Health Care Reform: What We Know Today Presented to OHCA Board April 8, 2010.

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Presentation transcript:

Health Care Reform: What We Know Today Presented to OHCA Board April 8, 2010

Hitting the High Points Today’s Focus: SoonerCare-specific points Challenge: Oklahoma’s Uninsured Opportunity: Health Care Reform  Financing  Enrollment Today vs Enrollment Post-Reform  Potential Impact Additional Opportunities  Potential Impact

Oklahoma FMAP Outlook: Newly Qualified Source: CMS, Regular reflects FY 2010 FMAP Estimates

Oklahoma CHIP FMAP Outlook Source: CMS, Regular reflects FY 2010 CHIP FMAP Estimates

Enrollment Today Source: OHCA Annual Report SFY 2009, page 21, figure revised from original publication

Enrollment Post-Reform Source: OHCA, per analysis of HCR bill as signed by the President on 3/23/10

Enrollment Post-Reform Source: SoonerCare figures from OHCA, business objects report retrieved 4/7/10; Uninsured figures from US Census Bureau, 2008 data collected in 2009,

Potential Oklahoma Impact Current Annual Uncompensated Care: Hospitals = $365 M Cost-Shifting to Insured = $1,000 per family or $1 B total Source: OHCA, per analysis of HCR bill as signed by the President on 3/23/10. Population figures estimated with US Census Bureau uninsured data. Cost figures estimated with average SoonerCare expenses and include 3% administration. Uncompensated care figures estimated with cost-reports from 103 Oklahoma hospitals, and national study conducted in 2005 by Dr. Kenneth Thorpe, PhD.

Additional Options… States may choose to expand coverage to childless adults under 133% FPL effective 4/1/10.  Regular FMAP applies. States may choose to establish a basic state health plan for families earning % FPL effective 1/1/14.  In lieu of FMAP states receive 85% of the tax credits and cost-sharing reductions that would have applied through Exchange plans.

Basic State Health Plan Example State receives 85% of the consumer’s affordability credits Compare state receipts to typical cost of coverage under SoonerCare

Other Reform Notables… Income definition for Medicaid & CHIP set as IRS, AGI, and a 5% income disregard. Medicaid enrollment must be coordinated with Exchange enrollment to provide seamless enrollment for all programs. States required to create and run a website which:  Allows application and enrollment in Medicaid, CHIP or Exchange plans.  Contains benefit/cost/quality information on plans. Medicaid provider rates must equal Medicare provider rates for preventive services.  Full 100% FMAP applies to the difference.

Sources: Reform Summaries NASMD Health Reform Side by Side Kaiser Side by Side of Major Health Reform Proposals Library of Congress  HR  HR