Impact of Health Reform on MiPCT March 12, :30-1:30pm

How to Join the Webinar Weblink: age/g.php?MTID=efe50c3cd27d345cf7d84496cd 4954e78 age/g.php?MTID=efe50c3cd27d345cf7d84496cd 4954e78 Event number: Event password: mipct Call-in toll number: Access code:

Agenda Webinar logistical details and goals (1o minutes) Theresa Landfair, Medicaid (10 minutes) Juanita Vorel, Priority Health (10 minutes) Stephen Chapoton, BCBSM (10 minutes) Q & A (20 minutes)

Webinar Goals To share information with MiPCT POs and practices to help you prepare for health reform implementation To allow an opportunity to ask questions and share best practices for reform preparation

Key Questions Asked of Payers Which plans are offered on the exchange? Do they vary by region? Can you describe enrollment so far? Which plans are expected to gain the most enrollment? How many new MiPCT patients are expected? What type of change do you expect in HDHP enrollment?

 Presentation overview: ◦ The Healthy Michigan Plan ◦ New eligibility methodology – Modified Adjusted Gross Income (MAGI)

 Affordable Care Act (ACA) authorization ◦ New eligibility category.  Funding must be appropriated by State.  House Bill 4714  Public Act 107 of 2013 was signed into law by Governor Snyder September 16,  This is called the Healthy Michigan Plan.

 Public Act 107 0f 2013 did not have an immediate effect.  Cannot implement prior to 90 days after the end of legislative session.  This is roughly around the April 1, 2014 timeframe.

 State law requires certain cost-sharing requirements (co-pays and contributions).  Some of these requirements are not stated in federal regulation.  Need a waiver amendment to implement what is in state law. ◦ Amended our current Adult Benefits Waiver.  Waiver Amendment was submitted Approved December 30, 2013.

 Federal government will pay 100% of the program cost for the first three years.  Will decrease federal match to 90% by  Current Match is about 64%

12 Impact on Low Income Citizens  Provides Health Insurance Coverage for Low Income Citizens  Dramatic Reduction in Uninsured in Michigan  Primary Care Is Available  Health Coverage Improves Health Status  Improves Employability  Anticipated that up to 400,000 – 500,000 people could be eligible for the Healthy Michigan Plan

13 Federal Eligibility Parameters  Includes people ages  Not receiving or eligible for Medicare  Not eligible for current Medicaid programs  Not pregnant at the time of application  Covers up to 133% of the federal poverty level (5% disregard = 138%)  No asset test  Must meet other federal requirements

Eligibility for Healthy Michigan Plan and Current Medicaid

15 Michigan Medicaid Caseload Thousands 1,885,924

1. Ambulatory patient services 2. Emergency Services 3. Hospitalization 4. Maternity and newborn care 5. Mental Health and substance use disorder services, including behavioral health treatment 6. Prescription drugs 7. Rehabilitative and habilitative services and devices 8. Laboratory services 9. Preventive and wellness services and chronic disease management; and 10. Pediatric services, including oral and vision care. 11. Other, Dental, vision, home health Benefit coverage must be based on federal benchmark coverage and include the 10 essential health care services. Covered Services

 Healthy Michigan beneficiaries will enroll into the one of the current Health Plans.  Current populations that are exempt or voluntary from managed care will remain exempt or voluntary.  Will use the current Prepaid Inpatient Health Plan (PIHP) system of care.

 Required by Public Act 107 of 2013  Cost-sharing ◦ Average co-pays ◦ Contribution of 2% annual income for beneficiaries with income between 100%-133% of the FPL.  Account will provide information on health care services cost and utilization.  Will show cost of services and amount of contribution in account.  Quarterly statements 18

 Healthy Behaviors  Health risk assessment form completed  If beneficiary engages in healthy behavior can have reduction in cost-sharing.  Goal is to have beneficiary more involved in health care decisions and improve health outcomes. 19

 New eligibility determination methodology for Medicaid (excludes disabled population)  Uses a single streamlined application  Provides for no wrong door for application ◦ Online ◦ In person ◦ Telephone  Standardizes the calculation of income with consistent formula  Relies on electronic data matching to the greatest extent possible  Removes asset test 20

 New websites –  The Healthy Michigan Plan waiver amendment and approval is posted.  Healthy Michigan Handbook is posted  Link to Healthy Michigan plan policy  Will continue to post information as it becomes available.

 New toll-free numbers for MAGI related activities.  MI healthcare helpline is  The phone application assistance helpline is  Call-line information will be updated when the Healthy Michigan Plan is implemented.

Presentation title here Impact of Health Reform on MiPCT Juanita Vorel, Health Reform Manager

Which plans are offered on the exchange? Priority Health offers 19 individual plans 6 HMO plans -+3 HMO plans with HSAs 6 PPO plans -+3 PPO plans with HSAs Catastrophic plan Plans are available in bronze, silver & gold metal tiers

Can you describe enrollment so far? 3,000+ members as of Jan. 31 for Priority Health Silver plans most popular

Which plans are expected to gain the most enrollment? Priority Health HMO is new to the individual market in 2014 HMO remains the most popular plan offering both at Priority Health and in Michigan Silver plans most popular

How many MiPCT patients are expected?

What is expected in HDHP enrollment? Remains popular among our pre-ACA members Dropping overall throughout the state

Doc ID Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. BCBSM and BCN 2014 Product Portfolio March 12 th, MiPCT March Health Reform Webinar

Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association Individual Market Product Portfolio 18 product choices - 5 product lines Blue Care Network Select HMOPreferred HMOBroad PPO Blue Cross® Select Value Blue Cross® Select Bronze Blue Cross® Select Silver Blue Cross® Select Gold Blue Cross® Preferred Gold Blue Cross® Preferred Silver Blue Cross® Preferred Bronze Blue Cross® Preferred Value Blue Cross® Premier Gold Blue Cross® Premier Silver Blue Cross® Premier Bronze Blue Cross® Premier Value Blue Cross® Gold, a Multi-State Plan* Blue Cross® Silver, a Multi-State Plan* $ Low $ High Blue Cross® Partnered Value Blue Cross® Partnered Bronze Blue Cross® Partnered Silver Blue Cross® Partnered Gold Partnered HMO BCBSM

Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 32 Blue Cross® Premier and Blue Cross® Multi-State Plan Product Lines Blue Cross® Premier Gold Blue Cross® Premier Silver Blue Cross® Premier Bronze Blue Cross® Premier Value BCBSM Broad PPO Platform - Blue Cross Blue Shield of Michigan - Preferred Provider Organization (PPO) Network - Trust Network -Members have a broad choice of doctors and hospitals within BCBSM’s unsurpassed statewide PPO network, including nationwide coverage. Service Area - Available statewide Blue Cross® Gold, a Multi-State Plan Blue Cross® Silver, a Multi-State Plan BCBSM Broad PPO Blue Cross® Gold, a Multi-State Plan Blue Cross® Silver, a Multi-State Plan

Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 33 Blue Cross® Preferred Product Line Blue Cross® Preferred Gold Blue Cross® Preferred Silver Blue Cross® Preferred Bronze Blue Cross® Preferred Value BCN Broad HMO Platform - Blue Care Network - Health Maintenance Organization (HMO) Network - Blue Care Network Commercial Network -Members have a broad choice of doctors and hospitals from BCN’s entire HMO network. Service Area - Available to residents of 70 Michigan counties

Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 34 Blue Cross® Select Product Line Blue Cross® Select Value Blue Cross® Select Bronze Blue Cross® Select Silver Blue Cross® Select Gold BCN Select HMO Platform - Blue Care Network of Michigan - Health Maintenance Organization (HMO) Network - PCP Focus Network -Members choose from a select network of quality primary care physicians (PCP Focus network) with complete access to specialists and hospitals within BCN’s entire HMO network. Service Area - Available to residents of 19 Michigan counties

Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 35 Blue Cross® Partnered Product Line Blue Cross® Partnered Value Blue Cross® Partnered Bronze Blue Cross® Partnered Silver Blue Cross® Partnered Gold BCN Partnered HMO Platform - Blue Care Network of Michigan - Health Maintenance Organization (HMO) Network - Partnered Network -Members will receive care within the Mercy Health system of doctors and hospitals. -Members may receive care within BCN’s entire HMO network, but outside the Mercy Health system, will require primary care physician and plan authorization. Service Area - Available to residents of Kent, Muskegon and Oceana counties

Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 36 Availability Varies By Geography