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New York State Health Benefit Exchange

New York State Health Benefit Exchange. TC LWV Panel Discussion Health Care: What's Up In Albany January 28, 2013 Linda Smith Chief of Staff for Assemblywoman Barbara Lifton. What Is the Health Benefit Exchange?. A centralized "marketplace" available online or through a

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New York State Health Benefit Exchange

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  1. New York StateHealth Benefit Exchange TC LWV Panel Discussion Health Care: What's Up In Albany January 28, 2013 Linda Smith Chief of Staff for Assemblywoman Barbara Lifton

  2. What Is the Health Benefit Exchange? A centralized "marketplace" available online or through a telephone hotline for the purchase and sale of health insurance to individuals and small businesses in accordance with the ACA.

  3. Why An Exchange? • Required under the Federal Patient Protection and Affordable Care Act (ACA) Signed into law on March 23, 2010. • States must establish their own Exchange by 2014 or participate in a federally operated Exchange • For states that choose to operate their own Exchange, they must show by 1/1/2013 it’ll be operational by 1/1/2014 and self-sustaining by 1/1/2015. .

  4. What’s the picture look like now? • Very difficult (impossible?) for many to find comprehensive affordable healthcare coverage on the open market • Uninsured often wait until they're very sick to seek treatment, resulting in early and unnecessary deaths.

  5. What's the Picture Look Like Now? About 2.7 million (16%) New Yorkers are uninsured; most are working families, 10,000 are cancer patients, costing: • State and local governments $600m/year to cover their health care costs • An additional $800/year for family premiums

  6. What's the Picture Look Like Now? • 800,000 workers have lost their employer-sponsored health insurance over the past decade • Only 55% non-elderly have insurance through employer

  7. What's the Picture Look Like Now? 5% purchase insurance directly 24% are in public programs 1m are eligible for public coverage but not enrolled

  8. How Will The Exchange Help? • The Exchange will help approximately 1 million New Yorkers get health coverage • Individuals who currently buy coverage directly could see premium savings up to 60% • Small businesses could reduce the cost of providing healthcare to their employees by 22%

  9. How Will the Exchange Help? • Individuals and small businesses purchasing coverage through the Exchange will receive $2.4 billion infederal tax credits and cost sharing subsidies • Subsidies up to 400% of FPL will help 450,000 New Yorkers $73,240 for family of 3 $92,000 for family of 4

  10. How Will The Exchange Help? • NYS DOB estimates $18 billion in savings to NYS over 10 years • Urban Institute estimates annual savings of $2.3 billion when reform fully implemented

  11. How Will The Exchange Help? Enhanced federal financing will pay 90% on all childless adults covered by Medicaid prior to ACA (NY currently pays 50% for those 800,000 enrollees)

  12. The Legislative Road to Establishing NYS Health Benefit Exchange • A8514 (Morelle)/S5849(Seward) (Governor Program #12) Passed Assembly 6/23/11 Died in Senate

  13. The Legislative Road to Establishing NYS Health Benefit Exchange • 2012-13 Executive Budget Assembly Budget Reso NOT included in final budget • April 12, 2012 Governor issues EO #42 establishing New York's Exchange (other states have gone this route, including RI, MS, IN)

  14. The Legislative Road to Establishing NYS Health Benefit Exchange • 2013-14 Executive Budget reflects the implementation of the Exchange • Conforms eligibility and benefits of public health insurance programs to better align w/Exchange - Medicaid, CHP,FHP, HNY

  15. The Road to Establishing NYS Health Benefit Exchange Eliminate FHP or make it part of Exchange? A budget item up for discussion Final Budget Agreement due April 1st - stay-tuned

  16. Federal Grants • Development and operation of the Exchange is funded by the federal government until 1/1/2015 • As of August 2012, NY had received a total of $183.2 million to support development of its Exchange

  17. Federal Grants have funded Planning/Development of Exchange 9/2010 - $1m Planning grant 2/2011 - $48.5 million $27.4 m Early Innovator grant 8/2011 - $10.7 m 8/2012 - $95.5m Development grant 1/17/13 - $186m Establishment grant

  18. Planning, Research, Studies • Hired 4 FT Exchange planning staff to work w/Agency staff on planning • Hired consultants to conduct numerous policy studies • Launched statewide Consumer Assistance Program (CAP) through Community Health Advocates (CHA) program

  19. Planning, Research, Studies • Held stakeholder meetings and public hearings to gather insight/input on setting up Exchange • Reviewed relevant IT systems for functionality and potential use in Exchange

  20. Planning, Research, Studies NYS Premium Rate Review (requirement of ACA) enhanced through prior approval law (2010) Established Bridge Plan - pre-existing conditions

  21. And Moving Forward • 6/28/2012 SCOTUS upholds most of ACA • Limits the federal government’s ability to force expansion of Medicaid by threatening states w/ the loss of existing federal payments. • This will reduce the # of low-income uninsured who get coverage

  22. And Moving Forward 10/1/2012 NY submits Benchmark Plan to HHS Health Insurance Oversight System -Oxford EPO, largest small group plan, Some amendments 10/26/2012 NYS submits Blueprint Application

  23. NY Is On Track • December 14, 2012, NY received conditional approval from the HHS to operate a state-based Exchange.  • This means that HHS has determined New York has made significant progress and is on track with setting up its Exchange. 

  24. What Will NY's Exchange Look Like? • There will be 2 Exchanges – one for individuals and one for small businesses (<50), called SHOP • Exchanges will be open for business beginning October 1st • You will provide information, including SS# - Exchange will provide choices and any tax credits you’re eligible for

  25. What Will NY’s exchange Look Like? Advance premium tax credits will be offered Health plans will be designated by “metals” to signify different benefit levels – gold, silver, bronze….

  26. What Will the Exchange Do? Facilitate enrollment in qualified health and dental plans to individuals/ small businesses Present comparative information to consumers Maintain a website and electronic calculator to compare costs

  27. What Will the Exchange Do? Ensure that small businesses and individuals receive premium tax credits and subsidies that they qualify for Handle premiums and multiple plans for employers Enroll eligible individuals in public health insurance programs

  28. Structure and Duties of NY’s Exchange • Established within the DOH, in conjunction w/ DFS and other agencies • Donna Frescatore, ED of the NYS Health Benefit Exchange • Authorized to enter into agreements w/federal, state, local agencies

  29. Structure and Duties of NY’s Exchange Must incorporate adequate protection for confidentiality re: shared info. Transparency Account for diversity of our population

  30. Structure and Duties of NY’s Exchange • Implement procedures for oversight of health plans, including certification, recert, decert • Ensure compliance with federal standards regarding governance plans and reporting • Run a grant program for Navigators

  31. Navigator Program • Exchange must establish a Navigator grant program that will provide funds to organizations to conduct public education and awareness programs, distribute fair and impartial information, and other consumer services • Strong training requirements

  32. Navigator Program RFP has been delayed, partly because the SHOP isn’t totally ready Potential Navigators? - experience in serving underserved, Workers Center, Family and Children Services, Human Services Coalition, Chambers, etc.

  33. Structure and Duties of NY’s Exchange • Establish and consult with Regional Advisory Committees • Consult with stakeholders - consumers, state Medicaid offices, advocates.. • No preemption of duties of DOH, DFS, other agencies • Any other duties required by the HHS

  34. Regional Advisory Committees • 5 regions throughout state, Committees are up and running, meetings, webinars • Provide advice, make recommendations about establishment and operation of Exchange

  35. Regional Advisory Committees Representatives from consumer advocates, small business, healthcare providers, insurers, labor, brokers, agents Must provide opportunities for public input

  36. In Conclusion • NY is well on its way to having its Exchange up and running by October 1st, 2013 and fully operational by the 1/1/ 2014 deadline. • There are some unanswered questions that will come up between now and then.

  37. Websites for Further informationand Updates www.healthbenefitexchange.ny.gov www.healthcarereform.ny.gov www.hcfany.org

  38. Questions and Updates Assemblywoman Barbara Lifton liftonb@assembly.state.ny.us 277-8030

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