North Dakota Medicaid Expansion

1. North Dakota Medicaid Expansion Julie Schwab, MNA, MMGT Director of Medical Services North Dakota Department of Human Services

2. Beginning in January 2014, North Dakota is expanding access to Medicaid to cover more individuals. • Enrollment will begin soon • There is no limited enrollment period to apply for Medicaid and expansion coverage will begin January 1, 2014 North Dakota Medicaid Expansion

3. In early 2013, North Dakota passed legislation to expand the Medicaid program in our state in response to the passage and signing of the 2010 Affordable Care Act by Congress and the President • The decision to expand Medicaid programs in the U.S. was left up to each state Why is North Dakota Medicaid Expanding?

4. Estimates say that an additional 20,000 – 32,000 individuals may qualify for the N.D. Medicaid expansion Approximately 66,000 North Dakotans are currently covered by Medicaid

5. Children up to age 21 • Pregnant women • Caretakers of deprived children • Low-income Medicare beneficiaries • Workers with disabilities • Other blind and disabled individuals of all ages • Low-income individuals over the age of 65 • Certain individuals in active breast or cervical cancer treatment Who does North Dakota Medicaid cover TODAY?

6. Individuals between the ages of 19 and 65 who meet the income requirements of the federal Poverty Level of 138% will be eligible for Medicaid expansion • For a single person, that is an annual income of about $15,856 • For a family of four, that is an annual income of about $32,499 Who qualifies for Medicaid under the new expansion?

7. Low-income adults without dependents will now be able to receive coverage through the Medicaid program • Individuals must be U.S. citizens, not be incarcerated, and not be entitled to Medicare Who qualifies for Medicaid under the new expansion?

8. Those who may have been turned down for Medicaid in the past MAY NOW QUALIFY

9. The expansion is making Medicaid available to more of our N.D. residents who previously may not have qualified • The expansion gives more individuals the opportunity to get affordable coverage, preventive services, and economic security against accidents and illness Who benefits from Medicaid expansion?

10. With more low-income adults qualifying for Medicaid, uncompensated care should decrease Who benefits from Medicaid expansion?

12. Medicaid expansion eligibility will be determined using a simpler standard that will be based on a person’s modified adjusted gross income (MAGI) from their most recent federal income tax filings • Income is measured by the household’s taxable income • Assets and other resources are not considered How will North Dakota residents know if they qualify for the expanded Medicaid?

13. Some individuals may be required to pay co-payments for services received • Services not covered under the plan will be the responsibility of the recipient. Will people who are covered under the expansion have to pay for services they receive?

14. The Request for Proposal for the healthcare coverage for the Medicaid expansion population was issued August 5, 2013 • Proposals are due October 8, 2013 • The contract is expected to be awarded mid-October • The plan will cover Essential Health Benefits, but may have other requirements as well. • The benchmark is the Sanford Health Plan along with other requirements. Medicaid Expansion will be covered through a managed care organization

15. Ambulatory patient services • 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 and chronic disease management • Pediatric services, including oral and vision care What are essential health benefits?

16. Training county eligibility staff, informing them of the changes resulting from the Affordable Care Act • Various state workgroups • Community meetings planned this fall throughout the state to continue training and disseminating information How is the State preparing for the expansion?

17. The online application system to be used for the new Medicaid expansion population will be ready to accept applications in November • Coverage for the Medicaid expansion begins no sooner than January 1, 2014 When can residents who believe they are eligible for Medicaid expansion apply electronically?

18. Online • With telephone assistance • Paper application Applying for Medicaid expansion

19. The federal government is covering 100% of the cost of The healthcare coverage for the Medicaid expansion through 2016 • After 2016, there will be a tiered approach to the federal governments share in coverage. Who is paying for Medicaid expansion in North Dakota?

20. Additional information about the Medicaid expansion is online at:www.nd.gov/dhs/medicaidexpansion

21. Questions?

22. NORTH DAKOTA MEDICAID Updates

23. $2.94 Billion 2013 – 2015 Budget

24. House Bill 1012 and other bills with appropriations resulted in a total 2013-2015 general budget of $2.94 billion. • Together these bills provided a general fund increase of $229 million, which is a 24.32% increase from the previous biennium. Provider Increases

25. 91.5 million increase for inflationary increases, wage pass-throughs, and fee increases to long-term care and long-term service providers. • Includes a 3% inflationary increase each year of the biennium for nursing homes, basic care facilities, developmental disability services providers, and qualified service providers who provide in-home caregiving services for department clients • Includes a $1 per hour wage pass-through to staff of nursing homes, basic care facilities, and developmentally disabled service providers • Includes a $1 per hour fee increase to qualified service providers Provider Increases

26. $32 million increase to provide a 4% inflationary increase each year of the biennium for all other providers who receive payment from the Department for services such as physicians, dental, ambulance, foster care and adoption Provider Increases

27. Includes $1.3 million to continue cost-based reimbursements to critical access hospitals for outpatient laboratory and care provided by certified registered nurse anesthetists • Includes $1.4 million to rebase rural health clinics to Medicare rates Medical Services