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Medicaid and SCHIP Expansion Innovations

Medicaid and SCHIP Expansion Innovations

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Medicaid and SCHIP Expansion Innovations

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  1. Medicaid and SCHIP Expansion Innovations Philip M. Bonaparte, MD Chief Medical Officer, HNJH National Medicaid Congress Thursday June 5, 2008

  2. NJ FamilyCare Advantage: The New Public-PrivateSCHIP Expansion Program Full Cost Buy-In Program for Uninsured Children in New Jersey

  3. Company Overview – Horizon NJ Health • Established in October 1993 as a Medicaid Managed Care Organization for the publicly insured • Based in West Trenton, NJ • Wholly-owned subsidiary of Horizon Blue Cross Blue Shield of New Jersey • More than 344,600 members & 45% market share • Includes members from following categories: AFDC/TANF; Aged, Blind and Disabled (ABD) With/ Without Medicare; Division of Youth and Family Services (DYFS) and NJ FamilyCare (SCHIP) • Recognized by MERCER as most effective Medicaid Managed Care plan in NJ 3

  4. Mission Statement Horizon NJ Health is a healthcare management company committed to expanding access and enhancing the quality of health for the publicly insured 4

  5. Medicaid Managed Care/NJ FamilyCare • As of 5/2008, there are 765,818 NJ residents enrolled in Medicaid/NJ FamilyCare • AFDC – 218,724 • ABD with Medicare – 15,437; ABD without Medicare – 57,473 • DYFS – 14,388 • NJ FamilyCare – 458,837 (113,952 are Parents, Adults, Aliens) • Five managed care plans make up the market – Horizon NJ Health; AmeriChoice; Amerigroup; University Health Plan/Centene; Health Net of NJ. Two new plans scheduled to enter market on 7/1/2008 – Healthfirst and WellCare 5

  6. Family Health Care Act (2005) • In September 2005, NJ implemented the Family Health Care Act, sponsored by Sen. Joseph Vitale • The Family Health Care Act not only made more children and some parents eligible for NJ FamilyCare (SCHIP), it also called for the creation of a buy-in program for families not eligible for NJ FamilyCare • 80,000 adults over a four-year period and 100,000 children over a three-year period • Since October 2005, more than 120,000 individuals have enrolled in Medicaid managed care/NJ FamilyCare 6

  7. Family Health Care Act (2005) • The Senator’s plan was for the NJ FamilyCare Buy-In program to be implemented in 2006 • It took two years to get one of the five Medicaid managed care plans to participate

  8. What is NJ FamilyCare Advantage? • In December 2007, NJ Governor Jon Corzine announced the NJ FamilyCare Advantage would start in January 2008 • The program is offered solely by Horizon NJ Health, “the only plan to step up to the plate” • Health insurance for NJ children whose families do not qualify for traditional NJ FamilyCare or Medicaid, (Coverage for children in household over 350% FPL) • At no cost to the State: program is member premium-based 8

  9. What is NJ FamilyCare Advantage? • Provides families the opportunity to “buy-in” to the traditional NJ FamilyCare (SCHIP) plan • The State estimates between 16,000 to 50,000 children may be eligible for the NJ FamilyCare Advantage Program

  10. Risks That Need to Be Considered • New Product to Market • No way of knowing what the interest/demand will be • Adverse Selection • Will only sick people sign up; what will be the mix of members? • Abandoning Existing Coverage • Will people cancel current insurance for less expensive coverage? • Pent Up Demand for Services • Most new members will utilize services right away • Eligibles have to be without insurance for at least six months prior to enrolling in Buy-In program 10

  11. So Why Do It? • Besides being the right thing to do (and in-line with the company’s mission) – it is also the right time to do it • There are 1.3 million NJ residents without health insurance, including 242,000 children • According to a recent AARP survey of NJ residents • 79% “strongly agree” that all New Jersey residents should have access to affordable quality health care • 90% said the Governor should make health care reform a priority 11

  12. The Future? • On March 17, 2008, Senator Vitale unveiled a plan to provide universal health care to New Jersey within three years by requiring uninsured residents to buy coverage and using state-funds to provide reduced-cost policies • Proposal would be phased in; Initial phase to focus on “Kids First”

  13. Who is Eligible? • For Children only - Adults are not eligible • Uninsured children under the age of 19 years old • Families with more than one child must enrollall of their children • Children must be uninsured/without health insurance coverage for previous six months • If there was a loss of Medicaid or traditionalNJ FamilyCare eligibility-children are immediately eligible • Legal resident of NJ • Family income must be above 350% of theFederal Poverty Level: $36,400 13

  14. What are the Costs? • Families pay low NJ State-set, monthly premium per child: • $137 a month for one child • $274 for a family with two children • $411 for a family of three or more children 14

  15. The Benefit Package • Very similar to NJ FamilyCare (SCHIP) benefits • Visits to child’s PCP • Specialty care • Dental care (under 12 years old) • Prescription drugs -$1 co-pay generic/$5 brand name • Hospital services: • Inpatient • Outpatient with $5 co-pay per visit • Emergency medical care/emergency services • Well child care, immunizations, lead screening/treatment • Laboratory services - covered with a $5 co-pay • Optometrist - yearly eye exam with a $5 co-pay • Optical - eyeglasses or contact lenses every 24 months 15

  16. Enrollment & Marketing • As of 5/1/2008, 34 members are enrolled in the plan • Slow and cautious approach to make sure operations run effectively • Phone line began taking calls 1/1/2008 • More than 125 applications sent out • NJ FamilyCare Advantage pages were added to Web site the first week of February • 91 applications were downloaded during the first 3 weeks • Grass Roots marketing/community relations • Continue to work with community-based organizations, faith-based organizations, providers, schools, etc. • Partnering with the State (Notify those not eligible for SCHIP) • Participating in more than 250 health fairs in 2008 16

  17. Thank You

  18. Contact Information:Philip M. Bonaparte, MD210 Silvia StreetWest Trenton, NJ 08628Email:phil_bonaparte@horizonnjhealth.comTel.: (609) 448-9424