this webinar is supported by a contract from the health resources and services administration...
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This webinar is supported by a contract from the Health Resources and Services Administration
Multi-shares and the Affordable Care Act
1
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
2
NH
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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
4
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
5
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
8
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
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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 [email protected]
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 [email protected]
Kathy WitgertProgram [email protected]
Denise OsbornPolicy [email protected]
Chris CantrellResearch [email protected]
Christina MillerResearch [email protected]