Transcript MPCA PowerPoint Template Presentation Title

The Healthy
Michigan Plan
Spring 2015 Update
Advocacy: How the Healthy
Michigan Plan Got Started
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Opportunity to extend coverage to roughly
half a million Michiganders
Better physical and mental health for
Michigan residents, and lower medical debt
100% federal funding for the expansion until
2017, 90% in 2020 and beyond
$1.1billion in net state budget savings in the
first ten years
Reductions in the profound burden of
uncompensated care on the healthcare
system, businesses, insurers and consumers
So, how are things going so
far?
 Enrollment
 Plan
Selection
 Health Risk Assessment
 Utilization
Enrollment
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As of April 20th, 2015 there were 589,490
individuals enrolled in HMP
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By all accounts, enrollment to-date has been
unexpectedly high and much faster than
anticipated
Roughly 83% of HMP beneficiaries are below
the federal poverty level, 17% are above
Enrollment by gender has been relatively
equal at 51.9% female and 48.1% male
Enrollment
650,000
600,000
550,000
500,000
450,000
400,000
350,000
300,000
250,000
200,000
Enrollment
 The
age diversity of HMP enrollees has
improved greatly since early enrollment
efforts began
Plan Selection
 447,404
HMP beneficiaries were enrolled
in a health plan as of April 1st, 2015
 73.5% of those health plan enrollees chose
their plan, 26.5% were auto-assigned
 Enrollment is concentrated in a handful of
health plans, in fact the five largest HMP
plans represent just over 70% of total plan
enrollment
Plan Selection
Health Plan
Percentage of Enrollees
Blue Cross Complete
7.9%
CoventryCares of MI
1.9%
HAP Midwest Health Plan
5.9%
Harbor Health Plan
0.8%
HealthPlus Partners
5.8%
McLaren Health Plan
11.6%
Meridian Health Plan of Michigan
26.9%
Molina Healthcare of Michigan
11.5%
Priority Health Choice
7.1%
Sparrow PHP
1.1%
Total Health Care
3.7%
UnitedHealthcare Community Plan
12.9%
Upper Peninsula Health Plan
3.0%
Health Risk Assessment
A
sizable number of beneficiaries are
completing the Health Risk Assessment
process, in fact many are completing the first
section during plan selection
Health Risk Assessment
Utilization
 Utilization
statistics released to-date don’t
provide a comprehensive perspective,
but we have seen is encouraging
What should we be paying
attention to now?
 Known
Eligibility Challenges
 Post-Application Education and Support
 Redetermination / Renewal
 DCH + DHS = DHHS
 Medicaid Health Plan Re-Bid
 Approval and Characteristics of the
Second CMS Waiver
 Medicaid Modernization
Known Eligibility Challenges
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Plan First! and Spenddown
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Emergency Services Only
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Some applicants have been incorrectly assigned
to ESO, especially when citizenship questions were
skipped or not verifiable on an application
5% Disregard
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Enrollment in another Medicaid program can
interfere with HMP eligibility, even when it shouldn’t
Some applicants between 133-138% FPL did not
have the income disregard applied correctly and
were not approved
Retroactivity
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Most approved applicants should be eligible for 3
months of retroactive coverage , but retroactive
coverage has not always been granted
Known Eligibility Challenges
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Counting Self-Employment Income
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No Correspondence
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Some applicants had an incorrect 25% cap on
deductions applied in reference to selfemployment income
Other applicants have had additional problems
related to self-employment income
Some applicants received a HMP eligibility
determination through MI Bridges but didn’t
receive a follow-up letter or enrollment packet
Pregnant Women (especially MOMS)
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Non-citizen pregnant women applied but only
received ESO instead of ESO + MOMS
Following Up on Eligibility
Challenges
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DHHS will only speak to a client or their authorized
representative about an individual’s case
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Most assisters are not authorized representatives, so
making contact together is essential
Making contact with a client’s assigned caseworker
is the best first step
If the caseworker contact is not successful,
advancing to a supervisor/manager or Director is the
next step
When problems cannot be resolved with local DHHS
staff, utilizing the appeals/hearing process may be
warranted
The appeals process is also appropriate for
applicants who believe they have been denied
coverage inappropriately
Post-Application Education
and Support
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Applying for coverage and getting an
eligibility determination only represent a third
of the steps involved in the HMP process.
Missing the steps beyond an eligibility
determination will leave new enrollees not
fully able to engage in their health and
healthcare.
And, the ultimate goal of HMP is to improve
health… not just enroll an individual in
coverage.
Resources to Support After
Sign-Up Activities
 MICoverage.org
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An interactive, web-based resource that
delivers customized content on important
coverage concepts and downloadable
worksheets to document and save key
information
Downloadable Worksheet
Web-Based Guide
Redetermination / Renewal
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On April 13th DHHS reported a drop in the HMP
enrollment total to 581,769 beneficiaries,
almost 22,000 less people than the reported
number of HMP beneficiaries on March 30th
Enrollment is growing again (as of April 20th)
but the drop in early April illustrates the need
for significant investment in renewal supports
and strategies
micoverage.org resources now include a
renewal worksheet similar to those used for
enrollment to support those assisting clients
DCH + DHS = DHHS
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The merger of Michigan’s former health (DCH)
and human services (DHS) departments is in
the early stages of implementation
We don’t yet know the full range of
implications, but we do know that changes
are in the works
Medicaid Health Plan Re-Bid
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The State of Michigan competitively procures
the services of Medicaid managed care
organization (health plans) through a bid
process
The current bid for Medicaid health plans in
Michigan will be released next month with
responses due in August and new health plan
contracts effective January 1, 2016
Michigan's Prosperity Regions will be used for
the bid, meaning all counties within a region
that is being bid on must be included in a
plan’s requested service area
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Regions 2 and 3 in northern lower Michigan must
be bid together
Approval and Characteristics
of the Second CMS Waiver
(20) By September 1, 2015, in addition to the waiver requested in subsection (1),
the department of community health shall seek an additional waiver from the
United States department of health and human services that requires
individuals who are between 100% and 133% of the federal poverty guidelines
and who have had medical assistance coverage for 48 cumulative months
beginning on the date of their enrollment into the program described in
subsection (1) to choose 1 of the following options:
(a) Change their medical assistance program eligibility status, in accordance
with federal law, to be considered eligible for federal advance premium tax
credit and cost-sharing subsidies from the federal government to purchase
private insurance coverage through an American health benefit exchange
without financial penalty to the state.
(b) Remain in the medical assistance program but increase cost-sharing
requirements up to 7% of income. Required contributions shall be deposited
into an account used to pay for incurred health expenses for covered benefits
and shall be 3.5% of income but may be reduced as provided in subsection
(1)(e). The department of community health may reduce co-pays as provided
in subsection (1)(e), but not until annual accumulated co-pays reach 3% of
income.
Approval and Characteristics
of the Second CMS Waiver
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CMS has previously rejected proposals from Iowa,
Indiana and Pennsylvania which included “Premiums
exceeding 2% of income for individuals with incomes
over FPL”
We are not currently able to find a find a
circumstance where CMS has approved or rejected
beneficiary cost-sharing up to 7% of income
State officials have heard from the federal
government that it will be “very difficult” for Michigan
to get a crucial second waiver for its Medicaid
expansion program without going back and
changing the law
Medicaid Modernization
 There’s
been some public recognition
from DHHS that the Department is now
considering a significant overhaul of
Medicaid systems, especially the IT side of
things
 This process of “modernizing” and
improving Medicaid systems could be a
very positive experience for beneficiaries,
assisters and providers
Questions? Discussion!