Kentucky Health Benefit Exchange Snapshot

KMA KMA Presentation Winter Update Kentucky Health Benefit Exchange Kentucky Health Benefit Exchange

Disclaimer KMA KMA Presentation Winter Update Kentucky Health Benefit Exchange Current State of Exchanges (Kaiser)

Kentucky Health Benefit Exchange

Cabinet for Health and Family Services (CHFS) Kentucky Health Benefit Exchange Letters of Intent Anthem Bluegrass Family Health Humana X* United Health Care KY CO-OP Coventry Cares Humana CareSource Passport WellCare Others – Anthem, etc. *regional plan Large Employers 2015

Expansion  308,000 uninsured may gain Medicaid and will include:  Adults with income under 138% of the FPL and not covered under current Medicaid eligibility criteria  Former foster care children up to age 26  Request for Proposal (RFP) for Medicaid expansion must be submitted by July 22, 2013  Bids will be for new vendors and will exclude Region Three  MCOs currently under contract outside of Region Three (WellCare and Coventry) will have an opportunity to amend their current contract.  In place – January 1, 2014 Medicaid Household Size/FPL Household Size/FPL 100%138% 1 $11, 490$15,856 2 $15,410$21,404 3 $19, 530$26, $23, 550$32, 449

Kentucky Health Benefit Exchange MAGI Premium Cost Proposed Rule: Eligibility evaluations for premium tax credits and Medicaid eligibility will be based on the “honor system” and will be performed manually by the state exchanges rather than being based on IRS data provided to the exchanges through the new federal data hub.

8 Kentucky Health Benefit Exchange

50 or less FTE Kentucky Health Benefit Exchange

10 Kentucky Health Benefit Exchange More than 50 FTE Delayed

Cabinet for Health and Family Services (CHFS) Kentucky Health Benefit Exchange

LevelPercentage of Medical Expenses Bronze60% Silver70% Gold80% Platinum90%

Kentucky Health Benefit Exchange Benefit Ambulatory patient servicesEmergency services HospitalizationMaternity and newborn care Mental health and substance use disorder services, behavioral health Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services including oral and vision care *KCHIP

Kentucky Health Benefit Exchange

Navigators - Individuals or Entities that: May include: Community/consumer-focused nonprofit groups, Chambers of commerce, resource partners of Small Business Administration, Health Care Providers, etc. Maintain expertise in eligibility, enrollment and programs; Provide information/services in fair, accurate, impartial way; Facilitate selection of Qualified Health Plans (QHPs); and Provide referrals to any applicable office, health insurance consumer assistance or ombudsman, or State agency for grievances, complaints, or questions about health plan. 16 Kentucky Health Benefit Exchange

ACA – Affordable Care Act CHFS – Children and Family Services E&E – Eligibility and Enrollment EHB – Essential Health Benefits KHBE – Kentucky Health Benefit Exchange IT – Information Technology MAGI – Modified Adjusted Gross Income MCO – Managed Care Organization QHP – Qualified Health Plan SHOP – Small Business Health Option Program Kentucky Health Benefit Exchange

Kentucky Health Benefit Exchange

Kentucky Medical Association Lindy Lady, CPC, CPCO Manager, Medical Business Advocacy 4965 US Highway 42 Suite 2000 Louisville, KY /Extension 228  Questions? Kentucky Health Benefit Exchange