October 18, 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 Rhode Island Market Stability Workgroup – Shared Responsibility………………8:05— 9:00am • Zachary Sherman, Director, HealthSource, Rhode Island Work Group Discussion – Shared Responsibility…….…………………………………..9:00— 9:20am • Representative Salinas, Chair, Work Group Medicaid Buy- in: Oregon Policy Goals and Approaches………………………........9:20— 10:00am • Tim Sweeney & Zachary Goldman, OHA Jesse O’Brien, DCBS, Oliver Droppers, LPRO Work Group Proposals – Review and Refinement…….………………………………10:15— 10:45am • Representative Salinas, Chair, Work Group Public Comment …………………………………………………………………………….....10:45— 11:00am Adjourn……………………………………………………………………………………………………....11:00 am 2
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE Today’s Objectives ➢ Learn about Rhode Island’s Shared Responsibility Proposal ➢ Consider Medicaid Buy-in options A-C • Discuss member feedback and program proposals • Clarify and potentially refine proposals • Summarize key considerations for policy makers ➢ Review and discuss preliminary list of policy concepts and topics identified by work group 3
THE RHODE ISLAND PRESPECTIVE: A PRESENTATION TO THE OREGON UNIVERSAL ACCESS TO CARE WORKGROUP By HealthSource RI Director Zach Sherman
AGENDA • The Rhode Island Market Stability Workgroup • Why a state Shared Responsibility Payment? • Anticipated Shared Responsibility Payment revenue impact • Q&A 5
RHODE ISLAND MARKET STABILITY WORKGROUP CHARGE Guiding Principles : Goal : Identify and propose sensible, state-based policy options for 1. Sustain a balanced risk Rhode Island that will be in service pool; to those Principles. 2. Maintain a market that is attractive to carriers, Membership: A diverse group of stakeholders including all Rhode consumers and providers; Island payers, providers, hospital and and medical societies, legislators, consumer advocates, nonprofit 3. Protect coverage gains leaders and brokers. achieved under the Affordable Care Act. 6
WORKGROUP RECOMMENDATIONS Near-term recommendations: • To secure a 1332 waiver under the ACA to implement a reinsurance program • Garner state authority to regulate Short-Term Limited Duration (STLD) and other limited benefit health plans • Implement a state-based shared responsibility requirement Further work remains, including: • Action to determine how to fund a state reinsurance program and how to best design and implement a shared responsibility requirement 7
REASONS TO CONSIDER A STATE SHARED RESPONSIBILITY PROVISION A state-level Shared Responsibility Payment would: • Incentivize people to get and stay insured • Help stabilize the risk pool, protect against adverse selection • Generate revenue for affordability programs • Provide data on the uninsured, create outreach opportunities 8
ANTICIPATED SHARED RESPONSIBILITY PAYMENT REVENUE The Shared Responsibility Payment, as currently structured could generate ~$10.6 M in 2020. RI Shared Responsibility Payment Revenue ($M) Rhode Island Uninsured Rate $10.6 $8.6 11.6% $4.3 7.4% 5.7% 2014 2015 2016 4.3% 4.6% $95/person or $325/person or $695/person or Amount is Larger o f: 1% of income 2% of income 2.5% of income # RI returns with 23,540 21,320 16,320 penalty 2013 2014 2015 2016 2017 % of RI returns 4.5% 4.0% 3.1% Note: Assumes enrollment/uninsured rate stays at current levels. 9 Sources: U.S. Census; Rhode Island Market Stability Workgroup (10/16/18); Faulkner Consulting Group
QUESTIONS? 10
Have questions? Email me at Zachary.Sherman@exchange.ri.gov or visit www.HealthSourceRI.com/market-stability- workgroup 11
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE S TATE -B ASED I NSURANCE M ANDATES : O REGON C ONSIDERATIONS 12
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE Data Considerations and Informational Needs - Discussion 13 Source: Oregon Health Insurance Survey 2017 – Summary and Results
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE State-Based Insurance Mandates Oregon 14
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE State-Based Insurance Mandates On average, the state mandates would reduce marketplace premiums by 11.8 percent if all states adopted the ACA’s federal individual mandate structure. 15
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE Work Group Discussion: State-Based Insurance Mandates 1. Initial reactions to Rhode Island’s state -based shared responsibility proposal? 2. What is your overall impression of state-based insurance mandates? 3. What questions do you have about a state-based insurance mandate in Oregon? Additional information or analysis to further explore this concept in ◦ Oregon? Penalties and enforcement? ◦ 4. Initial thoughts on potential advantages or disadvantages around an ACA-like state-based insurance mandate in Oregon? 16
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE M EDICAID B UY - IN : O REGON C ONSIDERATIONS 17
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE Medicaid Buy-in Oregon Design Considerations • Staff requested non-legislative members respond to a set of questions about their perspectives on Medicaid Buy-in • Members had two weeks to review and submit responses • Eight of the 12 non-legislative members submitted responses • Staff compiled and summarized member responses • Member feedback used to revise initial proposal ‘A,’ (September 20 th proposals) • Result: three different buy-in options for a Medicaid Buy-in program offered off the Marketplace without pursuit of a federal 1332 waiver (see Table 1, pgs. 8-9). 18
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE Medicaid Buy-in Design Proposals Proposal A Proposal B Increase Access and Competition : Improve Access 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 19
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE Medicaid Buy-in Design Proposals Proposal C Proposal D Strengthen Alignment Between Medicaid Spread coordinated care model: establish and 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) 20
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 21
LPRO : L EGISLATIVE P OLICY AND R ESEARCH O FFICE Medicaid Buy-in Oregon Design Considerations 1. Policy Goal: Medicaid Buy-in potentially moves Oregon closer to the goal of bringing more Oregonians into a coverage program. 2. Target Population(s): individuals who do not qualify for Medicaid or federal subsidies on the Marketplace. 3. Program Administration: CCOs enroll and administer the program, manage member premiums and provider reimbursement and networks. 4. Benefits: Oregon Health Plan (OHP) for adults including dental and vision. 22
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