NHHPP Waiver Program – What Is It? / What Does It Mean for Assisters? Tom Bunnell – Policy Consultant

NHHPP Waiver Program – What Does it Mean for Assisters?  Background  Benefits Package  Cost-Sharing  Application and Enrollment – Big Picture  Special MCO Consideration  Enrollment Walk Through  A Few Other Key Issues  Q & A

Background I  NHHPP enacted Mar 27, 2014 / bipartisan compromise  Immediate implementation of NHHPP (Medicaid expansion)  Sunset at end of calendar year 2016 unless reauthorized  Pursuit of “premium assistance” Medicaid Waiver  HIPP Program, Bridge Program, and Waiver Program  Premium Assistance Medicaid Waiver  App submitted Dec 1, 2014 / approved Mar 12, 2015  Brave new world – Merging Medicaid with private insurance  But NHHPP is still a Medicaid program

Background II  All NHHPP Bridge Program (Medicaid managed care) enrollees must transition to Medicaid-financed QHP coverage on the Marketplace effective Jan 1, 2016  All new NHHPP enrollees must be in a QHP on the Marketplace (except those that are exempt) effective Jan 1, 2016  Every insurance carrier offering a QHP on NH’s FFM in 2016 must offer an NHHPP-compliant Silver level plan  All carriers offering QHPs on NH’s FFM must accept NHHPP participants as enrollees

Benefits Package  The overall benefits package for NHHPP enrollees is exactly the same for the Waiver Program as it has been for the Bridge Program  But the package is separated into two parts for admin purposes :  Private insurance Essential Health Benefits (EHB) through QHP Silver Plan  Wrap-Around Benefits (satisfying Medicaid EHB) through Medicaid  Medicaid wrap-around benefits:  Non-emergency medical transportation (NEMT)  Early Periodic Screening Diagnosis and Treatment (EPSDT)  Family planning services and supplies  Limited adult dental and adult vision services  Enrollees will have one insurance card / seamless

Cost-Sharing  Unique cost-sharing arrangement for Marketplace  Although enrolled in a QHP on the Marketplace, NHHPP enrollees will pay no premiums or deductibles out of pocket  Medicaid will pay all premium and deductible expenses for NHHPP enrollees’ QHP coverage  NHHPP enrollees at less than 100% of FPL will have no co-pay obligations / no cost-sharing  Medicaid will be charged for and pay all co-pays  But there will be cost-sharing, in the form of co-pays only, for enrollees from 100% to 138% of FPL

Cost Sharing – Specifics  Co-Pays for Enrollees at 100% to 138% of FPL (subject to an out of pocket cap):  Generic Prescription Drugs – $2  Prescription Drugs – $6  Specialty Prescription Drugs – $6  Physician Specialist Services – $8  Complex Imaging (CT/PET Scans, MRIs) – $25  Behavioral Health Inpatient Admission – $50  Hospital Inpatient Admission – $50  For all such enrollees, cost-sharing on a quarterly basis cannot exceed 5% of income for quarter

Application and Enrollment I  QHP coverage under the Waiver Program begins Jan 1,  New NHHPP applicants can apply for coverage under the program starting Nov 1, 2015 (start of Open Enrollment 3 )  Enrollment will remain open year-round for NHHPP appli cants  Consumers may apply for the NHHP, select a QHP, and enroll in the program:  Through the DHHS online portal / NH EASY  By phone at the DHHS  NHHPP hotline, at  In person at a DHHS District Office

Application and Enrollment II  Consumers may also apply for the NHHPP via NH’s federally-facilitated Marketplace / but the app file will need to be transferred to DHHS for program enrollment and QHP selection:  Need for HIPP and Medically Frail screening (possible Waiver program exemption) at DHHS  Medicaid Wrap-Around enrollment  FFM will not yet have the technical capacity to restrict NHHPP applicant shopping to Medicaid-only QHPs

Bridge Program Transition – Special MCO Consideration  Special Medicaid MCO consideration in NHHPP authorizing statute and Waiver  If MCO offers QHP on Marketplace, their NHHPP Medicaid Managed Care enrollees will be auto-assigned to / auto- enrolled in the MCO’s QHP  Now know that NH Healthy Families (Centene) is offering a QHP on the Marketplace  WellSense (BMC HealthNet) is not

Enrollment Walk-Through – NH Healthy Families  On or about Nov , current NHHPP NH Healthy Families’ (NHHF) enrollees will receive a notice from DHHS that they’ve been auto-assigned to the NHHF QHP, effective Jan  Consumers will have 30 days to switch to a different Silver level QHP, if they would like.  There is still a question as to when, in this circumstance, the 30 day period kicks in  ISSUE WATCH: Provider networks may be different!

Enrollment Walk-Through - WellSense  WellSense NHHPP enrollees will receive a written notice from DHHS, on or about Nov 1, 2014, of the required transition, and the need to select a QHP for coverage  Notice is required to provide guidance on how to select a QHP  Notice is required to compare differences between available plans  The consumer needs to select a QHP Silver Plan within 30 days  If consumer doesn’t choose a QHP within 30 days, s/he will be auto- enrolled in a QHP  Follow-up notice will inform enrollee of their auto-assignment and of the right to select a different QHP within 30 days

Enrollment Walk Through – New Applicants  Enrollment for Marketplace coverage under the Waiver program begins Nov 1, 2015  Anyone who applies and is found eligible on or after Nov 1, 2015:  Will be enrolled in Medicaid fee for service, at the outset, until QHP coverage begins for the enrollee  Will be given a choice of plans for Marketplace coverage beginning Jan 1, 2016 or 30 days after notice of NHHPP eligibility, whichever occurs later  If an applicant does not choose a QHP within 30 days of being found eligible, s/he will be auto-assigned to a Silver level QHP  Upon notice of auto-assignment, the enrollee will have 30 days to select a different plan if s/he wants

Enrollment Walk Thru – Medically Frail  An applicant or enrollee can self-certify, at any time, that s/he is medically frail and opt out of Marketplace coverage / is exempt from the Waiver program  Medically frail person must then elect to enroll in either the Medicaid managed care Alternative Benefit Plan or the standard Medicaid benefit

Other Issues  Retroactive Coverage  Grievances and Appeals  NHHPP Reauthorization  NHHPP sunsets Dec 31, 2016 unless reauthorized by Legislature and Governor  Large coalition advocacy effort engaged to ensure that the program is reauthorized