Transcript NHHPP – What does it mean for Assisters?

NHHPP Waiver Program –
What Is It? / What Does It
Mean for Assisters?
Tom Bunnell – Policy Consultant
NHHPP Waiver Program – What Does it
Mean for Assisters?
 Background
 Benefits Package
 Cost-Sharing
 Application and Enrollment – Big Picture
 Special MCO Consideration
 Enrollment Walk Through
 A Few Other Key Issues
 Q&A
Background I
 NHHPP enacted Mar 27, 2014 / bipartisan compromise
 Immediate implementation of NHHPP (Medicaid expansion)
 Sunset at end of calendar year 2016 unless reauthorized
 Pursuit of “premium assistance” Medicaid Waiver
 HIPP Program, Bridge Program, and Waiver Program
 Premium Assistance Medicaid Waiver
 App submitted Dec 1, 2014 / approved Mar 12, 2015
 Brave new world – Merging Medicaid with private insurance
 But NHHPP is still a Medicaid program
Background II
 All NHHPP Bridge Program (Medicaid managed care) enrollees
must transition to Medicaid-financed QHP coverage on the
Marketplace effective Jan 1, 2016
 All new NHHPP enrollees must be in a QHP on the Marketplace
(except those that are exempt) effective Jan 1, 2016
 Every insurance carrier offering a QHP on NH’s FFM in 2016
must offer an NHHPP-compliant Silver level plan
 All carriers offering QHPs on NH’s FFM must accept NHHPP
participants as enrollees
Benefits Package
 The overall benefits package for NHHPP enrollees is exactly the
same for the Waiver Program as it has been for the Bridge Program
 But the package is separated into two parts for admin purposes:
 Private insurance Essential Health Benefits (EHB) through QHP Silver Plan
 Wrap-Around Benefits (satisfying Medicaid EHB) through Medicaid
 Medicaid wrap-around benefits:
 Non-emergency medical transportation (NEMT)
 Early Periodic Screening Diagnosis and Treatment (EPSDT)
 Family planning services and supplies
 Limited adult dental and adult vision services
 Enrollees will have one insurance card / seamless
Cost-Sharing
 Unique cost-sharing arrangement for Marketplace
 Although enrolled in a QHP on the Marketplace, NHHPP
enrollees will pay no premiums or deductibles out of pocket
 Medicaid will pay all premium and deductible expenses for
NHHPP enrollees’ QHP coverage
 NHHPP enrollees at less than 100% of FPL will have no co-pay
obligations / no cost-sharing
 Medicaid will be charged for and pay all co-pays
 But there will be cost-sharing, in the form of co-pays only, for
enrollees from 100% to 138% of FPL
Cost Sharing – Specifics
 Co-Pays for Enrollees at 100% to 138% of FPL (subject to an out
of pocket cap):
 Generic Prescription Drugs – $2
 Prescription Drugs – $6
 Specialty Prescription Drugs – $6
 Physician Specialist Services – $8
 Complex Imaging (CT/PET Scans, MRIs) – $25
 Behavioral Health Inpatient Admission – $50
 Hospital Inpatient Admission – $50
 For all such enrollees, cost-sharing on a quarterly basis cannot exceed
5% of income for quarter
Application and Enrollment I
 QHP coverage under the Waiver Program begins Jan 1, 2016
 New NHHPP applicants can apply for coverage under the
program starting Nov 1, 2015 (start of Open Enrollment 3)
 Enrollment will remain open year-round for NHHPP applicants
 Consumers may apply for the NHHP, select a QHP, and enroll
in the program:
 Through the DHHS online portal / NH EASY www.nheasy.nh.gov
 By phone at the DHHS NHHPP hotline, at 1-888-901-4999
 In person at a DHHS District Office
Application and Enrollment II
 Consumers may also apply for the NHHPP via NH’s
federally-facilitated Marketplace / www.HealthCare.gov ,
but the app file will need to be transferred to DHHS for
program enrollment and QHP selection:
 Need for HIPP and Medically Frail screening (possible
Waiver program exemption) at DHHS
 Medicaid Wrap-Around enrollment
 FFM will not yet have the technical capacity to restrict
NHHPP applicant shopping to Medicaid-only QHPs
Bridge Program Transition – Special MCO
Consideration
 Special Medicaid MCO consideration in NHHPP
authorizing statute and Waiver
 If MCO offers QHP on Marketplace, their NHHPP Medicaid
Managed Care enrollees will be auto-assigned to / autoenrolled in the MCO’s QHP
 Now know that NH Healthy Families (Centene) is offering
a QHP on the Marketplace
 WellSense (BMC HealthNet) is not
Enrollment Walk-Through – NH Healthy
Families
 On or about Nov 1 2015, current NHHPP NH Healthy
Families’ (NHHF) enrollees will receive a notice from DHHS
that they’ve been auto-assigned to the NHHF QHP, effective
Jan 1 2016
 Consumers will have 30 days to switch to a different Silver
level QHP, if they would like.
 There is still a question as to when, in this circumstance, the 30
day period kicks in
 ISSUE WATCH: Provider networks may be different!
Enrollment Walk-Through - WellSense
 WellSense NHHPP enrollees will receive a written notice from DHHS,
on or about Nov 1, 2014, of the required transition, and the need to
select a QHP for coverage
 Notice is required to provide guidance on how to select a QHP
 Notice is required to compare differences between available plans
 The consumer needs to select a QHP Silver Plan within 30 days
 If consumer doesn’t choose a QHP within 30 days, s/he will be auto-
enrolled in a QHP
 Follow-up notice will inform enrollee of their auto-assignment and of the
right to select a different QHP within 30 days
Enrollment Walk Through – New
Applicants
 Enrollment for Marketplace coverage under the Waiver program
begins Nov 1, 2015
 Anyone who applies and is found eligible on or after Nov 1, 2015:
 Will be enrolled in Medicaid fee for service, at the outset, until QHP
coverage begins for the enrollee
 Will be given a choice of plans for Marketplace coverage beginning Jan 1,
2016 or 30 days after notice of NHHPP eligibility, whichever occurs later
 If an applicant does not choose a QHP within 30 days of being found
eligible, s/he will be auto-assigned to a Silver level QHP
 Upon notice of auto-assignment, the enrollee will have 30 days to select
a different plan if s/he wants
Enrollment Walk Thru – Medically Frail
 An applicant or enrollee can self-certify, at any
time, that s/he is medically frail and opt out of
Marketplace coverage / is exempt from the
Waiver program
 Medically frail person must then elect to enroll
in either the Medicaid managed care Alternative
Benefit Plan or the standard Medicaid benefit
Other Issues
 Retroactive Coverage
 Grievances and Appeals
 NHHPP Reauthorization
 NHHPP sunsets Dec 31, 2016 unless reauthorized by
Legislature and Governor
 Large coalition advocacy effort engaged to ensure that
the program is reauthorized