1. Delaware’s Health Insurance Marketplace: Update on Activity Delaware Health Care Commission, May 1, 2014 Secretary Rita Landgraf, Department of Health and Social Services

2. Agenda Marketplace enrollment update Medicaid update Enrollment analysis Enrollment stories Special Enrollment Periods Consumer Assistance update Media and Outreach update SHOP update Important reminders 2

3. Enrollment Update

4. Marketplace and Medicaid Enrollment Update As of April 15, 2014, 18,614 Delawareans have enrolled in health care coverage through expanded Medicaid and the Marketplace since October 1, 2013 4

5. Marketplace and Medicaid Enrollment Update Enrollment for October 1, 2013 through April 15, 2014:* Total Number of Enrollees Increase from previous month Marketplace*14,39727% Medicaid4,21724% Total18,61426% *This number represents Delawareans who have selected a Marketplace plan, either through Healthcare.gov or through direct enrollment with an issuer (with or without the first premium payment having been received directly by the Insurance Company.) 5

6. Marketplace Enrollment

7. Marketplace Enrollment Update Marketplace Plan Selection by Metal Level — Silver plans account for 59% of the plan selections in the Delaware Marketplace. Metal level distribution (rounded to the nearest whole number): Bronze = 16% Silver = 59% Gold = 17% Platinum = 6% Catastrophic = 1% Marketplace Plans: Financial Assistance — More than three-quarters (81%) of the Delawareans who have selected a Marketplace plan will be receiving Federal financial assistance in paying their premiums. This includes people who qualify for an advance premium tax credit (APTC), with or without a cost-sharing reduction (CSR). Paid Premiums* — 64% of those who selected plans by April 15 th had paid their first month’s premium. *Reminder—those who enrolled between March 16 and April 15 th had until April 30 th to pay their first month’s premium for coverage to go into effect on May 1 st. 7

8. Marketplace Enrollment Update: Comparison by Age Enrollees% Enrolled Age Groups 0 -171,57811% 18 – 251,0777% 26 – 342,27616% 35 – 442,35516% 45 – 543,16022% 55 – 643,90227% 65+49<1% Total14,397100% 8

9. Marketplace Enrollment Update: Comparison by County Enrollees% Enrolled County New Castle8,47759% Kent1,80313% Sussex4,11629% Total14,396*100% 9 *Data received from the issuer only included county identification for 14,396 enrollees.

10. Marketplace Enrollment Update: Comparison by Gender Enrollees% Enrolled Gender Male6,48045% Female7,91755% Total14,397100% 10

11. Marketplace Enrollment Update: Metal Level Comparisons by Age 11 Delaware Marketplace Enrollment 0-1718-2526-3435-4445-5455-6465+ Bronze 20916033536654769711 Silver 7946331,3321,4301,9352,33434 Gold 4051633233775146882 Platinum 151731501811631832 Catastrophic 194813611N/A Total 1,5781,0772,2762,3553,1603,90249

12. Marketplace Enrollment Update: Metal Level Comparisons by Gender and County 12 Delaware Marketplace Enrollment New CastleKentSussex Bronze 1,564287474 Silver 5,3341,0862,072 Gold 1,489319663 Platinum 64279182 Catastrophic 1383235 Total 9,1671,8033,426 Delaware Marketplace Enrollment MaleFemale Bronze 1,1051,220 Silver 3,6864,806 Gold 1,1381,334 Platinum 432471 Catastrophic 11986 Total 6,4807,917

13. Marketplace Enrollment Update: Stand- Alone Dental Plans (SADPs) Total SADPs (Paid Premium Only) Child Only SADP Child + Adult SADP Total Count1,1721371,035 Total Percentage100%12%88% 13 NOTES: Some QHPs already include pediatric dental benefits, so children who enrolled in those medical plans have dental coverage. All SADPs must include the pediatric dental benefit to be certified for the Marketplace.

14. Medicaid Newly Eligible Enrollment

15. Medicaid (Newly Eligible) Enrollment Update: Comparison by Age Enrollees% Enrolled Age Groups 19 – 2574517.7% 26 – 341,05024.9% 35 – 4493222.1% 45 – 5486920.6% 55 – 6462114.7% Total4,217100% 15

16. Medicaid (Newly Eligible) Enrollment Update: Comparison by County Enrollees% Enrolled County New Castle219152.0% Kent86420.5% Sussex1,16227.6% Total4,217100% 16

17. Medicaid (Newly Eligible) Enrollment Update: Comparison by Gender Enrollees% Enrolled Gender Male1,39633.1% Female2,82166.9% Total4,217100% 17

18. Enrollment Analysis

19. Trend of Total Marketplace QHP Enrollments 19

20. QHP Enrollments by Time Period 20

21. Analysis: The “Young Invincibles” 21 59% of 18-34 year olds chose a Silver plan.

22. Young Invincible Enrollment: Medicaid and Marketplace *Medicaid Young Invincible age range is 19-34 years old

23. National Reports on ACA Impact on the Uninsured April 3, 2014: The Health Reform Monitoring Survey, conducted quarterly by the Urban Institute and Robert Wood Johnson Foundation, found that the uninsured rate for adults ages 18-64 declined 2.6% for states that decided to expand their Medicaid population. http://hrms.urban.org/briefs/early-estimates-indicate-rapid- increase.htmlhttp://hrms.urban.org/briefs/early-estimates-indicate-rapid- increase.html April 16, 2014: A Gallup Survey reported that the national uninsured rate for non- elderly adults was 15.6%, down from 17.3% in 2013 and a peak of 18% the three months before Open Enrollment. http://www.gallup.com/poll/168539/uninsured- rates-drop-states-embracing-health-law.aspxhttp://www.gallup.com/poll/168539/uninsured- rates-drop-states-embracing-health-law.aspx April 2014: RAND released a report, Changes in Health Insurance Enrollment Since 2013, which examined enrollment between September 2013 and March 2014. The report estimates that during this time the national uninsured rate fell from 20.5% to 15.8%. http://www.rand.org/pubs/research_reports/RR656.htmlhttp://www.rand.org/pubs/research_reports/RR656.html 23 Results from three national private surveys indicate that the number of uninsured adults has dropped since the ACA went into effect.

24. Going Forward — Analysis of Marketplace Data The state is waiting for additional data from HHS that will allow for more detailed demographic analysis on those consumers who enrolled through the Marketplace and through Medicaid expansion, and what the analysis may suggest about the overall impact on Delaware’s uninsured. HHS will develop and administer consumer surveys to understand how well the Marketplaces and qualified health plans are meeting consumers’ needs. National implementation by CMS in 2016. Will support federal and state quality monitoring, program improvements, and future research. The Kaiser Family Foundation offers more information about how the federal government will attempt to measure changes to insurance coverage : http://kaiserfamilyfoundation.files.wordpress.com/2014/04/8586-measuring- changes-in-insurance-coverage-under-the-affordable-care-act2.pdf http://kaiserfamilyfoundation.files.wordpress.com/2014/04/8586-measuring- changes-in-insurance-coverage-under-the-affordable-care-act2.pdf 24 The Marketplace team is working to better understand who signed up during the initial launch and how to reach those who didn’t.

25. Enrollment Stories

26. Stories from the Ground 26 A 52-year-old woman from Wilmington, who was “in line” March 31, finished her enrollment with assistance from a Guide on April 12. After a tax credit of $396, she will pay $45 a month. It took a 35-year-old Ellendale man three appointments with a guide at the Milford Library to choose his plan. He will not receive a tax credit, but is satisfied with the cost of his new plan. A Guide assisted a woman from Newark whose children are covered by CHIP. Her husband is not eligible for coverage through the Marketplace. After a tax credit of $271, she will pay $60 a month for her plan.

27. Stories from the Ground 27 A 34-year-old woman from Milford requested support from a Guide at the Milford Library. She was eligible for a tax credit of $156, making her monthly payment $114. She was grateful to get help in such a short time. On April 2, a Guide assisted a 62-year-old Dover man who had been unable to complete his enrollment before the deadline because of system issues. His previous insurance had expired and his new plan will have a monthly premium of $465. A 38-year-old single mother of two who works in home health care had been enrolled in Medicaid but was denied after her last renewal. She cannot enroll in her employer- based coverage until January. She qualified for a subsidy of $173 and will pay $87 a month. On April 16, a Guide assisted a couple in Middletown with their special enrollment. They are paying $1,100 a month for insurance that will be canceled June 1. They are excited that they will pay $256 a month for their new plan after a $803 tax credit.

28. Special Enrollment Periods

29. Complex Cases Although open enrollment is closed, Delawareans with certain complex cases will be allowed additional time to complete the Marketplace enrollment process. This may include consumers: Awaiting Medicaid eligibility results That received incorrect subsidy determinationsor calculations at Healthcare.gov That encountered problems verifying an eligible immigration status Delawareans with complex cases will have 60 days from the date their issue is resolved in which to apply for and select a Marketplace plan 29

30. PCIP Special Enrollment Period HHS announced that individuals currently enrolled in the Pre-existing Condition Insurance Program (PCIP) will be eligible for a Special Enrollment Period. PCIP enrollees should contact a Marketplace Guide or the Federal call center to begin an application by May 1, 2014. PCIP enrollees will have until June 30, 2014, to select a plan. If the consumer is otherwise eligible to enroll in a qualified health plan, coverage will be effective back to May 1, 2014 for anyone who uses this Special Enrollment Period. Consumers who are Medicaid eligible may enroll throughout the year without a Special Enrollment Period. 30

31. Qualifying Life Events Individuals who started their applications April 1 or later will be unable to purchase coverage until the next open enrollment unless they qualify for a special enrollment period because of a life change, including: Getting married Birth or adoption of a child Moving to Delaware Losing minimum essential coverage 31

32. Consumer Assistance Update

33. Marketplace Guide Activities to Date As of April 18, 2014: 1,184 completed enrollments 2,164 completed applications 2,237 outreach activities conducted 1,454 referrals to Medicaid 33

34. Guide Support Remains Available Guides will continue to provide enrollment assistance for consumers that qualify for a special enrollment period List of Guide assistance locations and contact information is available at www.ChooseHealthDE.comwww.ChooseHealthDE.com Guides will be in communities: Staffing outreach events Making presentations and educating consumers Assisting consumers in need of post-enrollment support 34

35. Guide Support Remains Available Guides will also provide support to consumers in using and maintaining coverage Navigating the premium payment process, obtaining insurance documentation from issuers and understanding the coverage renewal process Helping consumers to understand essential health benefits, other covered services and the importance of accessing preventive care and connecting with a primary care provider Educating consumers about how and when to report life changes to the Marketplace and Medicaid 35

36. Media and Outreach Update

37. Media and Outreach Comprehensive media analysis of open enrollment campaign is currently ongoing Near-term planning and activities include: Conducting an online survey to determine drivers of and barriers to enrollment Researching and developing a culturally- competent Spanish-language campaign Developing partnerships with and supporting key stakeholders to identify the uninsured population and create processes for integration and long-term sustainability 37

38. SHOP Update

39. Employers with 50 or fewer full-time equivalent employees (FTEs) can enroll their employees in the SHOP Marketplace anytime. Enroll by the 15th for coverage that starts as soon as the 1st of the month. Two new tools on Healthcare.Gov can help: FTE Calculator: A quick way to see if you qualify for SHOP, especially if you have a mix of full-time and part-time employees. SHOP Tax Credit Estimator: Employers with fewer than 25 employees can help determine if your business may qualify for the Small Business Health Care Tax Credit and how much it could be worth to you. Go to https://www.healthcare.gov/small-businesses/ and look for the “Take Action” links.https://www.healthcare.gov/small-businesses/ 39 A more comprehensive update on SHOP will be presented at the June HCC meeting, including key changes expected in upcoming federal regulations and guidance.

40. Important Reminders

41. Key Dates for Consumers DateMilestone June 30, 2014QHP enrollment deadline for those currently enrolled in the Pre-existing Condition Insurance Program (PCIP) November 15, 2014-February 15, 2015Open enrollment for coverage in Plan Year 2015 41 Notes: Medicaid enrollment can occur at anytime. Employers may continue to enroll in SHOP on a rolling monthly basis. The deadline to enroll is always the 15th of the month for coverage to be effective the 1st of the following month.