Access & Enrollment Subcommittee

1. Access & Enrollment Subcommittee PA Health Care Reform Advisory Committee Laval Miller-Wilson, PA Health Law Project Pennsylvania Health Law Project

2. Timeline: Expansion By 2014 Expanding Medicaid Coverage Presumptive Eligibility for Medicaid Individual Requirement to Have Insurance Health Insurance Exchanges Subsidies for Health Insurance Premiums and Cost Sharing Pennsylvania Health Law Project

3. Impact on Pennsylvanians 1 million + uninsured Pennsylvanians 500,000 newly eligible for Medicaid Hundreds of thousands eligible for subsidized coverage Pennsylvania Health Law Project

4. Answering Their Questions Why do I need health insurance? How do I get health insurance? Which type of health insurance is right for me (and my household)? Will it be affordable? Will enrollment be simple? Pennsylvania Health Law Project

5. Areas of State Action Helping eligible individuals enroll in and retain subsidized health insurance Improving affordability and continuity of coverage for low income-adults who are in eligible for Medicaid Increasing access to care within Medicaid Pennsylvania Health Law Project

6. PA’s HCR Committee’s Access Goals for Exchange Facilitate & encourage purchase of affordable health care coverage Provide one-stop, easy to use, accessible portal for consumers & businesses to learn & compare coverage options Link health coverage to existing access points for other health and human services for which people may be eligible. Pennsylvania Health Law Project

7. Key Issues for Enrollment & Retention Public Education & Facilitated Enrollment (Role of Community-based Organizations) Where: One-stop, easy to use, accessible web portal for consumers to learn & compare coverage options Help: Hands-on assistance in the community to inform employers and individuals to help them to select a health plan Pennsylvania Health Law Project

8. Key Issues for Enrollment Public reporting system for health plan performance on quality measures Application Forms & Procedures Single application for Medicaid, CHIP, & Subsidies Electronic verification replacing paper documentation Pennsylvania Health Law Project

9. Key Issues for Enrollment Lessons Learned from Part D Help people enroll well before January 1, 2014 Allow people to apply and be assigned to Medicaid, CHIP, or an Exchange plan before January 1. “Inreach” to people on adultBasic, the adultBasic waiting list and parents of children on Medicaid and CHIP Consider simply “converting” these adults based on known information Pennsylvania Health Law Project

10. Key Issues for Eligibility “A System That Gets to Yes” As It Is Now: Complex Eligibility Requirements for Medicaid & Electronic Data Exchanges Infrastructure: All state agencies work behind the scenes to assign individual to appropriate subsidy program Pennsylvania Health Law Project

11. Key Issues for Affordability Making Coverage Affordable for Residents with Incomes Too High For Medicaid Establish a basic health program (BHP) rather than offering coverage through the Exchange offer one or more standard plans with essential health benefits individuals with income up to 200% of the FPL through contractors, similar to HealthChoices Pennsylvania Health Law Project

12. Key Issue for Continuity of Care When eligibility for subsidized benefits changes, families and individuals should not have to change providers As It Is Now: Lack of Continuity of Care Health plans that participate in the Exchange should be expected to enable continuity of care Pennsylvania Health Law Project

13. Increasing Access to Care Within Medicaid Increased Payments in 2013 & 2014 to Primary Care Providers Access problems outside primary care: dentistry, mental health, specialty services Change licensure laws to increase range of services provided by non-physicians Pennsylvania Health Law Project

14. Goals for Breakout List goals for next review Specific items that will need to be resolved Pennsylvania Health Law Project