Transcript Document

Delaware’s Health
Insurance
Marketplace:
Update on Activity
Delaware Health Care Commission, November 14, 2013
Secretary Rita Landgraf, Department of Health and Social Services
Healthcare.gov
• Performance issues related to web-based portal
• As a state/federal partnership, Delaware relies on the
enrollment portal managed by the Federally Facilitated
Marketplace (FFM)
• HHS and CMS report that healthcare.gov is running
better every day and is expected to be working
smoothly by the end of November
• Will be providing updates on functionality to the public
as they become available
Delaware: State/Federal Partnership
• Chose a partnership model because an analysis of
the issue and the data showed it would be more cost
effective for the state and individual consumers
• Committed to working with the Federal government to
improve the experience for Delawareans and increase
enrollments
• Continue to proactively advocate for Delawareans
through this partnership
• As a partnership state, we have the ability to adjust
marketing, outreach, and education of citizens
Important Points to Remember:
• We are in week 7 of a 26-week open enrollment period.
Most open enrollments last 2-4 weeks
• The administration expects Healthcare.gov to be
functioning smoothly by the end of November
• Consumers who enroll in coverage by March 31, 2014
will not have to pay a penalty
By the numbers: Marketplace
• Number of enrollments verified by DE Department of
Insurance = 136 (October 1-November 12)
• Number of enrollments released by U.S. Dept. of
Health and Human Services = 97 (October 1November 2)
• Differences reflect:
• Dates
• Lag between systems
• Manual validation by insurers
By the numbers: Medicaid
• Number of individuals determined or assessed
eligible for Medicaid/CHIP by the Marketplace as
reported by the U.S. Dept. of HHS = 1,200
• DHSS will begin to run eligibility for Medicaid
expansion at the end of November
• For those not eligible for Medicaid expansion,
DHSS will refer people back to Marketplace and
assistance from a Marketplace Guide.
• Will provide further updates on the Medicaid program
at December’s HCC
Medicaid
• Actively working on implementing Medicaid expansion
which will include those with incomes up to 138% of
FPL
• Those that are eligible under current income rules can
gain access to coverage immediately
• Collecting application information from those whose
incomes make them eligible under new rules
• State will run eligibility and make a determination
• Coverage can begin on January 1, 2014
• FFM is sending likely-eligible applicants to the State;
State makes final eligibility determination regardless of
where they apply
Our Commitment
• The State is dedicated to ensuring that Delawareans
are able to access health coverage
• In addition to Healthcare.gov, we are actively helping
individuals access the system
• Encouraging use of FFM Contact Center
• Connecting people with Marketplace Guides who
can help them understand options and apply for
coverage
• DHSS and DOI are providing direct support to
consumers for complex cases
• Conducting pre-screening and directing consumers on
the most efficient way to access health care coverage
Our Commitment
• Share information on tax credits or cost sharing
reductions to those individuals who may be eligible
• Review enrollment data based on demographics and
geography and adjust marketing and outreach
accordingly
• Provide regular updates on Delaware’s enrollment
numbers to the public through the Health Care
Commission meetings
Choosing
the most
efficient
“door” “door”:
Choosing
the most
efficient
ASSIST
(<138% FPL or
<212% for
children and
pregnant
women)
Medicaid
eligible
Healthcare.
gov
(139-399%
FPL)
Eligible for
Federal
Subsidies
Insurers
(>400%
FPL)
Not-eligible
for
subsidies
Ways to Get Coverage
• No matter what “door” a consumer enters, they will be
able to get enrolled in the appropriate coverage
• Encouraging the use of the most direct door for most
efficient experience
• ASSIST – Delaware’s portal for those Medicaid
eligible https://assist.dhss.delaware.gov/
• Healthcare.gov – Federal portal for those who may
qualify for a subsidy
• Directly through insurers – for those who do not
expect a subsidy; links will be available from
ChooseHealthDE.com soon
What can I do at ChooseHealthDE.com?
Get
Ready
• Premium estimator
• Subsidy calculator
• Access FAQs
Compare
Plans
• Choose up to three at a time
• Shows costs and what’s covered
Find Help
• Contact information for Marketplace
Guides
• List of Agents/Brokers
• Calendar of local events
ChooseHealthDE.com (English version):
• As of Nov. 11, 2013, there have been 119,239 visits
• Visitors are staying an average of 2 minutes, 37 seconds
Health-Care/Espanol
ChooseHealthDE.com (Spanish version):
• As of Nov. 11, 2013, there have been 8,523 visits.
• Visitors are staying an average of 2 minutes, 48 seconds.
HEALTHCARE.GOV
Traffic from ChooseHealthDE.com to Healthcare.gov:
As of November 11, 2013, ChooseHealthDE.com has driven 21,709 visits
to Healthcare.gov.
Marketplace Guide Program
• Of the anticipated 106 Marketplace Guides – a mix of full-time
and part-time positions – 51 have achieved full certification
and are therefore able to help consumers to apply for and
enroll in coverage. The 106 positions are equivalent to the 68
full-time budgeted positions.
• The remaining Guide candidates are actively pursuing
certification. Federal background checks, the final step in the
certification process, are being received daily
• Delaware’s Marketplace Guides are responsible for broad
consumer outreach, including educating and informing
individuals on how health insurance works and what financial
assistance they may be eligible for. Guides also can help
individuals enroll.
Marketplace Guide Activities as of
11/12/13
• 454 outreach activities have been held
• More than 16,000 consumers have been engaged
• Guides have been assisting consumers in understanding
options and eligibility, creating Marketplace accounts and
applying for coverage
Stories from the Ground
• A Wilmington small business owner said he will keep
exploring his options on healthcare.gov, but “the
confidence level is low.”
• A Rehoboth Beach man and his wife said healthcare.gov
may be a frustrating and time-consuming experience, but
they will save $800 a month on the coverage they bought
there.
• A woman with a pre-existing condition is grateful to have
coverage starting Jan. 1.
Stories from the Ground
• Janice Baker from Selbyville, our first
known Delaware enrollee, will save
$150 a month on her insurance.
• A Wilmington man is frustrated that he
cannot keep the health insurance that
he has for his family.
• A Rehoboth Beach man appears
eligible for Medicaid, but is stuck in the
enrollment process.
• A 26-year-old Wilmington man will
leave COBRA and save money on his
new marketplace policy.
Stories from the Ground
• With the help of a marketplace
guide, a Wilmington man called
the Federal Contact Center at
800-318-2596 and will have his
income verification this week.
• A New Castle County man was
denied eligibility because of an
error in his application. He is
working with the federal
Advanced Resolution Center to
amend his application.
• A Hockessin hair stylist said she
will wait until after Nov. 30 to
shop for insurance.
QHP Standards and Monitoring
21
State Standards for QHP Certification
• November 1, 2012: The HCC approved and published the Statespecific standards for qualified health plans (QHPs).
• State standards augment, but do not supplant the federal standards
• Reflect broad stakeholder input gathered through a public Open
Comment process.
• Feedback included input regarding continuity of care, network
adequacy, accreditation, plan levels, essential community providers and
quality improvement standards
• HCC sought to balance the need to expand value for consumers and
to encourage Issuer participation in the Marketplace.
• A full list of approved QHP Standards may be found at:
http://dhss.delaware.gov/dhss/dhcc/files/certificationstandardsNov1.pdf
22
Delaware QHP Standards
• In addition to those outlined in the ACA, the State standards include,
but are not limited to:
– Requirement for Issuers to offer Bronze as well as Silver and Gold level
plans
– Statewide Rating Area
– Statewide Service Area that expands provider coverage throughout the
entire state
– Network Adequacy standards that align with Medicaid and Department of
Public Health standards
– Issuer-required Transition Plans that support continuity of care for
consumers as they move from QHPs to Medicaid and vice-versa
– Quality Improvement Strategies, including a requirement that all medical
QHP Issuers participate, at the prevailing rate, in the Delaware Health
Information Network (DHIN)
• State-specific QHP Standards will be extended for the 2015 Plan
Year.
• Standards will be revisited early in 2014 for the 2016 Plan Year;
HCC will be engaged in this process
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Monitoring Issuer/QHP Compliance
QHP Review Process
 Formal QHP application and review process included verification and/or
attestations to support compliance with state and federal QHP standards prior
to certification.
Ongoing QHP monitoring activities
 Review and analyze consumer and provider complaint data from multiple
sources (DOI Consumer Services, FFM Contact Center, Issuers)
 Conduct bi-annual Interrogatories that address specific federal and state
compliance areas such as network adequacy/access, Accreditation, Quality
Improvement Strategies, Continuity of Care, DHIN participation, provider reimbursement, marketing, among others.
 Leverage DOI Market Conduct practices to gather/address QHP compliance
issues, including formal market conduct reviews, action plans, etc.
24
In the News
25
Impact of ACA on existing health plan policies
• Beginning January 2014, Issuers are required to comply with many of the key
provisions of the ACA, thus impacting existing health plan policies for many
across the country.
• Provisions of the ACA have significant impact on benefit coverage and
premium rates for 2014.
 Coverage of all 10 essential health benefits and benchmark benefits, including
habilitative services, hospitalization, maternity/newborn, and mental health parity
 Removal of annual and lifetime limitations
 80/20 Medical/Loss Ratio, which requires Issuers to spend at least 80% of
premium on medical care and efforts to improve quality care, and no more than
20% on administrative costs.
 Issuers cannot deny coverage due to pre-existing conditions
 Rating factors that only include age, tobacco use, and family composition.
• President Obama today announced a one-year extension for current policies
that have received discontinuation notices
26
How will this affect Delaware Consumers?
• Because plans have to comply with the ACA , issuers have discontinued those
plans that are not compliant with the Act. As a result, letters informing
consumers of discontinuance/non-renewal were sent within the past few
months.
• The policies will be discontinued at the policy renewal date beginning on
January 1, 2014. Examples of when the non-renewal will affect consumers
are:
• If you renewed your policy in July 2013, the policy will continue to July
2014.
• If you renewed your policy in November 2013, the policy will remain in
effect until November 2014.
• Most carriers have sent the notification letters to all the members impacted even
if the date would fall later in 2014. Also at least 90-day notice has been given.
• Discontinuance letters were sent by multiple carriers, not just those participating
in the Marketplace
• To date, almost 12,000 policies in the individual market have been discontinued.
Of that group, approximately 2,000 of these will be affected as of January 1,
2014.
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Consumer options for those affected
1. Complete ‘early renewal’ for those that are offered it
• In some cases that includes cancelling their current policy and
purchasing the new one prior to December 2013.
2. Purchase a qualified health plan (QHP) on Healthcare.gov
• Some individuals may be eligible for tax credits and cost share
reductions
3. Select and purchase a plan from among the choices offered by their
existing insurance carrier
4. Shop for plans from a variety of carriers ‘off’ the Marketplace
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Significant Dates
• November 30, 2013 – Expected date for
healthcare.gov improvements
• December 15, 2013 – Last day to enroll for coverage
beginning on January 1, 2014
• March 31, 2014 – Must be enrolled in minimum
essential coverage by this date to avoid penalty