Delaware’s Health Insurance Marketplace: Update on Activity Delaware Health Care Commission, November 14, 2013 Secretary Rita Landgraf, Department of Health and Social Services

Healthcare.gov Performance issues related to web-based portal As a state/federal partnership, Delaware relies on the enrollment portal managed by the Federally Facilitated Marketplace (FFM) HHS and CMS report that healthcare.gov is running better every day and is expected to be working smoothly by the end of November Will be providing updates on functionality to the public as they become available

Delaware: State/Federal Partnership Chose a partnership model because an analysis of the issue and the data showed it would be more cost effective for the state and individual consumers Committed to working with the Federal government to improve the experience for Delawareans and increase enrollments Continue to proactively advocate for Delawareans through this partnership As a partnership state, we have the ability to adjust marketing, outreach, and education of citizens

Important Points to Remember: We are in week 7 of a 26-week open enrollment period. Most open enrollments last 2-4 weeks The administration expects Healthcare.gov to be functioning smoothly by the end of November Consumers who enroll in coverage by March 31, 2014 will not have to pay a penalty

By the numbers: Marketplace Number of enrollments verified by DE Department of Insurance = 136 (October 1-November 12) Number of enrollments released by U.S. Dept. of Health and Human Services = 97 (October 1- November 2) Differences reflect: Dates Lag between systems Manual validation by insurers

By the numbers: Medicaid Number of individuals determined or assessed eligible for Medicaid/CHIP by the Marketplace as reported by the U.S. Dept. of HHS = 1,200 DHSS will begin to run eligibility for Medicaid expansion at the end of November For those not eligible for Medicaid expansion, DHSS will refer people back to Marketplace and assistance from a Marketplace Guide. Will provide further updates on the Medicaid program at December’s HCC

Medicaid Actively working on implementing Medicaid expansion which will include those with incomes up to 138% of FPL Those that are eligible under current income rules can gain access to coverage immediately Collecting application information from those whose incomes make them eligible under new rules State will run eligibility and make a determination Coverage can begin on January 1, 2014 FFM is sending likely-eligible applicants to the State; State makes final eligibility determination regardless of where they apply

Our Commitment The State is dedicated to ensuring that Delawareans are able to access health coverage In addition to Healthcare.gov, we are actively helping individuals access the system Encouraging use of FFM Contact Center Connecting people with Marketplace Guides who can help them understand options and apply for coverage DHSS and DOI are providing direct support to consumers for complex cases Conducting pre-screening and directing consumers on the most efficient way to access health care coverage

Our Commitment Share information on tax credits or cost sharing reductions to those individuals who may be eligible Review enrollment data based on demographics and geography and adjust marketing and outreach accordingly Provide regular updates on Delaware’s enrollment numbers to the public through the Health Care Commission meetings

Choosing the most efficient “door” ASSIST (<138% FPL or <212% for children and pregnant women) Medicaid eligible ASSIST (<138% FPL or <212% for children and pregnant women) Medicaid eligible Healthcare. gov ( % FPL) Eligible for Federal Subsidies Healthcare. gov ( % FPL) Eligible for Federal Subsidies Insurers (>400% FPL) Not-eligible for subsidies Insurers (>400% FPL) Not-eligible for subsidies Choosing the most efficient “door”:

Ways to Get Coverage No matter what “door” a consumer enters, they will be able to get enrolled in the appropriate coverage Encouraging the use of the most direct door for most efficient experience ASSIST – Delaware’s portal for those Medicaid eligible Healthcare.gov – Federal portal for those who may qualify for a subsidy Directly through insurers – for those who do not expect a subsidy; links will be available from ChooseHealthDE.com soon

What can I do at ChooseHealthDE.com? Premium estimator Subsidy calculator Access FAQs Get Ready Choose up to three at a time Shows costs and what’s covered Compare Plans Contact information for Marketplace Guides List of Agents/Brokers Calendar of local events Find Help

ChooseHealthDE.com (English version): As of Nov. 11, 2013, there have been 119,239 visits Visitors are staying an average of 2 minutes, 37 seconds

Health-Care/Espanol ChooseHealthDE.com (Spanish version): As of Nov. 11, 2013, there have been 8,523 visits. Visitors are staying an average of 2 minutes, 48 seconds.

HEALTHCARE.GOV Traffic from ChooseHealthDE.com to Healthcare.gov: As of November 11, 2013, ChooseHealthDE.com has driven 21,709 visits to Healthcare.gov.

Marketplace Guide Program Of the anticipated 106 Marketplace Guides – a mix of full-time and part-time positions – 51 have achieved full certification and are therefore able to help consumers to apply for and enroll in coverage. The 106 positions are equivalent to the 68 full-time budgeted positions. The remaining Guide candidates are actively pursuing certification. Federal background checks, the final step in the certification process, are being received daily Delaware’s Marketplace Guides are responsible for broad consumer outreach, including educating and informing individuals on how health insurance works and what financial assistance they may be eligible for. Guides also can help individuals enroll.

Marketplace Guide Activities as of 11/12/ outreach activities have been held More than 16,000 consumers have been engaged Guides have been assisting consumers in understanding options and eligibility, creating Marketplace accounts and applying for coverage

Stories from the Ground A Wilmington small business owner said he will keep exploring his options on healthcare.gov, but “the confidence level is low.” A Rehoboth Beach man and his wife said healthcare.gov may be a frustrating and time-consuming experience, but they will save $800 a month on the coverage they bought there. A woman with a pre-existing condition is grateful to have coverage starting Jan. 1.

Stories from the Ground Janice Baker from Selbyville, our first known Delaware enrollee, will save $150 a month on her insurance. A Wilmington man is frustrated that he cannot keep the health insurance that he has for his family. A Rehoboth Beach man appears eligible for Medicaid, but is stuck in the enrollment process. A 26-year-old Wilmington man will leave COBRA and save money on his new marketplace policy.

Stories from the Ground With the help of a marketplace guide, a Wilmington man called the Federal Contact Center at and will have his income verification this week. A New Castle County man was denied eligibility because of an error in his application. He is working with the federal Advanced Resolution Center to amend his application. A Hockessin hair stylist said she will wait until after Nov. 30 to shop for insurance.

QHP Standards and Monitoring 21

State Standards for QHP Certification November 1, 2012: The HCC approved and published the State- specific standards for qualified health plans (QHPs). State standards augment, but do not supplant the federal standards Reflect broad stakeholder input gathered through a public Open Comment process. Feedback included input regarding continuity of care, network adequacy, accreditation, plan levels, essential community providers and quality improvement standards HCC sought to balance the need to expand value for consumers and to encourage Issuer participation in the Marketplace. A full list of approved QHP Standards may be found at:

Delaware QHP Standards In addition to those outlined in the ACA, the State standards include, but are not limited to: –Requirement for Issuers to offer Bronze as well as Silver and Gold level plans –Statewide Rating Area –Statewide Service Area that expands provider coverage throughout the entire state –Network Adequacy standards that align with Medicaid and Department of Public Health standards –Issuer-required Transition Plans that support continuity of care for consumers as they move from QHPs to Medicaid and vice-versa –Quality Improvement Strategies, including a requirement that all medical QHP Issuers participate, at the prevailing rate, in the Delaware Health Information Network (DHIN) State-specific QHP Standards will be extended for the 2015 Plan Year. Standards will be revisited early in 2014 for the 2016 Plan Year; HCC will be engaged in this process 23

Monitoring Issuer/QHP Compliance QHP Review Process Formal QHP application and review process included verification and/or attestations to support compliance with state and federal QHP standards prior to certification. Ongoing QHP monitoring activities Review and analyze consumer and provider complaint data from multiple sources (DOI Consumer Services, FFM Contact Center, Issuers) Conduct bi-annual Interrogatories that address specific federal and state compliance areas such as network adequacy/access, Accreditation, Quality Improvement Strategies, Continuity of Care, DHIN participation, provider re- imbursement, marketing, among others. Leverage DOI Market Conduct practices to gather/address QHP compliance issues, including formal market conduct reviews, action plans, etc. 24

In the News 25

Impact of ACA on existing health plan policies Beginning January 2014, Issuers are required to comply with many of the key provisions of the ACA, thus impacting existing health plan policies for many across the country. Provisions of the ACA have significant impact on benefit coverage and premium rates for Coverage of all 10 essential health benefits and benchmark benefits, including habilitative services, hospitalization, maternity/newborn, and mental health parity Removal of annual and lifetime limitations 80/20 Medical/Loss Ratio, which requires Issuers to spend at least 80% of premium on medical care and efforts to improve quality care, and no more than 20% on administrative costs. Issuers cannot deny coverage due to pre-existing conditions Rating factors that only include age, tobacco use, and family composition. President Obama today announced a one-year extension for current policies that have received discontinuation notices 26

How will this affect Delaware Consumers? Because plans have to comply with the ACA, issuers have discontinued those plans that are not compliant with the Act. As a result, letters informing consumers of discontinuance/non-renewal were sent within the past few months. The policies will be discontinued at the policy renewal date beginning on January 1, Examples of when the non-renewal will affect consumers are: If you renewed your policy in July 2013, the policy will continue to July If you renewed your policy in November 2013, the policy will remain in effect until November Most carriers have sent the notification letters to all the members impacted even if the date would fall later in Also at least 90-day notice has been given. Discontinuance letters were sent by multiple carriers, not just those participating in the Marketplace To date, almost 12,000 policies in the individual market have been discontinued. Of that group, approximately 2,000 of these will be affected as of January 1,

Consumer options for those affected 1.Complete ‘early renewal’ for those that are offered it In some cases that includes cancelling their current policy and purchasing the new one prior to December Purchase a qualified health plan (QHP) on Healthcare.gov Some individuals may be eligible for tax credits and cost share reductions 3.Select and purchase a plan from among the choices offered by their existing insurance carrier 4.Shop for plans from a variety of carriers ‘off’ the Marketplace 28

Significant Dates November 30, 2013 – Expected date for healthcare.gov improvements December 15, 2013 – Last day to enroll for coverage beginning on January 1, 2014 March 31, 2014 – Must be enrolled in minimum essential coverage by this date to avoid penalty