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Exchange Workgroup Meeting #1: June 22, 2010 Agenda

Exchange Workgroup Meeting #1: June 22, 2010 Agenda. Discuss/refine/confirm minimum statutory requirements of an exchange Discuss/feedback from group on background materials provided. Any key takeaways? BCBSRI exchange summary Amy Lischko brief: Comparison of MA and Utah exchanges

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Exchange Workgroup Meeting #1: June 22, 2010 Agenda

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  1. Exchange Workgroup Meeting #1: June 22, 2010 Agenda • Discuss/refine/confirm minimum statutory requirements of an exchange • Discuss/feedback from group on background materials provided. Any key takeaways? • BCBSRI exchange summary • Amy Lischko brief: Comparison of MA and Utah exchanges • Presentation by Nancy Turnbull on MA exchange • Other? • Questions for the group Prepared by Deb Faulkner on behalf of the Lt. Governor’s Subcommittee on Exchanges

  2. Role of Exchange: Who goes where? 0% 100% 200% 300% 400% 133% 185% 250% Childless Adults Now 2014 and beyond Unsubsidized Medicaid Exchange Based Subsidies Parents Now 2014 and beyond Medicaid Unsubsidized Medicaid Exchange Based Subsidies Children Now 2014 and beyond Medicaid Medicaid Exchange Based Subsidies Unsubsidized

  3. Minimum Required Exchange Functions (draft for discussion) Based on Section 1311 of health reform statute Exchange Requirement? • Consumer Information/communication…………………………………………….. • Toll free number • Maintain website with information on qualified plans • Standardized presentation of health benefit plans • Provide calculator for individuals to determine cost of coverage after subsidy • Rating/Qualifying Plans and Benefits………………………………………………… • Health plan Certification • Rate Qualified Health plans • Eligibility Determination……………………………………………………………………. • Determine eligibility for Medicaid, exchange subsidy • Certify individuals exempt from mandate • Enrollment/Premium Billing……………………………………………………………… • Enroll individuals in health benefit plans • Bill/collect premium • Subsidy Implementation.………………………………………………………………….. • Pay subsidy • Take in subsidy Yes Yes Yes(but can outsource to Medicaid) No No (but may facilitate advanced tax credit/cost sharing subsidy*) * Note: Exchange may facilitate advanced tax credit/cost sharing subsidy, by informing feds that individual qualifies for subsidy, so that health plan can charge a subsidized premium

  4. Who Goes Where: How to purchase insurance? Question 1: Access to Employer-Based Insurance, meeting Minimum Essential Benefits? Question 2: Is it Affordable? Question 3: Medicaid Eligible Child? Question 4: Access to Affordable, Employer Based Child-Only Plan? Must Purchase Employer-Based Coverage Unsubsidized Yes Individual or Family over 400% FPL No Must Purchase Unsubsidized Minimum Essential Benefits(thru exchange or direct) Yes Must Purchase Employer-Based Coverage Unsubsidized Check affordability Yes Individual or Family 250-400% FPL No No Must Purchase Exchange Qualified Plans, thru Exchange with Federal subsidy1,2 Child on Rite Share Yes Child on MedicaidParents purchase Exchange Qualified Plans with Federal subsidy1,2 Yes Must Purchase Employer-Based Coverage Unsubsidized Check affordability Yes Yes Child on Rite Care No Individual or Family 133-250% FPL No Is there a child in the family? No Must Purchase Exchange Qualified Plans with Federal subsidy1,2 No Yes Rite Share: Employer based coverage with Mcaid Wrap Check cost effectiveness Yes Individual or Family <133% FPL No Rite Care No • Exchange legislation does NOT appear to allow for a RIteShare-like wrap program for Exchange Based subsidies. Relies on employer penalties to ensure that employers offer minimum essential benefits, and that premiums are affordable • Legislation suggests that Exchange handles eligibility determination, then carriers charge subsidized rate, and are reimbursed by feds directly with no cash flow thru the exchange.

  5. For Discussion & Next Steps • What are the goals of a Rhode Island exchange? • How should the exchange interact with our Medicaid program? • How do we want the 600k commercially insured to interact with the exchange? • Based on these answers we can then consider • State operated exchange vs. regional exchange vs. federal fallback • What operational functions will we need to create? What capacities should we consider building/buying?

  6. Backup High level estimates of Reform Impacts * Uninsured estimates based on Mathematica study of RI Uninsured, estimate for 2010. Estimate of 5000 Medicaid enrollees transitioning to the exchange assumes parents over 133% are transitioned. Estimate is low – based on 2008 data, using 150% FPL cutoff.

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