health care reform implementation: what does it mean for community health centers? qi/pcmh...
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Health Care Reform Implementation: What does it mean for Community Health Centers?
QI/PCMH Roundtable3/14/2013
New System of Coverage Under Health Reform
Employer Sponsored Coverage – Not much will change
EXPANDED Public Program: - Medicaid, Medicare, CHIP- NEW Federal Basic Health
Option
NEW Exchange:- Individuals & Small Businesses- Subsidized & Unsubsidized
What Happens to Today’s Uninsured in 2014?
Program Type Transition to NEW Coverage
Projected NEW Enrollment in
2014Public Program EXPANDED Medicaid 192,000
Commercial NEW Health Benefit Exchanges – Individual and Small Group 303,000
TOTAL newly covered people in 2014 495,000
People remaining uninsured 367,000
NOTE: 270,000 currently uninsured seen at CHCs
Projected CHC Enrollment Opportunity
Coverage Source
Projected Eligibility from CURRENT CHC
Uninsured Patients
NEW Opportunity Pool from OUTSIDE
Medicaid 164,700 27,300
Individual Exchange 46,900 212,100
Remaining Uninsured 56,000 321,000
Uninsured Patients in CHCs Statewide in 2010 ~ 267,000
Health Coverage for Immigrant Adults• In 2010, 217,000 undocumented; 4% of state’s 5.9 million
residents under 65 yrs.
– Not eligible for Medicaid– Not subject to individual mandate– Barred from purchasing insurance in the Exchange (ACA sec. 1312(f)(3))– Remain eligible for emergency care under Medicaid– Pregnant women still covered
• Legally Present Resident Aliens:
DDd
Legally Present Under 5 Years 5 Years or More
0% - 138% of FPL Purchase on Exchange; eligible for cost sharing subsidies
Eligible for Medicaid
139% - 400% of FPL Purchase on Exchange; eligible for tax credits
Purchase on Exchange; eligible for tax credits
Healthplanfinder: The Enrollment Superhighway
• Assisted, easy-to-use process for all interested in coverage
• Seamless “one stop” shop where “apples to apples” comparisons can be made
• Simpler eligibility rules
• Efficient, technologically advanced systems with telephonic, internet and in-person options
• Strong navigator program to assist individuals seeking coverage
Benefits for Newly Eligible Medicaid Adults
• Called Alternative Benefit Plan (aka Medicaid Benchmark)
• Benefits for new adults must:– Cover all 10 essential health benefits as
defined for Medicaid (may be different for Exchange)
– Meet mental health parity (currently applies to private plans and Medicaid managed care, but not fee-for-service)
– Cover non-emergency medical transportation
– Cover Early Periodic Screening, Diagnosis and Treatment
• Benefits for new adults may:– Align with existing Medicaid benefits
package– Differ for different eligibility groups
Some Issues to Consider
• How will CHCs educate front-line staff and providers about new coverage opportunities?
• How can CHCs help their uninsured patients enroll in coverage?
• How can MLCHC retain current patients once they have insurance coverage?
• Does MLCHC have the capacity for new patients?
Where Does Quality Fit?
• Health Benefits Exchange provide quality measures per health plan
Questions