How Can Your State Select Good Plans for Its Health Insurance Exchange? November 11, 2010.

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Presentation transcript:

How Can Your State Select Good Plans for Its Health Insurance Exchange? November 11, 2010

Mission Statement To represent and strengthen not-for-profit, safety net health plans as they work with providers and caregivers in their communities to improve the health and well being of vulnerable populations in a cost- effective manner.

3 ACAP has 52 member plans representing over 7M Medicaid lives in 25 States – 25% of all Medicaid managed care lives

ACAP Plans 4 Affinity Health Plan (NY) Alameda Alliance for Health (CA) AlohaCare (HI) AmeriHealth Mercy Health Plan (PA) Amida Care (NY) Boston Medical Center HealthNet (MA) CalOptima (CA) CareOregon (OR) CareSource Michigan (MI) CareSource (OH) CenCal Health (CA) Childrens Community Health Plan (WI) Childrens Mercy Family Health Plan (KS) Childrens Mercy Family Health Plan (MO) Colorado Access (CO) Commonwealth Care Alliance (MA) Community Health Choice (TX) Community Health Group (CA) Community Health Network of Connecticut (CT) Community Health Plan (WA) Contra Costa Health Plan (CA) Cook Childrens Health Plan Denver Health Medical Plan (CO) Driscoll Childrens Health Plan (TX) Elderplan & Homefirst (NY) El Paso First Health Plans (TX) Health Plan of San Mateo (CA) Health Plus (NY) Health Services for Children with Special Needs (DC) Horizon NJ Health (NJ) Hudson Health Plan (NY) Inland Empire Health Plan (CA) LA Care Health Plan (CA) Maine Primary Care Association (ME) ** MD Community Health Systems (MD) * MDwise (IN) Metropolitan Health Plan (MN) Monroe Plan for Medical Care, Inc. (NY) Neighborhood Health Plan (MA) Neighborhood Health Plan of Rhode Island (RI) Network Health (MA) Prestige Health Choice (FL) Priority Partners (MD) San Francisco Health Plan (CA) Santa Clara Family Health Plan (CA) Texas Childrens Health Plan (TX) Total Care (NY) Univera Community Health (NY) University Physicians Health Plans (AZ) UPMC For You (PA) Virginia Premier Health Plan, Inc (VA) VNS CHOICE (NY) * Associate Member ** Incubator Plan Plans in Italics are original CHC plans

Medicaid Plans Need to Be in the Exchange On average, 40 percent of the nations low income subsidized Exchange population will have the following characteristics: – Previously enrolled in Medicaid/CHIP – Previously enrolled in a premium subsidy program for low- income populations – Previously uninsured (with our without family members in Medicaid) Family Cohesion Knowledge of Needs of Low-Income Populations

SNHPs Should Be Allowed in the Exchange Currently cover over 25% of all Medicaid Lives High Quality Plans – 5/10 top Medicaid Plans are ACAP Members Strong link to providers – Most affiliated with CHCs, Safety Net Hospitals, childrens hospitals Profits go back to Community – IT support, programs for uninsured Mission to serve low income populations Greater choice for consumers Experience working with government

Commercial Concerns with SNHPs Wellpoint Letter to CA legislators CA AHA concerns re: pricing

Medicaid Plans Should Not Be Required to Enter the Exchange Not all SNHPs will have the capital for reserves or operations Some plans may have enough on their plate with the Medicaid expansion

How Can the Exchange be Structured to Best Serve Subsidized Populations Deeming of Medicaid plans as Qualified Health Plans initially – Allow transition period for accreditation, licensing, reserves Simplify enrollment into Exchange – Nudge Medicaid enrollees into same plan in Exchange – Allow easy opt-out Robust risk adjustment system

How Can the Exchange be structured to Best Serve Subsidized Population Quality Rating System should be risk adjusted to reflect diversity of subsidized population Standardized Benefits to enhance comparability for consumers

Contact information Meg Murray, CEO, , Deborah Kilstein, Director of Quality Management and Operational Support, , Andrea Maresca, Director of Policy, ,