriers in the marketplace? Would certain populations pay no premiums? 7. Provider reimbursement? Medicaid level, commercial, or in between (e.g., Medicare fee-for-service)? Potential cost savings to the program based on differences between market coverage and the buy-in program? 8. What federal dollars would be available? How much federal funding would be available, if any, and what percentage of program costs can federal spending support? 7
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE Medicaid Buy-in Design Considerations Considerations outlined by OHA and DCBS Population – available to all or parameters to population Access and competition within the insurance market Affordability – offer subsidies based on marketplace standards, premium assistance Market alignment Risk pool – in Medicaid risk pool versus separate from Medicaid Financing 8
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE Medicaid Buy-in: Key Factors Influencing Affordability and Costs for Coverage Provider Level of Reimbursement Benefits Premiums, Availability of Deductibles, Federal/State and Co-pays Funds Coverage Affordability Less Affordable More Affordable 9
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE Medicaid Buy-in Design Proposals Proposal A Proposal B Increase se Access a ss and Competition : Improve Access a ss and Affordability : CCOs offer commercial insurance Contract with CCOs to provide consumers outside of Medicaid product on Marketplace in counties eligibility to purchase insurance with limited carriers (fewer than two product with similar design carriers). consideration to CCO plans. Stabilize/Strengthen Individual Market Expand affordable coverage in Oregon • Carrier of last resort • Reduce monthly premiums, or • More plans on the marketplace • Reduce out-of-pocket costs, or • Increased plan offerings • Enhance benefits or value for given (potentially) premium 10
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE Medicaid Buy-in Design Proposals Proposal C Proposal D Strengthen A Alignment Betwe ween Medicaid Spread c d coordi dinated c d care m mode del: establish and M Marketplace: ensure the same provider quality reporting and incentive structures networks are offered in Medicaid and modeled after those in Medicaid and CCOs Marketplace; enhance care continuity. for QHP offerings in Marketplace. Streamline transitions for consumers Spread Oregon’s Health Care between Medicaid and commercial coverage Transformation (coordinated care model) CCOs offer plans on the Marketplace CCO-type plans on the marketplace • • (individual market) (individual market) CCOs offer plans to small group market CCO-like financial incentives on the • • Accountability and quality (Triple Aim) marketplace (individual market) • 11
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE Medicaid Buy-in Design Proposals Proposal E H YBRID OF P ROPOSALS A-D Entirely DIFFERENT proposals (E-G) 12
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE Medicaid Buy-in Design Considerations Managed care or fee-for-service Delivery Model Marketplace, Stand Alone, other On or off the Marketplace Determine eligibly by income (FPL), ineligibility for Target population(s) federal coverage, other categories More or less generous coverage of benefits Benefit Coverage More or less consumer out-of-pocket costs including monthly premiums, deductibles, and co-pays for Cost-Sharing services Level of provider reimbursement Provider Reimbursement Pilot or statewide Scalability and Financial Model Identify federal waiver authorities and impact to Federal and State Considerations current coverage environment Feasibility and Implementation Risk pools, provider and/or carrier participation Considerations 13
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LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE Medicaid Buy-in Design Considerations 1. What is the overall policy goal? Is it to increase coverage? Improve affordability? Increase competition by creating another marketplace option? Leverage delivery system reform through Oregon’s Medicaid program? 2. How many individuals would gain new coverage or shift existing coverage? What is the target population? What’s the income level? Exclude individuals eligible for employer-based coverage? 3. Would the buy-in program be administered as an extension of the ACA Medicaid program (low-income individuals and families), or as a stand alone program? Managed care or fee-for-service? 4. What benefits would be covered? OHP benefits or 10 essential health benefits? Long-term services, adult dental benefits, non-emergency transportation 18
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