Transcript Document

Medicaid, BHP, and CHIP:
Current Issues in ACA Implementation
Eliot Fishman, PhD
Director, Children and Adults Health Program Group
Center for Medicaid & CHIP Services
Melissa Harris
Director, Division of Benefits and Coverage
Disabled and Elderly Health Programs Group
1
Topics to be Covered
• Implementation
• Alternative Benefit Plans
• CHIP and BHP
2
Implementation
How CMS is Reporting on
Eligibility & Enrollment
• States will begin reporting enrollment numbers
for the new adult group after March 31, 2014.
• State progress on eligibility and enrollment can
be found in the Medicaid & CHIP Monthly
Applications and Eligibility Determinations report.
Data are collected on types and quantities of
submitted applications and eligibility
determinations.
SOURCE: http://medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward2014/Downloads/Medicaid-CHIP-Monthly-Enrollment-Report-Nov-2013.pdf
4
States Moving Forward on Expansion
Expanding Medicaid
For 2014
Not expanding Medicaid
to date
DE
DC
So far, 25 states and DC have indicated they will expand
Medicaid to low-income adults in 2014 – discussions continue
to evolve.
Process and Coverage Improvements
• To date, half the states expanding Medicaid to lowincome adults; other states in discussion
• All states implementing new MAGI rules, new systems,
new applications, new verification policies,
coordination with Marketplace
• Continuity of coverage through modernized renewals
and coordination between Medicaid and the
Marketplace
6
Quality Measurement
• Upcoming reports to Congress will provide details
about states’ reporting on core measure sets for
children and adults.
• Highlights:
– The number of states reporting on children’s
measures has increased since last year’s report
– CMS has asked states to voluntarily report uniform
adult quality measures for the first time in FY2014
and has provided grants to 26 states to assist
them in collecting data
SOURCE: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-ofCare/Downloads/2013-Ann-Sec-Rept.pdf
7
Medicaid.gov
On Medicaid.gov, data
can be easily located
on a variety of topics,
including:
• Eligibility
• Outreach &
Enrollment
• Quality of Care
Data can be found in
multiple formats, such
as reports, charts, and
maps.
SOURCE: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/ByTopics/Quality-of-Care/Downloads/2013-Ann-Sec-Rept.pdf
8
Alternative Benchmark Plans
Medicaid ABP Benefit Design
Foundation for Essential Health Benefits (EHB):
• Step 1: States must select a coverage option from the choices
found in section 1937 of the Act.
• Step 2: States must determine if that coverage option is also
one of the base-benchmark plan options identified by the
Secretary as an option for defining EHBs.
• If so, the standards for the provision of coverage, including
EHBs, would be met, as long as all EHB categories are
covered.
• If not, states must select one of the base-benchmark plan
options identified as defining EHBs.
• Step 3: Select a base benchmark plan to define the EHBs.
10
Considerations for States
• Implications of benefit alignment between the ABP and the
underlying state plan:
– Ease of administration
– No need to identify individuals who are medically frail
– Benefit uniformity across all Medicaid populations
• Implications of different benefits between the ABP and the
underlying state plan
– Straightforward alignment with commercial product
– Necessitates process for identifying individuals who are
medically frail and counseling them on benefit options
11
Medical Frailty: Definition, Screening
Process, and Benefits
•
Definition:
• “Individuals with disabling mental disorders (including
children with serious emotional disturbances and adults
with serious mental illness), individuals with chronic
substance use disorders, individuals with serious and
complex medical conditions, individuals with a physical,
intellectual or developmental disability that significantly
impairs their ability to perform 1 or more activities of
daily living, or individuals with a disability determination
based on Social Security criteria or in States that apply
more restrictive criteria than the Supplemental Security
Income program, the State plan criteria.”
12
Medical Frailty:
Screening Process and Benefits
• Determination or Screening Process
• Benefits for Medically Frail Individuals
• Individuals in the new adult group, if
determined to be medically frail, will receive
the choice of ABP defined using EHBs or ABP
defined as state’s approved Medicaid state
plan
13
CHIP and BHP
CHIP Coverage Issues
• Requirement of certification for pediatric
coverage offered through the Exchange as
comparable to CHIP
• Efforts underway to analyze nature of CHIP
benefits and cost-sharing
• Maintenance of Effort (MOE) requirement for
states to maintain eligibility standards
• ACA requires that children <133% FPL move
from separate CHIP to Medicaid coverage
15
Basic Health Program (BHP)
• BHP will be an option for states in the 2015
coverage year.
• States will have the option to cover individuals
between 133% and 200% FPL who would
otherwise receive tax credits through the
Exchange.
• By March 31, 2014, we hope to publish final
regulations, payment methodologies, and the
tool (“Blueprint”) by which states can apply to
gain approval.
16