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Tribal Sponsorship Opportunities in The Affordable Care Act

Tribal Sponsorship Opportunities in The Affordable Care Act. Mim Dixon Tribal Self Governance Annual Meeting New Orleans, May 7, 2012. Affordable Care Act. Two new programs will offer insurance coverage for nearly everyone starting January 1, 2014 Medicaid Expansion

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Tribal Sponsorship Opportunities in The Affordable Care Act

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  1. Tribal Sponsorship Opportunities in The Affordable Care Act Mim Dixon Tribal Self Governance Annual Meeting New Orleans, May 7, 2012

  2. Affordable Care Act Two new programs will offer insurance coverage for nearly everyone starting January 1, 2014 • Medicaid Expansion • Health Insurance Exchanges

  3. Medicaid Expansion • Covers everyone under 133% FPL • No premiums, deductibles or co-pays

  4. Health Insurance Exchanges • Private insurance plans • Federal subsidies of premiums up to 400% FPL • Sliding scale • No cost sharing for AI/AN • Monthly enrollment for AI/AN

  5. What does this mean for your Tribe? • Tribe can bill for services provided to everyone who has insurance. • Insurance replaces expenditures for Contract Health Services. • More revenue for Tribe. • More $$ = more services for Tribal members

  6. The Challenge For Tribes to benefit, uninsured active users of Indian health services must enroll in Medicaid Expansion or Health Insurance Exchange plans.

  7. 4 Barriers to Enrollmentin Exchange Plans 1. Premium Payments SOLUTION: Tribal Sponsorship 2. Motivation to Enroll SOLUTION: Communications Plan 3. Complicated Rules SOLUTION: Enrollment Assistance 4. Advanced Tax Payments SOLUTION: Tax Assistance

  8. Tribal Sponsorship • Tribe pays portion of premium for selected individuals. • Federal funds can be used. • Aggregate payments • One check per month from Tribe • Payment to Exchange, Insurance or TPA • Exchange decides rules for Tribal Sponsorship.

  9. Investment For every dollar spent on premiums and administrative costs, Tribe can expect $1.77 to $5.99 back in revenues and CHS savings.

  10. Cost/Benefit Analysis • Tribes with higher poverty levels will have greater return on investment. • Larger Tribes will receive more revenue and CHS savings than smaller Tribes.

  11. Outreach and Enrollment • Administrative costs • Sources of Funding • Medicaid Administrative Match (MAM) • Navigator funding • Medicaid Expansion may have greatest benefit without premium costs

  12. Tribe as Network Provider • To get paid for services, become network provider. • Indian Addendum • Manage contracts • Referrals through CHS to avoid cost sharing

  13. Strategies • Select individuals to sponsor • Patients eligible for CHS • People with diabetes or cancer • 50-64 years old • Monthly enrollment, adding groups • Start with Medicaid Expansion • Consider Bronze plan (lower premiums) + no tax credits/subsidy • Work with one Plan for sponsorship and become network provider.

  14. Tribal Consultation for Exchange Rules • Each State will have Exchange • State or Federal Exchange • Exchange decides terms and conditions of sponsorship • Exchange must consult with Tribes • Important goals: • Aggregate payments • Tribes select individuals to sponsor • No penalties to end sponsorship

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