North Dakota – Medicaid Expansion

1. North Dakota – Medicaid Expansion October 8, 2014 ND Assoc of Counties

2. Background • Affordable Care Act (ACA) included a mandate for all states to expand Medicaid. • June 2012 Supreme Court decision indicated that the US Department of Health and Human Services could not enforce the mandate. • The North Dakota legislature passed and Governor Dalrymple signed legislation to authorize ND to expand Medicaid. • Coverage will begin January 1, 2014.

3. Eligibility • Individuals under the age of 65 and below 138% of the Federal Poverty Level. (About $16,000 for a household of 1 and $21,000 for a household of 2). • Historically for Medicaid, an individual had to be in one of the qualifying “categories” and be income eligible – in order to receive Medicaid.

4. Healthcare Coverage • The Department has issued a Request for Proposal (RFP) for private insurance carriers interested in providing coverage for the Medicaid Expansion population. • Responses to the RFP are due TODAY; and the Department expects to award a contract mid-October. • A choice of plans must be provided in Burleigh and Cass Counties.

5. Healthcare Coverage • Coverage will not be the same as the traditional Medicaid coverage. • Individuals who are medically frail will be offered a choice to receive traditional Medicaid coverage. • Coverage will include the essential health benefits and must also comply with the Mental Health Parity and Substance Abuse Equity Act.

6. Impact on County Jail Claims • More people will be eligible for Medicaid (Expansion) and so it is likely that more inmates would have Medicaid coverage. • Need to have the Medicaid Management Information System (MMIS) operational to implement the “inpatient” piece to allow Medicaid to pay for the “inpatient” claims. • Once implemented, this will save the county jails 50% of the cost of “inpatient” claims for Medicaid eligible inmates.

7. Application Processing • Estimates are between 20,000 and 30,000 thousand people in North Dakota may be eligible for the Medicaid Expansion. • It is uncertain as to how many of those individuals will apply for coverage (employer sponsored coverage, healthcare needs, individual mandate and penalty). • State office and county offices will be monitoring activity and may need to react to manage calls, applications, or in-person assistance needed.

8. Application Processing • The Department is working to engage a vendor to assist with any significant influx of applications or telephone calls. • The contract is expected to be in place by January 1and we will work with the county social service directors to monitor the usage and continuation of the contracted services.

9. Eligibility System • The Information Technology Department is building a system to manage eligibility processing for the Medicaid Expansion AND to process applications under Modified Adjusted Gross Income (MAGI) rules. • Goal is for most people applying for coverage (Medicaid expansion and other Medicaid) to use the electronic system. • The system is expected to be ready in November – Coverage for the Medicaid Expansion group begins in January.

10. Potential Impact and/or Concerns on County Social Services • Positives • Coverage- better health care • Two potential option paths for citizens • State Department Responses

11. Kiosk, Paperless, Available staff to assist in processing Potential Impact and/or Concerns on County Social Services • Concerns • Fear of the Unknown • Potential significant growth in Case Loads • Additional technical skill/knowledge and time required when processing MAGI and/or Non-MAGI cases • Cases with high Recipient Liabilities that may or may not benefit in switching to the health insurance 0ptions • Who helps them with this decision??? • Difficulty in keeping informed on changes and necessary training • Systems will have bugs that will need to be quickly resolved in order to create efficiencies • Many additional questions from community.

12. Summary • Proposals in response to the RFP for coverage for the Medicaid Expansion are due October 8. • Department is planning to contract with vendor(s) to assist with application and call volume. • Eligibility system for Medicaid Expansion group is expected to be ready in November. • The current online application and renewal system remains available for traditional Medicaid applications. Unknowns…Flexibility Goal – online vs. paper!

13. Summary • Department is hosting a number of meetings to provide information on the Medicaid Expansion. • Questions on coverage for private insurance through the Federal Health Insurance Marketplace should be directed to www/Healthcare.gov or 1-800-318-2596 Department of Human Services- Medicaid Expansion Federal Government- Private Insurance Coverage