Kentucky Health Benefit Exchange Snapshot

1. Kentucky Health Benefit Exchange Snapshot

2. Kentucky Health Benefit Exchange KMA Presentation Winter Update Kentucky Health Benefit Exchange

3. Disclaimer Current State of Exchanges (Kaiser) KMA Presentation Winter Update Kentucky Health Benefit Exchange

4. Kentucky Health Benefit Exchange Supreme Court ruled to uphold the ACA $1 Million Planning $7.7 Million - First Level One/ IT $57.8 Million Second Level One/IT Building $4.4 Million Third Level One/Navigator $183 Million June, 2012 State Run Exchange November, 2012 Blueprint filed December, 2012 Conditional Approval July, 2012

5. Kentucky Health Benefit Exchange Large Employers 2015 Cabinet for Health and Family Services (CHFS) • Letters of Intent • Anthem • Bluegrass Family • Health • Humana X* • United Health Care • KY CO-OP Coventry Cares Humana CareSource Passport WellCare Others – Anthem, etc. *regional plan

6. Medicaid Expansion • 308,000 uninsured may gain Medicaid and will include: • Adults 19-64 with income under 138% of the FPL and not covered under current Medicaid eligibility criteria • Former foster care children up to age 26 • Request for Proposal (RFP) for Medicaid expansion must be submitted by July 22, 2013 • Bids will be for new vendors and will exclude Region Three • MCOs currently under contract outside of Region Three (WellCare and Coventry) will have an opportunity to amend their current contract. • In place – January 1, 2014 Household Size/FPL 100% 138% 1 $11, 490 $15,856 2 $15,410 $21,404 3 $19, 530 $26, 951 4 $23, 550 $32, 449

7. Kentucky Health Benefit Exchange MAGI Premium Cost Proposed Rule: Eligibility evaluations for premium tax credits and Medicaid eligibility will be based on the “honor system” and will be performed manually by the state exchanges rather than being based on IRS data provided to the exchanges through the new federal data hub.

8. Kentucky Health Benefit Exchange

9. Kentucky Health Benefit Exchange 50 or less FTE

10. Kentucky Health Benefit Exchange More than 50 FTE Delayed - 2015

11. Kentucky Health Benefit Exchange Cabinet for Health and Family Services (CHFS)

12. Kentucky Health Benefit Exchange

13. Kentucky Health Benefit Exchange

14. Kentucky Health Benefit Exchange *KCHIP

15. Kentucky Health Benefit Exchange

16. Kentucky Health Benefit Exchange Navigators - Individuals or Entities that: • May include: Community/consumer-focused nonprofit groups, Chambers of commerce, resource partners of Small Business Administration, Health Care Providers, etc. • Maintain expertise in eligibility, enrollment and programs;Provide information/services in fair, accurate, impartial way;Facilitate selection of Qualified Health Plans (QHPs); and • Provide referrals to any applicable office, health insurance consumer assistance or ombudsman, or State agency for grievances, complaints, or questions about health plan.

17. Kentucky Health Benefit Exchange ACA – Affordable Care Act CHFS – Children and Family Services E&E – Eligibility and Enrollment EHB – Essential Health Benefits KHBE – Kentucky Health Benefit Exchange IT – Information Technology MAGI– Modified Adjusted Gross Income MCO– Managed Care Organization QHP – Qualified Health Plan SHOP– Small Business Health Option Program

18. Kentucky Health Benefit Exchange http://healthbenefitexchange.ky.gov/ www.kyma.org www.glms.org

19. Kentucky Health Benefit Exchange • Questions? Kentucky Medical Association Lindy Lady, CPC, CPCO Manager, Medical Business Advocacy 4965 US Highway 42 Suite 2000 Louisville, KY 40222-6301 502 426-6200/Extension 228 lady@kyma.org

20. Kentucky Health Benefit Exchange