Health Reform and Its Impact on You and Those You Serve

1. Health Reform and Its Impact on You and Those You Serve Arizona Coalition to End Homelessness October 29, 2013

2. Why Is Reform Needed? • Nearly 1-in-5 Arizonans lack health coverage • Medical debt significant cause of financial insecurity • Growth in healthcare costs are unsustainable, crowding out other public spending, personal income

3. Why Is Reform Needed? • Americans are getting far too little bang for our healthcare dollar • We have a sick care system, not a healthcare system • Status quo is unacceptable

4. Health Reform and the Homeless • Seventy percent of those experiencing homelessness are uninsured • Those who are homeless often experience chronic health conditions, including behavioral health issues • Medicaid coverage has been limited for many among the homeless population in recent years • People who are homeless are often high medical care utilizers, driving up healthcare costs for us all

5. Health Reform • Access and Coverage • Quality • Cost

6. Principles for Reform • Encouraging healthy behaviors • Improving access to early, preventive care • Changing how healthcare is delivered • Managing the care of high utilizers • Changing the incentives • Eliminating waste

7. Coverage Expansion Employer-based coverage Medicaid The “Exchange”

8. Medicaid Expansion • Over 300,000 Arizonans could benefit • Supported by the Governor, passed by the Legislature • Approximately 60 percent of voters support restoration or expansion • Restores coverage to childless adults

9. Medicaid Expansion • Increases eligibility up to 133 percent of the federal poverty level (approximately 15,000/year for an individual) • Eligibility screening began October 1st • Coverage begins on January 1, 2014

10. Health E Arizona Plus • Online application for AHCCCS as well as programs such as TANF and SNAP • Began mid-October, 2013 • Consolidation, update of existing state eligibility systems

11. Health E Arizona Plus • Access to federal data hub, making eligibility determinations easier • Renewals less frequent, easier • More affordable options for community providers to participate • Connection to Marketplace

12. Improvements to Coverage • Requires many health plans to offer ten essential health benefits • Provides broader access to behavioral health and substance abuse services • Prohibits many insurance plans from charging cost sharing for preventive services

13. Improvements to Coverage • Prevents discrimination in pricing based on pre-existing conditions • Those who have self-insured or grandfathered plans will not benefit from essential benefits, elimination of cost-sharing • Those on traditional Medicaid may not benefit from essential benefits in some instances

14. Essential Benefits • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance use disorder services • Prescription drugs; • Rehabilitative and habilitative services and devices • Laboratory services • Preventive and wellness services • Chronic disease management • Pediatric services, including oral and vision care

15. Essential Benefits • Arizona picked state employee plan, administered by United Health Care, as benchmark • www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/arizona-ehb-benchmark-plan.pdf

16. The Marketplace • Online site for individuals and small businesses to compare and purchase health coverage • Intended to simplify and structure health insurance choices for individuals, families and small businesses • Exclusive mechanism for receiving federal subsidies and plans with cost-sharing limits

17. The Marketplace • Open enrollment began October 1 • Open enrollment will occur through the end of March • 1.3 million Arizonans predicted to eventually receive coverage through the marketplace

18. Plan Levels of Coverage

19. Premium Subsidies • Tax credit is advanceable or refundable • Eligibility is based on • Projected household income and family size • 100 – 400% FPL ($23,550 -$94,200 for a family of four in 2013) • Obtaining qualified coverage through the marketplace • Ineligible for government-sponsored coverage, affordable-sponsored insurance, or certain other minimum essential coverage

20. Cost Sharing Reduction • Eligibility for reduced cost sharing is based on incomes at or below 250% of FPL ($58,875 annually for a family of four in 2013) • Receiving the new premium tax credit • Enrolling in a marketplace silver-level plan • No cost sharing for members of Tribes

21. Individual Mandate • Beginning in 2014, most people must have health coverage or pay a fee when you file your tax return • Some people may qualify for an exemption

22. Cover Arizona • Builds off of the successful outreach efforts for the Pre-Existing Conditions Insurance Pool • More than 600 members • Two goals: • Maximize enrollment of individuals and families in the new insurance marketplace and Medicaid • Identify and assess outreach efforts so that we can build on our successes

23. How Cover Arizona is Organizing • By Demographics • By Geography • By Strategy

24. Enrollment Assistance • Navigators • Certified Application Counselors • Brokers • Health E Arizona Plus Assisters

25. Resources • healthcare.gov • www.cuidadodesalud.gov • marketplace.cms.gov • 1-800-318-2596 (open 24/7, 150+ languages) • www.healthearizonaplus.gov • 1 855 HEA-plus • coveraz.org

26. Optimizing Coverage Among Those Experiencing Homelessness • Having staff dedicated to outreach, education, and enrollment assistance • Building community partnerships to assist with outreach and enrollment activities • Educating individuals about the specific benefits of coverage and the overall enrollment process

27. Optimizing Coverage Among Those Experiencing Homelessness • Providing direct hands-on, one-on-one assistance through each step of the enrollment process • Assisting in obtaining documentation by helping to fill out paperwork, going with or providing transportation to the offices, and covering the cost of replacing documents • Storing copies or originals of documents in client file to keep them safe and secure

28. Optimizing Coverage Among Those Experiencing Homelessness • Providing transportation and accompanying individuals on visits to the eligibility office • Maintaining contact over time to assist in the renewal of coverage • Engaging providers to remind individuals about steps needed to complete enrollment during patient visits • Educating consumers about how to use their benefits, access health care

29. Improving Quality, Lowering Costs Opportunities to move forward on: • Coordination of care, integration • Community-based care • Chronic disease management • Primary care • Prevention • Incentivizing value-based health care

30. Changes in Care Delivery • Accountable Care Organizations and other models aimed at rewarding outcomes • Penalties for inappropriate hospital readmissions • Movement towards medical home model where care is coordinated • Integration of acute care and behavioral healthcare

31. Opportunities • To serve an essential community provider for a health plan • To partner in helping hospitals manage inappropriate hospital readmissions • To become a member of a provider networks for those caring for persons with behavioral health needs • To partner with a federally qualified health clinic to provide care coordination

32. www.slhi.org