1. Delaware’s Health Insurance Marketplace: Update on Activity Delaware Health Care Commission, February 6, 2014 Secretary Rita Landgraf, Department of Health and Social Services

2. Agenda Stories from the Ground Updates since last Health Care Commission meeting Marketplace enrollment update Medicaid update Marketplace Guide update Key dates for the Marketplace Plan Management update 2

3. Stories from the Ground A Hockessin woman and her two adult children who were denied coverage under Medicaid are now having difficulty applying on the Marketplace because HealthCare.gov is flagging her application as being potentially eligible for Medicaid. Her case has been referred to a Rapid Response Team at the Centers for Medicare and Medicaid Services. A Townsend woman is transitioning to a new part-time job that doesn’t offer insurance. With the help of a Marketplace Guide, she qualified for a subsidy that will cover her costs entirely. She also chose a dental plan and will pay $31 a month. 3

4. Stories from the Ground A Dover man who lost his job in the fall thought he might be eligible for Medicaid, but he was not. He was referred to a Marketplace Guide for assistance. A 54-year-old retired woman from Delmar requested support from a Marketplace Guide at the Laurel State Service Center. Eligible for a $650 tax credit, she will pay $21 a month. She is happy to have affordable insurance and grateful to have been assisted. A Marketplace Guide at Westside’s Northeast office helped a 24- year-old single man enroll. He is eligible for a $82 tax credit and will have a monthly premium of $141. 4

5. Recent Updates On January 14 th, the U.S. Department of Health and Human Services announced an extension of the Pre- existing Condition Insurance Plan until March 31 st. Those currently enrolled in PCIP can remain in that plan until this new deadline. This impacts 249 Delawareans. As was reported in The Washington Post, a small percentage of HealthCare.gov enrollees nationwide have encountered errors and have filed appeals to correct those errors, but find themselves stuck in the system. CMS is working to manually contact these individuals to resolve their cases and has made system changes to resolve the issues they are encountering. 5

6. Recent Updates This week the Congressional Budget Office reduced by 2 million the number of uninsured people expected to get covered this year through the Affordable Care Act. The office expects 6 million people to sign up through the federal and state marketplaces, down from the previous estimate of 7 million, and another 8 million to get covered through the Medicaid expansion, down from 9 million. Earlier issues with adding dependents through special enrollments have been resolved 6

7. Marketplace and Medicaid Enrollment Update As of January 31, 2014, 6,458 Delawareans have enrolled in health care coverage through expanded Medicaid and the Marketplace since October 1, 2013 7

8. Marketplace and Medicaid Enrollment Update Enrollment for the 4-Month Period: October 1, 2013 through January 31, 2014* Total Number of Enrollees Increase from previous month Medicaid1,39632% Marketplace*5,06259% Total6,45853% *To be consistent with the Federal government’s reporting, 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.)

9. Marketplace Enrollment Update Marketplace Plan Selection by Metal Level — Silver plans account for 52% of the plan selections in the Delaware Marketplace. Metal Level Distribution (rounded to the nearest whole number): Bronze = 14% Silver = 52% Gold = 23% Platinum = 9% Catastrophic = 1% Marketplace Plans: Financial Assistance — More than three-quarters (76%) 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). 9

10. Marketplace Enrollment Update— Comparison by Age Enrollees% Enrolled Age Groups 0 -174368.6% 18 – 253015.9% 26 – 3471914.2% 35 – 4476415.1% 45 – 541,07421.2% 55 – 641,75334.7% 65+15.3% Total5,062100% “ Young Invincibles” (Age 18-34) represent 20% of Enrollment 10

11. Marketplace Enrollment Update - County Enrollees% Enrolled County Kent59712% New Castle3,09361% Sussex1,37227% Total5,062100% 11

12. Marketplace Enrollment Update— Gender Enrollees% Enrolled Gender Male2,22744% Female2,83556% Total5,062100% 12

13. Trend of Marketplace Enrollments 13

14. Medicaid (Newly Eligible) Enrollment Update – Comparison by Age Enrollees% Enrolled Age Groups 19 – 2526418.9% 26 – 3433423.9% 35 – 4430521.8% 45 – 5429521.1% 55 – 6419814.2% Total1,396100% 14

15. Medicaid (Newly Eligible) Enrollment Update – Comparison by County Enrollees% Enrolled County Kent31122.3% Sussex43030.8% New Castle65546.9% Total1,396100% 15

16. Medicaid (Newly Eligible) Enrollment Update – Comparison by Gender Enrollees% Enrolled Gender Male39128% Female1,00572% Total1,396100% 16

17. Marketplace Guide Activities to Date As of February 4, 2014: 386 completed enrollments 779 completed applications 1,251 outreach activities conducted Between October 1, 2013 and February 4, 2014, Marketplace Guides have referred 539 consumers to Medicaid 17

18. Enrollment Support Guides are now stationed at dozens of locations throughout Delaware, ready to help consumers apply for and enroll in coverage Locations include public libraries, state agency offices and Service Centers, healthcare facilities, schools, churches, and community centers Most locations accept walk-ins as well as scheduled appointments As always, please check www.ChooseHealthDE.com for the most up-to-date information about Marketplace Guide activities, including enrollment eventswww.ChooseHealthDE.com 18

19. Key Dates DateMilestone February 15, 2014Last day to enroll for coverage to begin on March 1; those who enroll between February 16-28 will have coverage beginning April 1. March 15, 2014Last day to enroll for coverage to begin on April 1; those who enroll between March 16-31 will have coverage beginning May 1. March 31, 2014Last day of open enrollment for coverage in Plan Year 2014. In order to buy a Marketplace health insurance plan outside the open enrollment period, you must have a qualifying life event. November 15, 2014-January 15, 2015 Open enrollment for coverage in Plan Year 2015 19

20. Plan Management Update Current Activities : QHP/Issuer Monitoring & Oversight Verify participation by medical QHP Issuers in the Delaware Health Information Network (DHIN). Ensure adherence to state and federal network adequacy standards for Essential Community Providers, including federally-qualified health centers (FQHCs). Preparation for the next QHP Review cycle Published DOI Bulletin (Feb 4, 2014) inviting Letters of Intent from Issuers to apply for QHP certification for 2015 Plan Year. Review proposed federal regulations and guidance to Issuers to identify changes from the previous year; and Develop proposed QHP application instructions, schedules, and templates for Issuers. 20

21. Plan Management—Looking Ahead The Marketplace Program team will work with HCC to review current state-specific QHP Standards and Essential Health Benefits (EHBs), and develop recommendations for changes for implementation in Coverage Year 2016. Planned Activities Review current QHP Standards and EHB benchmark to identify opportunities for modification/additions. Conduct Public Comment Period on proposed changes to QHP Standards and EHB Benchmark. Review stakeholder feedback on proposed changes and develop final recommendations for HCC review. Review Final Recommendations with HCC; and Approve and publish Delaware EHB benchmark and QHP Standards for Coverage Year 2016. 21