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Expanding Medicaid

Expanding Medicaid. The Who, What, When and How of LB 887. Sections of LB 887. Section 1 – Name of the Act S ection 2 – Findings Section 3 – Purpose Section 4 - 35 – Definitions Section 36 – State plan amendment

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Expanding Medicaid

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  1. Expanding Medicaid The Who, What, When and How of LB 887

  2. Sections of LB 887 Section 1 – Name of the Act Section 2 – Findings Section 3 – Purpose Section 4 - 35 – Definitions Section 36 – State plan amendment • Directs DHHS to apply for a state plan amendment that will be in effect until WIN waivers are enacted. • Directs DHHS to apply for waivers to implement WIN, • Permits DHHS to establish a employer-sponsored insurance premium assistance if cost effective

  3. Sections of the Bill (continued) Section 37 – Marketplace coverage • 100%-138% of FPL and no exceptional medical conditions • Enroll in a 100% actuarial value silver plan • Effective first day of month following month of application • Medicaid coverage until effective date and wraparound coverage for MA services not covered by QHP

  4. Sections of the Bill (continued) Section 38 – Employer sponsored insurance • Available to persons up to 138% of FPL who have access to coverage through an employer that meets ACA standards. • DHHS may pay for premium associated with employer share of premiums, cost sharing and wrap around benefit. • Employer sponsored insurance shall only be provided if determined to be cost effective.

  5. Sections of the Bill (continued) Section 39 – WIN Medicaid • Available to those with incomes below 100% of FPL. • Private managed care organizations providing WIN Medicaid coverage must assure that newly eligible have access to a primary care provider and enrolled in a patient-centered medical home, where available.

  6. Sections of the Bill (continued) Section 40 – Health systems transformation • Use delivery models that improve patient health outcomes, improve care and reduce costs. • Include safety net providers in networks. • Role of patient-centered medical homes Section 41 – Health homes • Role in providing care for medically frail

  7. Sections of the Bill (continued) Section 42 – Reimbursement Models • Development of models that promote quality and contain costs • Develop ACO reimbursement methodology Section 43 – Models to promote cost-conscious consumer behavior • Conditional exemption from contributions • Prepare for transition to exchange coverage

  8. Sections of the Bill (continued) Section 43 (cont.) • Eligible persons above 50% FPL would pay contribution of 2% of income. • Contribution waived if the covered person participates in preventive/wellness activities. • No copayments for WIN Marketplace or WIN Medicaid coverage

  9. Sections of the Bill (continued) Section 44 – Conditions of participation • A member is eligible for benefits for 12 months from initial enrollment. • Annual review of eligibility. • Coverage can be cancelled if program is discontinued. Section 45 – Content of waiver application

  10. Sections of the Bill (continued) Section 46 – WIN Oversight Committee • Chair of HHS Committee • Two members of HHS Committee • Two members of Appropriations Committee • Two members of Banking, Commerce and Insurance Committee • Two members not on those committees • Meet quarterly with representative of DHHS

  11. Sections of the Bill (continued) Section 47 – Failsafe • If federal funding percentage falls below amount stipulated in ACA, Legislature will take review continued participation. Section 48 – Rules and Regulations Section 49 – Emergency Clause

  12. Who Would be Covered by LB 887 • WIN coverage would be offered to Nebraskans with MAGI below 138% of FPL. • Premium support for employer sponsored coverage • Premium support for marketplace coverage for those between 100% and 138% of FPL • Medicaid coverage for those below 100% of FPL

  13. Three Types of Coverage Employer Sponsored Insurance • Option that could be used if it is cost-effective • DHHS would pay employee costs of coverage WIN Marketplace • Premium support to buy a special issue plan • Wraparound coverage for MA-only services WIN Medicaid • Medicaid coverage extended to newly eligible

  14. What is the Potential Market for WIN Less than 100% FPL Employer Coverage 30,234 Direct Purchase 16,506 Uninsured 51,599 100% to 138% FPL Employer Coverage 22,859 Direct Purchase 7,759 Uninsured 26,245

  15. Federal Poverty Level 100% 138% One Person 11,670 16,105 Two Persons 15,730 21,707 Three Persons 19,790 27,310 Four Persons 23,850 32,913 Five Persons 27,910 38,516 Six Persons 31,970 42,919

  16. Examples of Cost of Coverage Costs vary by: • Age • Income • Location • Tobacco Use • Household Size • Access to Medicaid • Number of Persons Covered Handout

  17. Issues Cost of Implementation through FY-2020 ($million) • LB 887 Fiscal Note Federal $2,107 State $90 • Milliman (State Plan) Federal $2,407 State $97 • Milliman (Waiver) Federal $3,374 State $155

  18. Issues Marketplace Plan vs. Medicaid • Using private coverage instead of Medicaid will increase costs substantially (Milliman) • Private coverage for 100-138 FPL will limit access to coverage for Medicaid enrollees (Platte Institute)

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