Health Insurance Exchange Overview - Idaho Health Insurance

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					      State of Idaho
Health Insurance Exchange
   Information Session

         Tribal Meeting
         May 19, 2011

            Penelope Schwiebert
Project Business Analyst/Process Reengineer
     pennny.schwiebert@doi.idaho.gov
    Meeting Purpose
1. Inform tribal representatives on the Idaho
   Health Insurance Exchange Project
2. Solicit feedback from tribal
   representatives on their specific needs in
   the Idaho Health Insurance Exchange
3. Identify how tribes would like to be
   involved on the Idaho Health Insurance
   Exchange project
4. Review next steps

                      2
      Purpose & Functions of
     Health Insurance Exchange
    • Purpose
       – An Exchange an organized portal where
         individuals and small employers can
             • Compare qualified health plans
             • Enroll
             • Secure financial assistance if eligible
    • Functions
       – Certify health plans that are available through an
         Exchange
       – Provide information on health plan options to enrollees
       – Facilitate selection and enrollment in a health plan
       – Determine eligibility for the premium and cost-sharing
         assistance for enrollees
       – Conduct risk adjustment function across plans
•    Patient Protection & Affordable Care Act (PPACA) signed into law March 23, 2010
•    Health Care and Education Reconciliation Act of 2010
 Federal Principles & Priorities
       for an Exchange
• State-based
• Promotes efficiency by streamlining access and continuity
  of care
• Avoids adverse selection
• Engages stakeholders
• Provides accountability and transparency
• Is financially self-sustaining by 1/1/15
• Health and Human Services will certify if each state is on
  track to meet 1/1/14 date
• Minimum requirements are defined, with latitude for States
  to design core functions such as:
        •   Exchange Governance Model
        •   Navigator Program
        •   Market Participation Rules
        •   Financial Sustainability Model
                                     4
Idaho-Specific Health Insurance
     Exchange Objectives
• Develop a solution that works for Idaho and
  prevents the federal fallback exchange
• Retain control of a state-based exchange
• Improve access to health coverage options
• Build on existing programs and systems
• Maintain simplicity and transparency in design,
  function, and support of a sustainable health
  insurance exchange
• Preserve health insurance market outside of
  exchange
• Reduce Idaho’s health care uninsured population
                        5
           Benefit Plan Categories*
Benefit Category   Description

Bronze             Minimum creditable coverage
                   Providers essential health benefits
                   Covers 60% of the benefit costs of the plan
                   Cost-sharing may not exceed HSA current law limit in 2014
                   (currently $5,950 individual/$11,900 family for 2010)

Silver             Provides essential health benefits
                   Covers 70% of the benefit costs of the plan
                   Cost-sharing may not exceed HSA current law limit in 2014

Gold               Provides essential health benefits
                   Covers 80% of the benefit costs of the plan
                   Cost-sharing may not exceed HSA current law limit in 2014

Platinum           Provides essential health benefits
                   Covers 90% of the benefit costs of the plan
                   Cost-sharing may not exceed HSA current law limit in 2014

Catastrophic       Up to age 30 or those exempt from mandate to purchase
                   coverage
                   Provides essential health benefits
                   Only individual market
                                        *Source: Kaiser Family Foundation, Summary of New Health
                                  6     Reform Law — Last Modified: March 26, 2010
            Exchange Basics:
          Who makes it happen?
Where do you fit in?
                           Medicaid
                            & CHIP                     Individual
 Producers                                            Consumers
& Navigators



                           Exchange                       Small Group
                                                           Employers
     Health
    Insurers
                                                 Tribal


                                       Federal
                   State                Gov’t,
                   Gov’t                HHS,
                                      Treasury


                               7
Specific Tribal Provisions
• Cost-Sharing
   – Cost-sharing is eliminated for Indians below 300% of the
     federal poverty level who are enrolled in any individual
     market insurance plan offered through the Exchange
   – No cost-sharing is to be charged for services provided by
     IHS directly, an Indian Tribe, Tribal Organization, Urban
     Indian Organization or through the Contract Health Service
     program if the individual is enrolled in a qualified health
     plan
• Enrollment
   – Exchanges are to provide special monthly enrollment
     periods for Indians


                                8
Specific Tribal Provisions
• Shared Responsibility
   – Members of Indian tribes are exempt from the shared
     responsibility penalty, for failure to comply with the
     requirement to maintain essential insurance coverage, and
     Exchanges may certify members as qualifying for that
     exemption
• IHS, an Indian Tribe, Tribal Organization, or Urban
  Indian Organization
   – Could serve as an “Express Lane Agency” to determine
     eligibility and help facilitate enrollment of Indians
   – Health programs operated by IHS, Indian Tribes, and Tribal
     and Urban Indian Organizations are the payers of last
     resort for services provided to individuals eligible for
     services under such programs
                               9
                    Project Schedule


         Planning        Implementation         Plan Certification &
                            & Testing            Open Enrollment




1/1/11               1/1/12               1/1/13                  1/1/14



                                       HHS determines            Exchange
                                       if state will have       Operational
                                      an Exchange ready

                                10
            Project Activities
 Core focus areas:
      1.  Background Research
      2.  Stakeholder Engagement
      3.  Legislative and Regulatory Action
      4.  Governance
      5.  Program (Medicaid) Integration
      6.  Information Technology
      7.  Funding/Financial Planning
      8.  Oversight and Program Integrity
      9.  Health Insurance Market Reforms
      10. Assistance to Individuals and Small Businesses,
          Coverage Appeals and Complaints
      11. Business Operations
                          11
Stakeholder Engagement Process




              12
    Meeting Purpose
1. Inform tribal representatives on the Idaho
   Health Insurance Exchange Project
2. Solicit feedback from tribal
   representatives on their specific needs in
   the Idaho Health Insurance Exchange
3. Identify how tribes would like to be
   involved on the Idaho Health Insurance
   Exchange project
4. Review next steps

                     13
          Idaho
Health Insurance Exchange
         Concerns


           14
                        Future State
       • What
          – Name three criteria you want in the Health
            Insurance Exchange
       • Why
          – Why do you want each of the criteria identified in
            each “what”
       • How
          – If applicable, how do you want the criteria
            identified in each “what”
       • When
          – If applicable, when do you want the criteria
            identified in each “what”
       Follow your responses horizontally across
What       Why                      How            When



                       Stakeholder Focus Group
          Idaho
Health Insurance Exchange
        Advantages


           16
    Meeting Purpose
1. Inform tribal representatives on the Idaho
   Health Insurance Exchange Project
2. Solicit feedback from tribal
   representatives on their specific needs in
   the Idaho Health Insurance Exchange
3. Identify how tribes would like to be
   involved on the Idaho Health Insurance
   Exchange project
4. Review next steps

                     17
• How would you like the tribes to be
  involved in the Exchange
  development process?

• Why is this method important?




                 18
    Meeting Purpose
1. Inform tribal representatives on the Idaho
   Health Insurance Exchange Project
2. Solicit feedback from tribal
   representatives on their specific needs in
   the Idaho Health Insurance Exchange
3. Identify how tribes would like to be
   involved on the Idaho Health Insurance
   Exchange project
4. Review next steps

                     19
What Can Tribal Representatives
             Do?
• Support Idaho’s HIE objectives

• Help educate tribal members about the
  2014 Exchange

• Participate in Exchange planning and design
  efforts




                      20
                  Wrap-Up
 Other Input – penny.schwiebert@doi.idaho.gov

 Website - http://healthexchange.idaho.gov

 Questions?

                    Thank you!




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