this webinar is supported by a contract from the health resources and services administration...

This webinar is supported by a contract from the Health Resources and Services Administration

Multi-shares and the Affordable Care Act

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Multi-shares and the Affordable Care ActMarch 2, 2011

This webinar will begin at 1:00pm eastern. Please hold until Anne Gauthier starts the conference.

This webinar is supported by a contract from the Health Resources and Services Administration

Multi-shares and the Affordable Care Act

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NH

`

MA

NJ

CTRI

DE

VT

DC

MD

PA

FL

GA

SC

KY

IN OH

MI

TN

MSAL

MO

IL

IA

LA

AROK

NE

ND

SD

HI

MT

WY

UT

AK

AZ

NM

ID

CA

The State Health Access Program (SHAP)

This webinar is supported by a contract from the Health Resources and Services Administration

Multi-shares and the Affordable Care Act

3

Today’s AgendaIntroductions Anne Gauthier

Senior Program Director, NASHP

Overview Kathy WitgertProgram Manager, NASHP

Presentation Gary PackinghamCommunity Health Ventures

State Reactor Megan WoodColorado Department of Health Care Policy and Financing

State Reactor Cara BaileyMinnesota Department of Human Services

Question and Answer

This webinar is supported by a contract from the Health Resources and Services Administration

Multi-shares and the Affordable Care Act

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What Are Multi-Shares?

Kathy WitgertProgram Manager, NASHP

This webinar is supported by a contract from the Health Resources and Services Administration

Multi-shares and the Affordable Care Act

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What Are Multi-shares?Traditional ESI

Employee Employer

Multi-shares

Employee Employer Third Share

This webinar is supported by a contract from the Health Resources and Services Administration

Multi-shares and the Affordable Care Act

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Multi-share ModelsClassic Multi-share

Employee Employer Community

ER Diversion Multi-share

Hospital Funds Enrollee Fees

This webinar is supported by a contract from the Health Resources and Services Administration

Multi-shares and the Affordable Care Act

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The ACA and Multi-shares

• Individual Responsibility• Insurance Regulations

– No annual or lifetime limits– Essential benefits– Grandfathering rules

• Hospital community benefit

This webinar is supported by a contract from the Health Resources and Services Administration

Multi-shares and the Affordable Care Act

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Issues for Multi-Shares and States

• Is this coverage an insurance product?• Who is the population currently served?

– What will their potential coverage sources be in 2014?

• How will multi-shares assist enrollees with possible transition to different coverage sources in 2014?

• Will partners in the multi-share shift?• How will states support those who do not

have coverage after 2014?

Health Care Reformand the

Multi-Share Plan

Gary Packingham, Vice President CHV

March 2, 2011

Community Health Ventures, Inc. 2011

How do MSPs fit in the ACA?

20 million people remain uninsured - CBO estimate

These are people largely exempt from individual mandate

Most will have "affordability exemptions"- premiums available on exchange exceed 8% household income

Most will work in small businesses exempt from employer requirement

Likely to earn above 250% FPL

Community Health Ventures, Inc. 2011

Affordability Table

Community Health Ventures, Inc. 2011

Based The Kaiser Health calculator for a Silver Plan in 2014 on the exchanges costing $3,500 / yr. for a 40 year old individual.

Policy Challenges for MSPs in the ACA

Must provide essential health benefit in sec. 1302 (b) MSP essential health benefit must be accepted by

IRS MSPs are "grandfathered plans" operating outside

the exchange Nothing in ACA terminates coverage in existing

grandfathered plans under sec. 1251 Uncertainty for new MSPs

Must be recognized as Qualified Health Plans to be on exchanges

Community Health Ventures, Inc. 2011

Barriers to Becoming a Qualified Health Plan (QHP)

Community Health Ventures, Inc. 2011

ACA criteria for QHP is specific to insuranceo State licensing and related insurance requirements

o Must meet ACA insurance reform criteria

MSPs are not insuranceo Licensed by states as alternatives to Insurance

o Typically regulated outside of state insurance commission

Potential opportunities for MSPs

Community Health Ventures, Inc. 2011

HHS regulators could recognize MSPs as meeting

QHP criteria equivalency o Licensed and certified under state statutes to provide essential

health benefit

o Regulated by states to ensure solvency and consumer protections

CO-OPs could possibly include MSPs as QHPs o Subject to Regulations for Sec. 1332

State Flexibility (sec. 1324) could allow states to

include MSPs in 2017 (or 2014 if amended)o Can MSPs survive until 2017 or 2014 in current budget climate

Sec. 9007: Community Benefit Hospital Reporting to IRS

Changes in sec. 9007 require more specific hospital CB spending

Tied to Community Health Needs Assessment Reflects decrease in charitable care Potential increase in community program spending

offset MSPs can qualify as eligible CB spending under

this section

Community Health Ventures, Inc. 2011

Challenges for MSPs and State Exchange Planning

How to plan for MSP role on exchanges ahead of key regulatory decisions Availability on SHOP Exchanges for small group

coverage- Availability on individual exchanges How to limit individual market to small business

employees How to have exchanges recognize MSP coverage

for compliance to the individual mandate How to create exchange legislation that would

include MSPs

Community Health Ventures, Inc. 2011

Summary of MSP Policy Issues

ACA leaves millions uninsured MSPs have potential to remedy part of this problem Policy and regulatory framework currently limits

MSP opportunities Budget priorities threaten some MSPs near term

viability Community partnerships can work through all these

challenges

Community Health Ventures, Inc. 2011

Colorado’s Multi-Share Programs

March 2, 2011

Megan Wood HRSA SHAP Grant Project Director

Megan.Wood@state.co.us

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Two Multi-Shares• Health Access Pueblo (

www.healthaccesspueblo.org) – Five year legislation passed in June 2007– Enrollment began October 2008– Serves Pueblo county – 32 employers and 101 enrollees

• CarePoint – Five year legislation passed in June 2009– Enrollment began May 2010– Covers six counties in southern Colorado

(Alamosa, Conejos, Costilla, Mineral, Rio Grande and Saguache)

– 19 employers and 68 enrolleesColorado Department of Health Care Policy and

Financing

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Multi-Share Counties

Colorado Department of Health Care Policy and Financing

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Colorado Multi-Share Overview

• Traditional multi-share concept– Monthly premium divided evenly among (1)

employees, (2) employers and (3)community share

• Not an insurance product• Contracting with employers with 2 or more

employees– Working a minimum of 15 hours/week– Not currently offered any other health insurance

coverage– Earn between minimum wage and $25/hour

• Locally governed

Colorado Department of Health Care Policy and Financing

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Colorado’s Multi-Share Roles

• Network of coordinated care within the community

• Wellness programs for enrollees• Educate and refer people to public

coverage• Coordination with local community efforts

for getting people health care coverage

• Plays a key role in covering lives until ACA is implemented

Colorado Department of Health Care Policy and Financing

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Colorado and the ACA

• Uninsured individuals post ACA– Exempt from individual mandate– Below the tax filing threshold that are eligible for

Medicaid (no penalty for not enrolling in Medicaid)

– Opting to pay tax penalty– Undocumented individuals– Incomes that fluctuate and they become eligible

for different programs on a regular basis (churn)

Colorado Department of Health Care Policy and Financing

Source: Colorado Health Institute analysis of 2008-09 Colorado Household Survey and 2008 American Community Survey

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Colorado’s Numbers after ACA Implementation

Multi-share counties

Colorado Department of Health Care Policy and Financing

Adults Children TOTALPopulation Percentage

Current Uninsured

624,000

176,000 800,000 18.6%

Post ACA Uninsured

258,000

76,000 258,000 6.0%

Pueblo County

Population

Percentage

San Luis

Valley

Population

Percentage TOTAL

Current Uninsured

23,735 18.8% 9,137 24.3% 32,872

Post ACA Uninsured

7,646 6.0% 2,944 7.8% 11,943

Colorado

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Current Questions on the Table

• Who will be the (new) target population?• Of those uninsured post ACA, how many will

enroll in ‘charity care’?• Will there still be enough providers given

the spike of new enrollees in an already strained system?

• Will (and/or how will) multi-shares integrate with the Exchange?

• Will multi-shares continue in their current capacity or will their role change?

Colorado Department of Health Care Policy and Financing

Minnesota’s SHAP Multi-Share Programs

Cara Bailey, Project Directorcara.l.bailey@state.mn.us

Minnesota Department of Human Services

Local Access to Care Programs (LACPs)

LACPs cover enrollees ≤ 350% FPG• HealthShare

– Contracts with employers – Northeast Minnesota (Duluth)– Jan. 2011 SHAP-funded enrollment:

• 110 employers, 308 members

• Portico HealthNet– Works directly with low-income

uninsured individuals– Twin Cities Metro Area (St. Paul)– Jan. 2011 SHAP-funded enrollment:

• 682 members

• Values Health [PrimeWest]– Contracts with employers – Greater Minnesota (Alexandria)– Jan. 2011 SHAP-funded enrollment:

• 8 employers, 46 members

HealthShare

• Serves 4 Northeast counties:– Carlton, Cook, Lake, and Saint Louis

• Traditional “multi-share” – Three shares: Employer, employee, and community share

• Recruits small employers (< 50 employees)– Median wage must be ≤ $18.22/hour ($37,905/year)

• Limited benefit set: Primary, specialty, hospital, lab/X-ray/imaging, pharmacy, equipment/supplies

• Care management supported through annual health risk appraisal

• Online: www.healthsharemn.com

Portico Healthnet

• Located in 4 Metro counties:– Dakota, Hennepin, Ramsey, Washington

• Limited benefit pre-paid individual plan• Recruits individuals, typically working poor

– Also assists with MHCP application process• Limited benefit set: Primary, preventive, specialty, urgent,

outpatient mental health, prescriptions, interpreters• Care management supported by face-to-face family

interview upon enrollment• Online: www.porticohealthnet.org

Values Health• Will enroll in 13 Western counties:

– Beltrami, Big Stone, Clearwater, Douglas, Grant, Hubbard, McLeod, Meeker, Pipestone, Pope, Renville, Stevens, Traverse

– Counties already served by PrimeWest (parent company)• Traditional “multi-share”

– Three shares: Employer, employee, and community share• Recruits employers; targets small businesses (< 50 employees)• Benefit set: Preventive, primary, specialty, urgent care,

maternity/childbirth, emergency room, lab/X-ray/imaging, prescription drugs, chiropractic, outpatient mental health

• Care management supported through initial health risk assessment • Online: www.primewest.org, www.valueshealth.org

Minimum LACP Components

• Affordable limited benefit set• Comprehensive network of designated providers• Preventive care• Care management• Health assessment, coaching• Easily navigable services• Enrollee empowerment• Cost-sharing

Value Added

• Expand affordable coverage options• Reduce disparities in access to health care

coverage• Provider network, coordinated care• Increase enrollment of eligible individuals into

Medicaid

Lessons Learned

• Steep start up costs• Challenging to break into the small business

market, but once done, enrollment accelerates due to “word of mouth”

• Community-based organizations can facilitate enrollment into public programs and reach populations considered “hard to reach”

• Limited benefit set, but access to coordinated primary care valuable

State Perspective: Multi-shares and the ACA

We know that multi-shares can bridge the gap until

implementation of the ACA in 2014.

State Perspective: Multi-shares and the ACA

For planning beyond 2014, questions to be asked:

– Will there continue to be a gap in coverage after 2014 that can be served by the multi-share model? What are the characteristics of that population and how are they best served?

– How can we assure that access to coordinated care is provided and not just “coverage”?

– How can populations not likely to engage the Exchange be reached?

This webinar is supported by a contract from the Health Resources and Services Administration

Multi-shares and the Affordable Care Act

Use the chat function to submit your questions

Question and Answer

This webinar is supported by a contract from the Health Resources and Services Administration

Multi-shares and the Affordable Care Act

• Webinar archived on www.healthcarecommunities.org

• Visit www.nashp.org for additional resources

• For additional resources related to health reform, visit State Refor(u)m at www.statereforum.org

Additional Resources

This webinar is supported by a contract from the Health Resources and Services Administration

Multi-shares and the Affordable Care Act

Please feel free to contact the SHAP team with any questions.

Thank You

Anne GauthierSenior Fellowagauthier@nashp.org

Kathy WitgertProgram Managerkwitgert@nashp.org

Denise OsbornPolicy Specialistdosborn@nashp.org

Chris CantrellResearch Assistantccantrell@nashp.org

Christina MillerResearch Assistantcmiller@nashp.org