1. 1 Coverage Expansion Laura Appel

2. Political setting 2013 Term limits – more than 90 state lawmakers with ≤ 4 yrs. exp. Medicare and Medicaid account for half of avg. hospital revenue More than 1.1 million people uninsured in Michigan More than 1.8 million people in Medicaid, 167,000 eligible but not enrolled and 400,000 people projected to be added in 2013 2

3. Medicaid Expansion Why do it? Why not do it? resistance to Obamacare, $17 trillion in debt What’s in the expansion legislation? $1.5 billion appropriation Waiver requirements Personal responsibility requirements Health plan requirements Reduced general fund expenditure No immediate effect 3

4. Medicaid Expansion—next steps Spending appropriated funds contingent on waiver approval Federal waiver for new Medicaid design including health savings account Initiate Medicaid beneficiary enrollment program Expand Medicaid coalition to assist with enrollment process Effective date of HB 4714: end of first quarter 2014 Enrollment/eligibility for new Medicaid population is dependent on waiver approval 4

5. The Insurance Mall (online) Health Insurance Marketplace opened October 1 for enrollment 12 insurers offering products online Variety of plans—162 in Michigan Variety of premiums—depends on plan selected Variety of subsidies—depends on income Coverage begins January 1, 2014 5

6. Coverage Single application for all No denial for pre-existing conditions Insurers must cover a minimum set of services called essential health benefits Must organize their plan offerings into five levels of patient cost-sharing from least to most protective –Catastrophic for those 30 and under –Bronze –Silver –Gold –Platinum 6

7. Example 7 Most enrollees will pay a lower monthly premium than the unsubsidized rates presented above. For example, a 40-year-old with an income of 250 percent of the federal poverty level (roughly $29,000 per year) would pay about 8 percent of his or her income or $193 per month to enroll in the second-lowest-cost silver plan, regardless of the rating area.

8. Who can receive a subsidy? Anyone with income between 100 and 400 percent of the federal poverty level People with incomes between 100 and 133 percent of the FPL may choose between a product on the exchange (insurance mall) or a Medicaid managed care plan Plans available through Medicaid are likely to be lower cost—co-pays, deductibles and premiums will apply to some Medicaid enrollees 8

9. Michigan Qualified Plans Filed for Health Insurance Exchange 9 Health Insurance CompanyType of Filing Alliance Health and Life InsuranceIndividual/ Small Group Blue Cross Blue Shield of MichiganIndividual/ Multi State Plan/Small Group Consumers Mutual Ins of MI (CO-OP) Individual/Small Group Health Alliance PlanIndividual/Small Group Humana Medical Plan of Michigan, Inc.Individual McLaren Health PlanIndividual/Small Group Meridian Health Plan of Michigan, Inc.Individual Molina Healthcare of MichiganIndividual Priority HealthIndividual/Small Group Total Health Care USAIndividual/Small Group United Healthcare Life Insurance Company Small Group

10. Premium information available at DIFS http://www.michigan.go v/difs/0,5269,7-303- 12902_35510_66707- 313356--,00.html#noprint 10

11. Outreach and Enrollment Medicaid expansion + Subsidy-eligible population = More than 1 million people Health literacy among public is low Many are lower income workers who need assistance applying for coverage Exchange opened Oct. 1, continues through March 31, 2014 Coverage begins at different times

12. Who is Helping People Apply? Insurance agents Navigators DHS Certified Application Counselors (CACs): voluntary, 5+ hours training (all online) Who can be CACs? Hospitals, health centers, community-based organizations, physician offices, volunteers http://www.getcoveredamerica.org/page/event/search_si mplehttp://www.getcoveredamerica.org/page/event/search_si mple www.enrollmichigan.com www.michigan.gov/hicap

13. Available Role for Providers Opportunity to significantly decrease the number of uninsured people –Fewer uncompensated ER visits –Greater ability to connect people with preventive care –Maintain healthy population/productive workforce Hospitals are an obvious place to go for help; recommend preparing hospital staff to educate and assist Physician offices, FQHCs, free clinics—all trusted voices of care for those seeking coverage

14. How health systems are engaging in enrollment Certified Application Counselors Patient financial services staff, volunteer leadership, patient advocates Engaging trustees, volunteers and staff regarding the basics of coverage expansion Educating patients May conduct local outreach using detailed databases available from Enroll America—Michigan chapter

15. What MHA is Doing MHA tools for hospitals –FAQs –Outreach methods –CAC guidance –Sample news release, flyer –Flowchart of uninsured person’s options –Website links www.mha.org

16. Presumptive Eligibility ACA allows hospitals to determine presumptive eligibility for all Medicaid-eligible populations (including the expansion population) starting Jan. 1, 2014 Hospitals must move forward with these expanded determinations in compliance with state-issued policies and procedures A proposed policy issued by the state late this summer did not reflect these expanded privileges for hospitals This week the Department of Community Health provided informal notice to the MHA that this expansion of presumptive eligibility privilege for hospitals will not take effect until June 2014 16