Transcript PowerPoint Template 1

Healthcare Reform in Michigan
Chris Milligan, MBA
Agenda
 State of Uninsured
 Medicaid Expansion
 Qualified Health Plans
 QHP Enrollment Process
 Financial Impact
 What Can You Do?
 Resources
STATE OF UNINSURED
State of Uninsured – National
48.6 Million (January 2013)
 48.6 Million = 16.3% of Americans are Uninsured
 1.006 x Bush vote total in 2000
 1.8 x the number of Twitter users
 1.12 x the number of smokers
Managing the uninsured cost providers
over $49 billion a year!
State of Uninsured – Michigan
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1,237,500 = 13% of Michigan Citizens
Poverty Rate: 20% (Nation: 20%)
Average Income: $48,281 (Nation: $50,022)
Unemployment Rate: 8.9% (Nation: 7.9%)
“The Healthy Wait” – Is Over!
Courtesy of Kaiser Health News
State Uninsured - ACA
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Reduce Uninsured by 37.6 Million (74%)
17 Million – Medicaid Eligible
16.3 Million – Subsidies
4.3 Million – Individual Mandate
Medicaid DSH Payments Reduced
Medicare Payments Flat Line
What We Know – National Level
 Federal/State Exchanges (Insured)
–Beginning 12:01 a.m. January 1, 2014
–Sign up begins NOW!!!
 Financial counselors will become more important
 Insurance pays better than Medicaid and Charity
Care
–Pre-existing conditions will not impact insurance coverage
What We Know - Michigan
 Approved Medicaid Expansion
– Estimated that 35% of uninsured (1,237,500) will qualify for
Medicaid resulting in 433,125 new Medicaid enrollees
 Partnership Exchanges
– Exchange developed and supported by Federal Government
– Web brokers will be able to participate in exchange
– Estimated that 52% of uninsured will participate in QHP’s
643,500 newly “insured” leaving only 160,875 uninsured in
Michigan (1.7% uninsured)
MEDICAID EXPANSION
Comparison between Medicaid and a
Qualified Health Plan
Criteria
MAGI-Based Medicaid/CHIP
Qualified Health Plan
Household
Tax household with exceptions
Tax household
Income
Tax rules with exceptions
Tax rules
Disregard
5%
Not applicable
Budget Period
Point in time
Annual based on
(current month)
last tax return
Up to 3 months retroactive
Prospective
Start Date
QUALIFIED HEALTHCARE PLANS (QHP)
The Healthcare Enhance
Open Enrollment
 October 1, 2013-March 31. 2014
 October 2, 2014-December 31. 2014
 With a Qualifying Event
– Birth of a Child
– Marriage
– Loss of Employer based insurance among others
Subsidized Insurance Plans
Level
Bronze
Silver
Gold
Platinum
Coverage
60%
70%
80%
90%
Benefits are similar with the biggest difference being
the share of expected health care costs the plan will
cover “Actuarial Value”
Three Types of Forms
These will determine Eligibility
 Individual Short Form
 Family
 Individual without filing for assistance
Choosing the policy is done on a separate form
Example One
 Family of four headed by a
40 year-old making $35,000 per year
– Annual Premium $12,130
– Tax credit of $10,742
– Will pay $1,388/year or about 4% of
income (about $115 per month)
Example Two
 Family of four headed by a 40 year-old
making $90,000 per year
– Annual premium $12,130
– Tax credit of $3,580
– Will pay $8,550/year or about
9% of income (about $712 per month)
Income Levels for Marketplace
FAMILY SIZE
1
2
3
4
5
6
YEARLY INCOME
$45,960
$62,040
$78,120
$94,200
$110,280
$126,360
Insurance Penalty Calculation
The tax is the great of either
1) A flat dollar amount based on the number of
people in your household or
2) A percentage of your income (up to the cost
of a Bronze plan on your state marketplace
QHP ENROLLMENT PROCESS
Navigator’s
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Established at the state level via federal grants
Insurance companies prohibited as navigators
Federal funding for initial year only
Conduct public education activities
Provide information in a fair and accurate manner
Facilitate selection of a Qualified Health Plan
Provide referrals to any applicable of health
consumer assistance
In-Person Assisters (IPA’s)
 Limited to state based exchanges
 Federal government looking at partnership
exchanges
 Federal funding provided to establish IPA’s
 Scope similar to Navigator process
Certified Application Counselors (CAC’s)
 A CAC must be certified by state exchange or state
Medicaid agency
 No federal funding available
 Medicaid administrative matching funds maybe
available
 Anyone can be a CAC (hospital staff)
 Scope similar to Navigator/IPA’s
Agents & Brokers
 States determine broker affiliation.
 Once approved, brokers roll is to assist with
application and enrollment process
 State law determines compensation for brokers
 Insurance agents and licensed brokers required to
register with the state exchange to participate
 Role defined as an “advocate” for the patient, just
Navigators, IPA’s & CAC’s.
FINANCIAL IMPACT
Financial Benefits
 Medicaid FFS Increase
 Charity Care Reduction
 Insurance Increase
 Bad Debt Reduction
Financial Impact
 Flat Line Medicare Payment
 Decreased DSH Funding
 Increased A/R
– Medicaid FFS
– Exchanges/QHP
 Increase Patient Liability
– QHP premiums/co-pays
Case Study: 350 Bed Urban Facility (MI)
Total Claims
Average Charges
Average Cost
12,583
$29,144
$9,080
Reimbursement
Medicaid
Medicare
Insurance
Medicare DSH %
Bad Debt
Today
23%
30%
42%
17.20%
4% (cost)
ACA Impact
20%
29%
38%
17.20%
2% of cost
Today
28%
33%
22%
17%
ACA Impact
34%
33%
31%
3%
Case Mix
Medicaid
Medicare
Insurance
Uninsured/Bad Debt
Case Study: 350 Bed Urban Facility (MI)
Current State
Medicaid
Medicare
Insurance
Medicare DSH
Uninsured/Bad Debt
Claims
3,523
4,152
2,768
NA
2,139
12,583
Reimbursement
$6,703
$8,743
$12,240
NA
$363
Revenue
$23,616,701
$36,305,176
$33,884,831
$2,672,318
$776,925
$97,255,951
ACA Impact
Medicaid
Medicare
Insurance
Medicare DSH
Uninsured/Bad Debt
Claims
4,272
4,152
3,881
NA
364
12,669
Reimbursement
$5,829
$8,452
$11,075
NA
$182
Revenue
$24,900,217
$35,095,004
$42,976,527
$668,080
$66,039
$103,705,866
Variance
$6,449,915
WHAT CAN YOU DO
Future of Uninsured – Impact on Providers
 Expanded Process – Assessment / Enrollment
 Increased Compliance – Data / Cost Report
 Staffing Efficiencies
 Changes To Reimbursement
 State / Federal Process Delays
Things to Do Now
 Prepare for Medicaid Expansion
– Staffing Capacity (Billing/Enrollment)
– Forecast A/R increase for Medicaid payments
 QHP Enrollment
– Proactive approach
– Utilize all resources available (Navigator/Broker/ACA)
 Train/Prepare Staff
– Define their role in ACA
– Provide training/education
 Look to physicians to help identify chronic uninsured patients
 Forecast financial impact of ACA (reimbursement/case mix changes)
RESOURCES
Interactive Online Application
 CMS YouTube Videos:
http://www.youtube.com/cmshhsgov
 State Medicaid Expansion:
http://www.advisory.com/DailyBriefing/2012/11/09/MedicaidMap
 ACA Webinars/Blogs/Education Links:
http://www.humanarc.com
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Thank You
Chris Milligan
Associate Vice President
[email protected]
216.965.2718