Expanding Medicaid The Who, What, When and How of LB 887

Sections of LB 887 Section 1 – Name of the Act Section 2 – Findings Section 3 – Purpose Section – Definitions Section 36 – State plan amendment -Directs DHHS to apply for a state plan amendment that will be in effect until WIN waivers are enacted. -Directs DHHS to apply for waivers to implement WIN, -Permits DHHS to establish a employer-sponsored insurance premium assistance if cost effective

Sections of the Bill (continued) Section 37 – Marketplace coverage -100%-138% of FPL and no exceptional medical conditions -Enroll in a 100% actuarial value silver plan -Effective first day of month following month of application -Medicaid coverage until effective date and wraparound coverage for MA services not covered by QHP

Sections of the Bill (continued) Section 38 – Employer sponsored insurance -Available to persons up to 138% of FPL who have access to coverage through an employer that meets ACA standards. -DHHS may pay for premium associated with employer share of premiums, cost sharing and wrap around benefit. -Employer sponsored insurance shall only be provided if determined to be cost effective.

Sections of the Bill (continued) Section 39 – WIN Medicaid -Available to those with incomes below 100% of FPL. -Private managed care organizations providing WIN Medicaid coverage must assure that newly eligible have access to a primary care provider and enrolled in a patient-centered medical home, where available.

Sections of the Bill (continued) Section 40 – Health systems transformation -Use delivery models that improve patient health outcomes, improve care and reduce costs. -Include safety net providers in networks. -Role of patient-centered medical homes Section 41 – Health homes -Role in providing care for medically frail

Sections of the Bill (continued) Section 42 – Reimbursement Models -Development of models that promote quality and contain costs -Develop ACO reimbursement methodology Section 43 – Models to promote cost-conscious consumer behavior -Conditional exemption from contributions -Prepare for transition to exchange coverage

Sections of the Bill (continued) Section 43 (cont.) -Eligible persons above 50% FPL would pay contribution of 2% of income. -Contribution waived if the covered person participates in preventive/wellness activities. -No copayments for WIN Marketplace or WIN Medicaid coverage

Sections of the Bill (continued) Section 44 – Conditions of participation -A member is eligible for benefits for 12 months from initial enrollment. -Annual review of eligibility. -Coverage can be cancelled if program is discontinued. Section 45 – Content of waiver application

Sections of the Bill (continued) Section 46 – WIN Oversight Committee -Chair of HHS Committee -Two members of HHS Committee -Two members of Appropriations Committee -Two members of Banking, Commerce and Insurance Committee -Two members not on those committees -Meet quarterly with representative of DHHS

Sections of the Bill (continued) Section 47 – Failsafe -If federal funding percentage falls below amount stipulated in ACA, Legislature will take review continued participation. Section 48 – Rules and Regulations Section 49 – Emergency Clause

Who Would be Covered by LB 887 WIN coverage would be offered to Nebraskans with MAGI below 138% of FPL. – Premium support for employer sponsored coverage – Premium support for marketplace coverage for those between 100% and 138% of FPL – Medicaid coverage for those below 100% of FPL

Three Types of Coverage Employer Sponsored Insurance Option that could be used if it is cost-effective DHHS would pay employee costs of coverage WIN Marketplace Premium support to buy a special issue plan Wraparound coverage for MA-only services WIN Medicaid Medicaid coverage extended to newly eligible

What is the Potential Market for WIN Less than 100% FPL Employer Coverage 30,234 Direct Purchase 16,506 Uninsured 51, % to 138% FPL Employer Coverage 22,859 Direct Purchase 7,759 Uninsured 26,245

Federal Poverty Level 100% 138% One Person11,67016,105 Two Persons15,73021,707 Three Persons19,79027,310 Four Persons23,85032,913 Five Persons27,91038,516 Six Persons31,97042,919

Examples of Cost of Coverage Costs vary by: -Age -Income -Location -Tobacco Use -Household Size -Access to Medicaid -Number of Persons Covered Handout

Issues Cost of Implementation through FY-2020 ($million) -LB 887 Fiscal Note Federal$2,107 State $90 -Milliman (State Plan) Federal$2,407 State $97 -Milliman (Waiver) Federal$3,374 State $155

Issues Marketplace Plan vs. Medicaid -Using private coverage instead of Medicaid will increase costs substantially (Milliman) -Private coverage for FPL will limit access to coverage for Medicaid enrollees (Platte Institute)