Arkansas’s Health Insurance Marketplace ***** Arkansas Social Workers in Healthcare

1. Arkansas’s Health Insurance Marketplace ***** Arkansas Social Workers in Healthcare Little Rock, April 25, 2014 ***** Cindy Crone, APRN, Deputy Commissioner Arkansas Insurance Department Arkansas Health Connector Division ASWHC

2. Goals of ACA • Reduce the growth of healthcare costs • Promote high quality care • Expand availability of affordable coverage ASWHC

3. How? • Public and Private Coverage Expansions • Change in Benefits and Access to Care • Insurance Issuer Market Reforms • Individual Responsibility • Establishment of Health Insurance Exchanges ASWHC

4. Is health reform needed in AR? • In Arkansas, 550,000+ uninsured at the end of 2013 • Historic blend of low-incomes and poor health, reflect: • Lack of health care • Uncompensated care • Arkansas healthcare leaders already addressing health system improvements before ACA ASWHC

5. Selected Health Indicators(Kaiser Family Health, 2014) ASWHC

6. Following three years of planning…. The Health Insurance Marketplace in Arkansas is open for business ASWHC

7. Status of Marketplaces State-Based Marketplace State-Based Marketplace (SHOP only) Partnership Marketplace Federal Marketplace ASWHC

8. Diverse Partners • Government Policy Makers • State <–> Federal (Appointed and Elected) • State <–> State (Appointed and Elected) • Policy Makers <–> Non-Government Constituents • Consumers and Consumer Advocates • Health Care Providers • Health Care Insurers • Businesses ASWHC

9. Inclusive Stakeholder Engagement Consumer Assistance and Plan Management Advisory Committees Steering Committee Final Recommendation to Commissioner Arkansas Health Connector Staff &Consultants Research / Alternatives Analysis Consumer Assistance Advisory Committee Plan Management Advisory Committee Develop Recommendations with Alternatives ASWHC

10. Examples of Arkansas-Specific Plan Management Decisions • Essential Health Benefits Base Benchmark Plan • QHP approval by Certification vs. Competitive Bidding • HabilitativeServices Defined • Defined Seven Rating (and Service) Areas • Maximum 20% Upcharge for Tobacco Use Allowed Cont’d…. ASWHC

11. Medicaid Premium Assistance Plan (Private Option) will be High-Level Silver Plan • Network Adequacy Standards • Quality Standards • Federal Government to administer 3R’s (Reinsurance, Risk Corridors, Risk Adjustment) for Arkansas in 2014-2015. ASWHC

12. Examples of Arkansas-SpecificConsumer Assistance Decisions • Standards for In-Person Assister (IPA) entities and Guides/other assister licensure. • Standards for Assister Training. • Development of Arkansas Health Connector Resource Center. • Respond to ongoing feedback and improvement recommendations for outreach/education efforts, Resource Center, and enrollment. ASWHC

13. Health Care Independence Act • “Private Option” passed in 2013 Arkansas General Assembly • Medicaid expansion unique to Arkansas • Covers newly eligible adults ages 19-64, up to 138% FPL • Incorporates private health insurance • Helps with continuity of coverage • Creates a more favorable risk pool ASWHC

14. Individual Premium Tax Credit Eligibility • Household income 139% to <400% FPL • Enrolled in a QHP through the Marketplace • Lawfully present • Not incarcerated (post conviction) • Not eligible for other coverage such as Medicare, Medicaid, or affordable employer-sponsored insurance. ASWHC

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17. AR State Partnership Marketplace Health Insurance Medical Issuers - 2014 • Arkansas Blue Cross and Blue Shield • Blue Cross and Blue Shield Multi-State • QualChoice of Arkansas • Celtic, doing business as Arkansas Health and Wellness Solutions (Ambetter) ASWHC

18. Qualified Health Plansin Arkansas Marketplace - 2014 Additionally, 8 catastrophic plans are offered ASWHC

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21. Stand-Alone Dental IssuersOffer 24 Plans in 2014 • Arkansas Blue Cross and Blue Shield • Best Life and Health • Delta Dental of Arkansas • DentegraInsurance Company ASWHC

22. Premium Limits Based on Income ASWHC

23. 2013 Federal Poverty Guidelines ASWHC

24. Tax Credits at Work With an average base individual monthly premium of $259 in Arkansas for second-lowest price Silver plan, these examples show what a 30-year-old non-smoker will pay in monthly premium: ASWHC

25. What about family costs? ASWHC

26. With an average base monthly premium of $874 for a family of four (two adults age 40 with two children) in a second-lowest cost silver plan, these examples show monthly costs: ASWHC

27. Premiums Vary by Age ASWHC

28. Seven rating areas in Arkansas ASWHC

29. Issuers/Plans per Service/Rating Area ASWHC

30. Regional variancesPremiums without tax credits ASWHC

31. Average Premiums Without Subsidies March 23, 2014 ASWHC

32. Premium payment status HFMA

33. Important for Families Maximum Annual Out of Pocket Maximums (which include Deductibles, Co-Insurance and Co-pay) for Plans on Marketplace: • $6,350 per individual – often less on sliding scale • $12,700 per family – often less on sliding scale HSAs are available on some plans. Independence Accounts will be available in 2015 ASWHC

34. FFM 2014 Individual Marketplace Enrollment (without HCIP)

35. What is covered? ASWHC

36. Essential Health Benefits • Outpatient Services • Hospitalization • Emergency Services • Maternity and Newborn Care • Mental Health and Substance Use Disorder Treatment Cont’d … ASWHC

37. Prescription Drugs • Rehabilitative and Habilitative Services/Devices • Laboratory Services • Preventive, Wellness, and Chronic Disease Management • Pediatric Services, Including Oral and Vision Care ASWHC

38. Preventive services include • Abdominal Aortic Aneurysm one-time screening • Alcohol Misuse screening and counseling • Aspirin use to prevent cardiovascular disease for men and women of certain ages • Blood Pressure screening • Cholesterol screening • Colorectal Cancer screening • Depression screening • Diabetes (Type 2) screening • Diet counseling • HIV screening • Immunization vaccines • Obesity screening and counseling • Sexually Transmitted Infection (STI) prevention counseling • Syphilis screening • Tobacco Use screening for all adults and cessation interventions for tobacco users ASWHC

39. Mental Health Coverage Includes behavioral health and substance use disorder treatment. Must cover: • Professional Services (by licensed practitioners acting within the scopeof their license) • Diagnostics • Inpatient hospital or other covered facility • Outpatient hospital or other covered facility ASWHC

40. Mental Health Parity Coverage for the medical treatmentof mental illness andsubstance use disorder must be provided under the same terms and conditions asthat coverage provided for otherillnesses and diseases. ASWHC

41. Enrollment Options – Individual Market ASWHC

42. Through April 17… 2,275 Marketplace assister licenses were issued by AID … 1,452 licenses to producers … 566 to guides … 236 to certified application counselors … 30 to navigators. HFMA

43. What about business coverage? • The Small Business Health Options Program (SHOP) is part of the Marketplace. • Aim is to help reduce health care costs for small business. • Eligible businesses have 50 or fewer full-time equivalent employees. • Shopping on Healthcare.gov delayed until November 2014 at soonest. ASWHC

44. SHOP in AR SPM in 2014 • One Issuer – Arkansas Blue Cross Blue Shield • Three Plans Offered in 2014 • One Gold • One Silver • One Bronze • Only way for Business to get Tax Credits. ASWHC

45. Outreach and Education Broad multi-media “Get Informed” campaign across Arkansas July 1 – September 30, 2013 ASWHC

46. http://www.arhealthconnector.org ASWHC

47. Speakers’ Bureaus • “Get Enrolled” Enrollment Action Phase scheduled to begin October 1, 2013 not implemented due to Arkansas Legislature’s denial of continuing outreach and education contract. ARHealthConnector.org redirected to www.ahc.arkansas.gov • Healthcare.Gov now working well after rocky start. • Access.Arkansas.gov and InsureArk.org for Private Option. ASWHC

48. http://ahc.arkansas.gov/ ASWHC

49. Challenges • Finding a way to educate people about buyingtheir health insurance. • Finding a way to educate people about usingtheir health insurance. • Lack of knowledge can lead to consumers making wrong choices. ASWHC

50. The four phases of Open Enrollment trends ASWHC