Eligibility and Enrollment: How It Really Works

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Maryland Takes Action on Health Care
Reform: The Affordable Care Act
Leni Preston, Chair
[email protected]
(301) 351-9381
© 2012 Maryland Women’s Coalition For Health Care Reform
About the Coalition
• Nonpartisan alliance of individuals and 88
state-wide organizations committed to
transforming our health care system to
meet the needs of all Marylanders.
• National Partners
– Raising Women’s Voices
– National Women’s Law Center
– Open Society Institute – Baltimore
© 2012 Maryland Women’s Coalition For Health Care Reform
Coalition Mission
Work collaboratively with our members
and partners to seek solutions and advance
reforms to ensure that every resident of
Maryland has access to affordable,
comprehensive & high quality health
care that is always there.
© 2012 Maryland Women’s Coalition For Health Care Reform
How We Achieve Our Mission
• Educate and engage our members and
supporters, elected officials, policy makers
and the public
• Reach out to all potential allies of reform
• Advocate and take action, as a
Coalition and as individuals, to achieve
our shared mission.
© 2012 Maryland Women’s Coalition For Health Care Reform
Why Health Care Reform Is
Important to Women
• Caregivers for ourselves, our families & our
communities – historically being a woman has
been considered a pre-existing condition.
• 80% of health care decisions are made by
women (Department of Labor).
• In 2008, 1 in 4 women went without necessary
health care services.
• Only 13% of plans in individual market included
comprehensive maternity care.
© 2012 Maryland Women’s Coalition For Health Care Reform
Why It Matters to Maryland Women
•
•
•
•
•
•
15% (280,000) are uninsured in Maryland
56% are currently employed
A majority are under 200% FPL
38.7% are Hispanic/Latino
17.7% are African American
10.4% are Caucasian
© 2012 Maryland Women’s Coalition For Health Care Reform
The Patient Protection and
Affordable Care Act
A 3-Legged Stool:
1.Everyone is “in”
2.Personal responsibility
3.Affordability
© 2012 Maryland Women’s Coalition For Health Care Reform
Patient Protections: What We Have
Gained to Date
By December 2011:
• 46,000 young adults up to age 26 can stay on
their parents’ health plans
• 1, 153,000 individuals gained preventive care
coverage without co-pays or deductibles
• Policies purchased or renewed by women after
August 1st - 1,042,794 will get additional
preventive services
• 872,000 women and 585,000 children no longer
worry about lifetime limits for their care
© 2012 Maryland Women’s Coalition For Health Care Reform
More Patient Protections
• 52,234 seniors got help paying for their
prescription drugs
• 553,920 people on Medicare received free
preventive services or a free annual
wellness visit with their doctor
• Insurance companies now have to spend
larger share of your dollars (80%) on
health care services – 141,291 Marylanders
benefited
© 2012 Maryland Women’s Coalition For Health Care Reform
Maryland: A National Leader
• Commitment and
Leadership
• Effective Process:
– HCRCC
– OHCR
– Health Benefit
Exchange Board
• Roadmap
• $157 million – 4
federal grants
© 2012 Maryland Women’s Coalition For Health Care Reform
Affordability in the Affordable Care Act
• Expand Medicaid program: individuals
with incomes up to 138% FPL
• Tax-credits to individuals with incomes
between 138% & 400% FPL
• Tax credits for small businesses
• Creates Individual and Small Business
Health Exchanges (SHOP)
• Qualified health plans – 4 “metal” levels
© 2012 Maryland Women’s Coalition For Health Care Reform
Maryland Health Connection:
A Health Insurance Marketplace
• Exchange will
describe each plan in
a standard format
– Monthly cost and copays
– Plan performance on
quality measures
– Plan ratings by quality
and price
• Compare Apples to
Apples
• Can’t decide between
a Fuji and a Rome?
Get help!
– Website
– Telephone hotline
– Navigators
© 2012 Maryland Women’s Coalition For Health Care Reform
Maryland Health Connection
Timeline
Landmark ACA Legislation signed into Law 3/23/2010 by President Obama
4/12/2011
Governor
O’Malley
Signed
Health
Benefit
Exchange Act
into Law
10/1/2013
Individuals
and Groups
Begin
Enrolling in
Exchange
9-11/2011
Advisory
Committees
Met
6/3/2011
Exchange
Board 1st
Meeting
1/1/2013
Exchange
Must be
Certified by
Federal
Government
Source: A Report to the Governor and Maryland General Assembly
Maryland Health Benefit Exchange, December 23, 2011, p. 1
© 2012 Maryland Women’s Coalition For Health Care Reform
1/1/2014
Maryland
Health
Connection
will be
Operational
Maryland Health Connection
• Public corporation/independent unit of state
government
• 9-member board
• 7 Principles
– Access
– Affordability
– Sustainability
– Stability
– Health Equity
– Flexibility
– Transparency
© 2012 Maryland Women’s Coalition For Health Care Reform
Creating the Exchange:
Stakeholder Input
Exchange Advisory Committees
• Navigator
• Continuity of Care
• Plan Management
• Exchange Implementation
OHCR Advisory Committees
• Essential Health Benefits
• Finance & Sustainability
• Communications
© 2012 Maryland Women’s Coalition For Health Care Reform
Stakeholder Representation - 2011
Advisory Committee Membership by Affiliation
Business Owners
9%
Consultants
Local
3%
Government
3%
Academia
12%
Health Insurance
Industry
34%
Community
Members and
Advocates
21%
Source: A Report to the Governor and Maryland General
Assembly, Maryland Health Benefit Exchange
December 23, 2011, p. 2
Community Care
Providers and
Associations
18%
© 2012 Maryland Women’s Coalition For Health Care Reform
Decisions To Date:
Essential Health Benefits
Benchmark for Qualified Health Plans
Ambulatory services
Emergency services
In-patient hospital services
Prescription drugs
Laboratory services
Maternity & newborn care
Rehabilitative and habilitative service
Pediatric, inc. oral & vision
Preventive/wellness services & chronic disease m’ment
Mental health and substance use disorder treatment
© 2012 Maryland Women’s Coalition For Health Care Reform
Decisions To Date:
Plan Management
Insurance Carriers: Certification
Standards
– # of QHPs at 4 “metal” levels Carrier
Certification for Qualified Health Plans (QHP)
– Data Collection
– Provider Network
• MH/SUD Parity
• Essential Community Providers
© 2012 Maryland Women’s Coalition For Health Care Reform
Decisions To Date:
Navigator Program
Navigator Entities & Individual Navigators
– Conduct public education and outreach
– Distribute fair and impartial information that is culturally &
linguistically appropriate for all populations
– Facilitate enrollment in health plans – Medicaid & subsidized
insurance
– Provide referrals for grievances, complaints and questions
SHOP
– SHOP navigators – licensing/training through MIA – receives
compensation from Exchange
– Authorized brokers can sell in and out of the Exchange –
compensated by carriers
© 2012 Maryland Women’s Coalition For Health Care Reform
Issues To Watch
• Financing –self-sustaining by 2015
• Continuity of Care
– “churn” & transitioning between plans
• Affordability
• Pediatric & Adult Dental & Vision
• Communications
© 2012 Maryland Women’s Coalition For Health Care Reform
Relationship of Health Improvement Efforts
Workforce
Diversity &
Development
Federal
Health Care
Reform/ACA
Cultural
Competency
Maryland
Health Care
Reform
SHIP-Local
Action
Continuity of
Care
Health
Literacy
Health
Equity
Affordability
Resources You Can Use:
State & Federal
– Maryland Health Connection
www.marylandhealthconnection.gov
– Exchange Stakeholder Website
www.dhmh.maryland.gov/healthreform/exchange/index.html
– Department of Health & Mental Hygiene
www.dhmh.maryland.gov
– Health Care Reform Coordinating Council
www.dhmh.maryland.gov/healthreform/index.html
– Department of Health & Human Services
www.healthcare.gov
© 2012 Maryland Women’s Coalition For Health Care Reform
Stay Informed & Get Involved
• Join the Coalition & Encourage Others to Join
– Newsletters, Alerts, Member Calls & Webinars
– Information/Resources: September 8th Women of
Color Health Care Reform Conference
– Host or Attend Health Care Reform Events
• October 27 – NAMI-MD
• October 28 – Prince George’s County Commission for
Women – Women’s Legislative Conference
• Facebook and Twitter
• Share your stories
www.mdhealthcarereform.org
© 2012 Maryland Women’s Coalition For Health Care Reform
Leni Preston, Chair
Phone: (301) 351-9381
E-mail: [email protected]
Website: www.MDHealthCareReform.org
© 2012 Maryland Women’s Coalition For Health Care Reform
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