Health Care Reform in Maryland Looking Back & Looking Forward Leni Preston, Chair (301) © 2012 Maryland Women’s Coalition For Health Care Reform

Maryland: A National Leader Commitment & Leadership Pro-Active & Effective Process Stakeholder Engagement © 2012 Maryland Women’s Coalition For Health Care Reform

Health Benefit Exchange Timeline 4/12/2011 Governor O’Malley Signed Health Benefit Exchange Act into Law 6/3/2011 Exchange Board 1 st Meeting 9-11/2011 Advisory Committees Met 1/1/2013 Exchange Must be Certified by Federal Government 10/1/2013 Individuals and Groups Begin Enrolling in Exchange 1/1/2014 Maryland Health Benefit Exchange will be Operational © 2012 Maryland Women’s Coalition For Health Care Reform Source: A Report to the Governor and Maryland General Assembly Maryland Health Benefit Exchange, December 23, 2011, p. 1 Landmark ACA Legislation signed into Law 3/23/2010 by President Obama

General Assembly 2012 Three Major Bills – Health Benefit Exchange Act of 2012 (SB238/HB443) – Health Improvement & Disparities Reduction Act of 2012 (SB234/HB439) – Cultural Competency & Health Literacy – Education Support (HB679) © 2012 Maryland Women’s Coalition For Health Care Reform

Health Benefit Exchange Act of 2012 What’s An Exchange? An Insurance Marketplace Each Plan will be set out with monthly cost and co-pays; plan performance on quality measures; ratings by quality and price Compare Apples to Apples and if you can’t decide between a Fuji and a Rome, you can get help through a website, telephone hotline, and navigators © 2012 Maryland Women’s Coalition For Health Care Reform

Legislation builds on 2011 legislation to ensure Exchange is operational by 1/1/2014 Reflects recommendations in the 12/23/2011 Exchange Board report Developed through a collaborative and consensus process with stakeholders at the table Coalition worked with its partners, legislators, and Carolyn Quattrocki in the Governor’s Office of Health Care Reform to ensure passage Health Benefit Exchange Act of 2012 The Legislative Process © 2012 Maryland Women’s Coalition For Health Care Reform

Health Benefit Exchange Act of 2012 Key Provision: Operating Model – All carriers can participate; all plans must be certified by Exchange – Stakeholder Committee will advise Exchange on appropriate standards 2016 – Exchange may propose “active purchasing” strategies (competitive bidding &/or negotiation) to further decrease health care costs and increase quality of health care © 2012 Maryland Women’s Coalition For Health Care Reform

Health Benefit Exchange Act of 2012 Key Provision: Navigator Program The Navigator Program will provide outreach & education to individual consumers & small businesses on: – Eligibility for Medicaid (up to 133% FPL) – Eligibility for financial assistance (133% to 400% FPL) – Tax credits for small businesses – Appropriate health insurance plans Navigators will also facilitate enrollment © 2012 Maryland Women’s Coalition For Health Care Reform

Health Benefit Exchange Act of 2012 Key Provision: Navigator Program/ Individual Exchange The Exchange will contract with navigator entities (including community-based organizations) to provide all outreach, education, eligibility & enrollment services Individual navigators will receive training & certification to conduct outreach & education activities Stakeholder Committee will provide expertise & advice on the further design of the program © 2012 Maryland Women’s Coalition For Health Care Reform

Health Benefit Exchange Act of 2012 Key Provision: Navigator Program/ SHOP Exchange SHOP Navigator Program will be separate from individual exchange SHOP Navigators will be overseen by MIA Insurance producers/brokers must obtain authorization and training to sell plans in either the SHOP or individual Exchange Producers will be paid by the carriers © 2012 Maryland Women’s Coalition For Health Care Reform

Health Benefit Exchange Act of 2012 Key Provision: Design of the SHOP Separate from individual exchange – Serves small businesses - up to 50 employees, expands to 100 employees in 2016 Two ways to offer insurance to employees: – Employer picks one carrier & designates plans from which employee can choose – Employer picks coverage level (platinum, gold, silver, & bronze) & employee chooses plan from any carrier at that level © 2012 Maryland Women’s Coalition For Health Care Reform

Health Benefit Exchange Act of 2012 Key Provision: Qualified Health Plans Only Qualified Health Plans (QHP) will be sold in the Exchange. These must: – Include the Essential Health Benefit Package – Be certified by the Exchange Exchange will also offer stand-alone and bundled qualified dental and vision plans Pediatric dental and vision benefits must be part of the Essential Benefit Package © 2012 Maryland Women’s Coalition For Health Care Reform

Health Benefit Exchange Act of 2012 Key Provision: Financing Maryland has received over $34 million in federal grants to fund establishment of the Exchange State will submit its request for Level 2 Establishment Grant in June ACA requires Exchange to be self-sustaining by 2015 Joint Executive-Legislative Committee will provide recommendations – Stakeholder Committee will provide advice Legislation is expected in 2013 © 2012 Maryland Women’s Coalition For Health Care Reform

Health Benefit Exchange Act of 2012 Key Provision: Essential Health Benefits Beginning in all health insurance plans sold in and outside the exchanges must include essential health benefits. These will be based upon an existing “benchmark” plan. Health Care Reform Coordinating Council working with a stakeholder group will determine what the plan will be. – Decision deadline is September 30, 2012 © 2012 Maryland Women’s Coalition For Health Care Reform

Essential Health Benefits & Behavioral Health Behavioral health treatment must be included as one of the 10 essential health benefit categories These benefits must be compliant with the Mental Health Parity and Addiction Equity Act (MHPAEA) – Requires that limits or cost-sharing for behavioral health treatment be no more restrictive than for physical health Qualified Health Plans in Maryland will demonstrate compliance with MHPAEA – Plans would demonstrate that cost-sharing, medical management policies and procedures, or authorization requirements for behavioral health are not more restrictive For more information on mental health parity – Contact Adrienne Ellis, Director Maryland Parity Project – Please take our short survey © 2012 Maryland Women’s Coalition For Health Care Reform

General Assembly Additional Legislation Health Improvement & Disparities Reduction Act of 2012 (SB234/HB439) Cultural Competency & Health Literacy – Education Support (HB679) © 2012 Maryland Women’s Coalition For Health Care Reform

Communications: Framing the Message What Works Pre-existing conditions – Insurance plans will no longer deny insurance due to pre-existing conditions & thanks to ACA that’s true for children now Security – Those currently uninsured, or worried about job loss and loss of insurance, will have the security of knowing they can go to the Exchange Peace of Mind - Members of Congress will be required to get their health insurance from the same Exchanges as everyone else Fairness/No Discrimination – Women can no longer be charged higher rates for their insurance than men Following particularly effective with men: Personal Responsibility – Exchange encourages personal responsibility and control over your own health care Competition – Insurance costs will come down as competition among insurance companies increases © 2012 Maryland Women’s Coalition For Health Care Reform Source: Tips prepared by the Herndon Alliance based on a February 2012 poll.

Communications: Countdown to Coverage Senator Mikulski’s Women’s Preventive Services Amendment - A win for women! On August 1, 2012, all new plans must cover preventive care for women w/o co-pays or deductibles including: Comprehensive contraceptive care Screening & counseling for domestic partner violence Screening for gestational diabetes Breastfeeding counseling & equipment Screening for sexually transmitted diseases Well women preventive care visits %20FINAL.pdf © 2012 Maryland Women’s Coalition For Health Care Reform

Communications: Learn More Office of Health Care Reform Website Coalition-sponsored Forums – Reform. It’s Good For Your Health – Health Care. Women of Color Get It on September 8, 2012 in Baltimore HealthCare Access Maryland (HCAM) Forum – For CBOs in Baltimore City & Metro Area to get the latest information on health care reform, the Navigator Program, and more – June 13, 2012 – Call for more information © 2012 Maryland Women’s Coalition For Health Care Reform

Looking Forward: Coalition Priorities Making the Exchange Work for Consumers Health Equity – “The nation is either making no progress or is heading in the wrong direction in reducing racial, ethnic, and income-related disparities in access to care.” – Forum – Health Care. Women of Color Get It – September 8, 2012 – Issue Brief – Health Equity: Maryland’s Call To Action – Release date – September 8, 2012 – Maryland’s State Health Improvement Process Source: Agency for Health Research & Quality (AHRQ) © 2012 Maryland Women’s Coalition For Health Care Reform

Get Involved: Make A Difference Coalition Initiative – Outreach to Groups Representing Women of Color Forums State Health Improvement Process & Local Health Improvement Coalitions Share Our Stories © 2012 Maryland Women’s Coalition For Health Care Reform

Resources You Can Use Maryland – Health Benefit Exchange – Department of Health & Mental Hygiene – Maryland Health Insurance Plan (MHIP) – Health Care Reform Coordinating Council Federal – Department of Health & Human Services © 2012 Maryland Women’s Coalition For Health Care Reform

Stay Informed & Get Involved Join the Coalition – Newsletters, Alerts, Member Calls & Webinars – Educational forums: September 8 th in Baltimore – Facebook and Twitter Encourage others to join MDHealthCareReform.org © 2012 Maryland Women’s Coalition For Health Care Reform

Contact Us Leni Preston, Chair Sandy Kick, Health Policy Analyst – Issue Brief & Forum Jamie Shopland – Outreach & Education MDHealthCareReform.org © 2012 Maryland Women’s Coalition For Health Care Reform

Copyright 2011 Maryland Women’s Coalition For Health Care Reform

Everyone Call in to access code # please for the voice portion of the webinar Copyright 2011 Maryland Women’s Coalition For Health Care Reform