Federal Health Reform in Tennessee May 30, 2013

1. Federal Health Reform in Tennessee May 30, 2013

2. Agenda Strategic Planning and Innovation Group Uninsured Insurance markets changes Exchange implementation status Medicaid expansion status Update on Navigators/In-Person Assisters Questions 2

3. Strategic Planning and Innovation Group • Payment Reform • Governor led • Pay for value instead of volume • State innovation model design grant • Cover Tennessee • Adjust CoverTN, AccessTN, CoverKids, and CoverRx for the 2014 policy context • Insurance Exchange • Monitor the federal insurance exchange, assist TN stakeholders

4. Payment Reform • The new initiative is Governor-led, multi-payer, will change the way physicians are paid (episode-based payment), and improve population health. • TN received a State Innovation Model grant from Centers for Medicare and Medicaid Services to design a comprehensive payment reform plan. • Design states (16 grants, $~1-3M each) • Pre-testing states (3, $~1-3M each) • Testing states (6 grants, $~45M each)

5. Cover Tennessee Programs CoverTN – partnership between the state, employers and individuals to make insurance affordable for lower-income workers, closed to new enrollment (~16,000 lives) AccessTN- state’s high-risk pool, premium assistance closed to new enrollment (~2,800 lives) CoverRx- pharmacy assistance program for those without access to prescription drug coverage (~ 55,000 lives) CoverKids- state’s CHIP program up to 250% FPL (~59,000 lives)

6. United States Uninsured Income Health Insurance Coverage of the Nonelderly, 2011 ≤138% FPL (51%) 139-399% FPL (39%) ≥400% FPL (10%) Employer-Sponsored Coverage Uninsured State and Federal Programs* Private Non-Group 266.4 Million Nonelderly 47.9 Million Uninsured *The majority of this is Medicaid, but also includes other public programs: CHIP, other state programs, Medicare and military-related coverage. The federal poverty level for a family of three in 2011 was $18,530. Numbers may not add to 100% due to rounding. SOURCE: KCMU/Urban Institute analysis of 2012 ASEC Supplement to the CPS.

7. Tennessee Uninsured Approximately 9% of the state’s 6.3 million residents are uninsured (CBER, 2012) Proportion of Uninsured Non-elderly Adults under 400% FPL by County SOURCE: U.S. Census Bureau, Small Area Health Insurance Estimates, 2010

8. Tennesseans ages 18-34 are a disproportionate share of the uninsured Age Distribution by Insurance Status in Tennessee SOURCE: U.S. Census Bureau, American Community Survey, 3-year estimates 2009-2011

9. The typical uninsured Tennessean has a high school education or less Educational Attainment by Insurance Status in Tennessee SOURCE: U.S. Census Bureau, American Community Survey, 3-year estimates 2009-2011

10. Most uninsured Tennesseans are members of working families and have low incomes Family Work Status, Nonelderly Uninsured Population in Tennessee SOURCE: U.S. Census Bureau, Current Population Survey, 2010-2011

11. A majority of the state’s uninsured will be eligible for subsidized Exchange coverage Income Distribution by Insurance Status in Tennessee SOURCE: U.S. Census Bureau, American Community Survey, 3-year estimates 2009-2011

12. What does Federal Health Reform do? • Health Insurance Market Reforms • Individual Mandate • Employer Penalties • Health Insurance Exchanges • Medicaid Expansion

13. Insurance Market Changes 13

14. Insurance Market Changes: Effect on Rates • Premium competition • Reinsurance, risk corridors (temporary) • Age bands for older people • No gender rating for women • Increasing cost of health services, lack of wellness • Unknowns: Uninsured health needs, take-up rates • Rich “essential health benefit” • Age bands for young people • No gender rating for men

15. What is an Insurance Exchange? What is a PPACA Federal Marketplace? • Eligibility Engine: Enables consumers to qualify for public programs (Medicaid and CHIP), tax credits, and cost sharing reductions • Market stabilization policies (through reinsurance, risk adjustment, and risk corridors) A method for buying insurance such as a web portal or toll-free call center. Allows consumer comparisons of multiple plans Multiple existing private examples Two existing state examples: Utah and Massachusetts 15

16. Federal Premium Assistance Tax Credits • Residents 100% to 400% FPL eligible for tax credits if they lack affordable coverage (e.g., through work). • Tennessee’s median household income is $43,989, which is lower than this threshold.

17. What will the Exchange look like? www. ux2014 .org 17

18. The Future of Eligibility Determinations $ Data Hub # HEALTH INSURANCE Medicaid CHIP Exchange Single Application for Multiple Programs Use of Electronic Data to Verify Eligibility Multiple Ways to Enroll Near Real-Time Eligibility Determinations Dear ______, You are eligible for…

19. Exchange Portal Process 1. Sign in and enter household information 2. Apply for health coverage 3. Compare health plans 5. Pay carrier first months premium 4. Confirm plan selection 19

20. Tennessee will have a federally-run Exchange ME VT WA NH MT ND MN OR MA NY WI SD ID MI RI CT WY PA NJ IA NE OH DE IN IL NV MD CO UT WV DC VA CA KS MO KY NC TN SC OK AR AZ NM GA AL MS LA TX FL AK HI State-Based Exchange (16 states + DC) Partnership Exchange (7 states) Federal Exchange (27 states) As of May 25, 2013 SOURCE: Kaiser Family Foundation State Health Facts

21. Current Medicaid/CHIP Eligibility Categories Medicaid/CHIP Eligibility Threshold, January 2013 SOURCE: Kaiser Commission on Medicaid and the Uninsured and the Georgetown University Center for Children and Families, 2013.

22. Medicaid Eligibility Levels for Working Parents of Dependent Children as of January 2013 138% NOTE: Ten states (CT, IL, ME, MA, MN, NJ, NY, RI, VT, WI) and DC offer coverage to parents at or above 138% FPL SOURCE: Kaiser Commission on Medicaid and the Uninsured and the Georgetown University Center for Children and Families, 2013.

23. Tennessee is pursuing an Alternative Model for Medicaid Expansion VT WA ME ND MT NH MN OR MA NY WI SD ID RI MI CT PA WY NJ IA DE OH * NE NV IN IL MD CO UT WV VA CA DC KS MO KY NC TN OK SC AZ AR NM GA AL MS TX LA AK FL HI Participating Expansion (26 states & DC) Not participating Expansion (20 states) Pursuing Alternative Model (4 states) *Ohio is also exploring alternative options SOURCE: The Advisory Board Company. As of May 24, 2013

24. Who will help people enroll in new coverage options? • Navigators • Required in every state Exchange • Paid with federal funds in Partnership and FFE states ($54M) • In-person Assistors • Optional, except for consumer partnership Exchanges • Certified Application Counselors • Volunteers, do not receive state or federal funding • Hospital staff, non-profit organizations, faith-based organizations • Brokers • To the extent permitted by a state, brokers will continue to enroll consumers in coverage and will be reimbursed by issuers

25. Federal Navigator Grants ($54M) by State

26. Community Health CentersAdditional Funding for Outreach • This month HHS announced an additional $150 Million for community health centers to provide in-person enrollment assistance to uninsured • Available to CHCs in ALL states through HRSA • New funds available for CHCs to hire new staff, train existing staff, and conduct community outreach events and other educational activities. • CHC staff will be trained to help consumers understand coverage options, determine eligibility, and enroll.

27. Questions? Julia Harris Julia.Harris@tn.gov