1. Health Reform in King County Housing Development Consortium November 13, 2012 Jennifer DeYoung Health Reform Policy Analyst, Public Health - Seattle & King County jennifer.deyoung@kingcounty.gov Susan McLaughlin Health and Human Services Integration Manager, Department of Community and Human Services susan.mclaughlin@kingcounty.gov

2. Presentation Overview Health Reform in King County – Benefits to date Access and Outreach Efforts Delivery System Reforms – Managed Care – Health Homes Health Reform and Housing Questions 2

3. The Affordable Care Act: Four Key Strategies 3 3

4. Timeline of Key Health Reform Activities Affecting Seattle & King County 4 New Medicaid Managed Care contracts in effect Medicaid beneficiaries with disabilities phased into mandatory Managed Care Open enrollment begins for Exchange & Medicaid Expansion (Oct 1) Medicaid Expansion & Exchange Coverage Begins (Jan. 1) July 2012 January 2013 January 2014 October 2013 March 2010 Supreme Court ruling June 2012 ACA signed into law Development of Health Benefit Exchange Health Homes Initiative for high risk Medicaid (Nov 1)

5. Benefits Today: Health Reform in King County About 736,000 individuals no longer face lifetime caps on their health benefits About 15,000 young adults up to age 26 are covered by their parents’health plans About 368,000 individuals have coverage for preventive care with no co-pays or deductibles Source: Public Health-Seattle & King County, 2012. 5

6. Next 14 Months: A Critical Time for King County to Shape Health Reform To gear up for enrollment To shape Medicaid delivery system changes focused on high-risk, high-need enrollees To influence Exchange policies and Medicaid program changes 6

7. King County Health Reform Planning Team Co-convened by Public Health and Department of Community & Human Services Adoption of Framework for an Accountable, Integrated System of Care Identification of priority areas of focus 7

8. King County Health Reform Planning Team Vision (Framework) Create a Transformed System of Care with a Single Point of Accountability for Low- Income Residents Through person-centered medical home, intensive care management, comprehensive community hubs, and prevention and wellness. Priority Areas of Focus for Achieving Vision: Access Ensure residents obtain coverage Capacity Ensure system of care can provide the right care at the right time in the right setting Delivery System Integration Promote systems of care that effectively integrate clinical care, community prevention, and human services Resources Sufficient resources to achieve the Framework vision and meet residents’ health and human service needs Education Ensure the safety-net consumer and provider community understands how health reform will impact them

9. Key Changes Still to Come How Will We Get to Expanded Coverage? 9 Medicaid Program Coverage (up to 133% FPL) Federal Basic Health Option ? 133% - 200% FPL Employer- sponsored coverage Exchange (Tax credits & cost sharing subsidies for those 100-400% FPL) Individual mandate FPL = Federal Poverty Level. 133% of FPL is about $15,000 for an individual. 9

10. Providing input on development of Health Benefit Exchange Influencing shape of Essential Health Benefits package Developing community-wide enrollment strategy 10 Access Ensure residents obtain coverage Access and Outreach Efforts

11. Managed Care in King County 11

12. Health Home Models of Care Comprehensive care management including – Intensive/chronic disease management – Transitions management/readmission reduction – Self-management support/patient education – Linkages to community/social support services Health Assessment Coordinated Health Action Plans Use of Health Information Technology 12

13. Health Home Structure Network of organizations that provide health home services Each network has an identified “lead entity” that is responsible for administrative functions Bridges all service domains including medical, mental health, chemical dependency, long term services and supports May include health plans, community based organizations, clinics, etc. 13

14. Timeframe/Next Steps State will “qualify” health home networks – King County exploring creating a Health Home Network including PHSKC, DCHS, and AAA Implementation being phased in regionally King County implementation November 1, 2013 14

15. Health Reform and the Housing System Key areas of opportunity and planning for the Housing System and health reform: 1.Enhanced roles in helping people get enrolled in and retain health coverage. 2.Care coordination & care transition partnerships with Medicaid managed care organizations. 3.Potential for reimbursement of certain services under Medicaid

16. 1. Enhanced roles in helping individuals get enrolled in and retain health coverage Community-wide strategy to assure people get enrolled in Medicaid expansion & Exchange will be crafted. Potential for longer-term payoff for housing providers→ greater access to earlier medical & behavioral health care.

17. 2. Care coordination & care transition partnerships for those on Medicaid Significant numbers of formerly homeless clients will be on Medicaid and in a managed care plan. Over time housing providers will need to cultivate working relationships with all 5 Managed Care Organizations (MCOs). Many may be involved in a health home and receiving care coordination & care transition functions Housing providers will play a critical role as essential partners in health home networks

18. 3. Potential for reimbursement Medicaid Expansion provides a potential source of revenue for people in supportive housing who have clinical service needs Health Home Networks provide an opportunity to serve people with the highest needs more efficiently Opportunities for WA to propose new ways of approaching healthcare through different state “authorities” or “waivers” 18

19. Corporation For Supportive Housing Develop a “cost case” for supportive housing that demonstrates that housing is healthcare Develop a crosswalk of the services provided in supportive housing with one or two possible state waivers Keep housing and other stakeholders involved 19

20. Health Reform Challenges Can’t underestimate the work needed to get and keep people covered Some will remain uninsured (including undocumented); others will fall off and on Lack of capacity in the safety net health system to serve increase in people Historic challenges of managed care in providing quality services for individuals with significant behavioral health issues 20

21. Staying Engaged WA State Health Benefit Exchange – http://www.hca.wa.gov/hcr/exchange http://www.hca.wa.gov/hcr/exchange WA Medicaid Expansion – http://www.hca.wa.gov/hcr/me http://www.hca.wa.gov/hcr/me WA State Health Care Authority listserv – http://www.hca.wa.gov/ http://www.hca.wa.gov/ King County Health Reform Planning Team – http://www.kingcounty.gov/healthservices/health/partnerships/Healt hReform.aspx http://www.kingcounty.gov/healthservices/health/partnerships/Healt hReform.aspx 21

22. Questions 22