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Delaware HRSA State Planning Grant

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Developing options to offer affordable health insurance to the pre-Medicare ... insurance options more affordable: Healthy ... Dirigo Health Insurance (DHI) ... – PowerPoint PPT presentation

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Title: Delaware HRSA State Planning Grant


1
Delaware HRSA State Planning Grant Alice
Burton, Director AcademyHealth December 2, 2004
2
Presentation
  • HRSA pilot grants are helping states to further
    develop coverage strategies
  • Broad range of state initiatives meet different
    needs
  • You are not alone - there are resources to help
    states move through planning and policy analysis
    process

3
HRSA Update
  • Fiscal Year (FY) 2004, HRSA has awarded more than
    13 million through
  • 9 new state planning grants
  • 17 continuation planning grants
  • 9 pilot project planning grantswhich are new
    this year.

4
Pilot Project Planning Grants
  • Pilot grants are providing funds to states that
    have already developed policy options through
    state planning grant funds to enable them to
  • Plan for the implementation of a specific policy
    option(s) on which consensus has been reached
  • Test a particular option in one or more areas
    and/or for a specific population in the state or
    territory and
  • Implement a plan that will cover a significant
    portion of the uninsured.

5
Pilot Project Planning Grants, cont.
  • Nine FY2004 Recipients
  • Connecticut, Delaware, Georgia, Illinois,
    Indiana, Kansas, Oklahoma, the U.S. Virgin
    Islands, and West Virginia

6
Connecticut Pilot Grant
  • Two different approaches
  • -Provide premium assistance targeted to
    low-income workers in firms that already offer
    coverage and
  • - Implement a small employer health insurance
    subsidy pilot targeted to small firms that do
    not currently offer coverage.

7
Georgia Pilot Grant
  • Will implement separate pilots in four
    communities.
  • Exploring several options, including a
    three-share pilot program and another pilot that
    will partner with commercial insurers to reduce
    costs to a target population.

8
Indiana Pilot Grant
  • The project team intends to create a small
    business pool coupled with an employer/employee
    buy-in and premium-assistance program.

9
Illinois/Kansas/Oklahoma Pilots
  • INDIANA - looking into contracting with an
    actuary to develop a three-share program in two
    counties.
  • KANSAS - exploring the option of reinsurance and
    planning a pilot to modify how to model tax
    credits to employers.
  • OKLAHOMA - considering creating a small group
    purchasing pool with their grant funds.

10
U.S. Virgin Islands Pilot Grant
  • Plans to develop an association health plan as a
    purchasing collaborative. In the process, they
    will develop a comprehensive Preferred Provider
    Organization (PPO) network, implement effective
    disease management in the PPO, increase Medicaid
    enrollment, and continue to analyze the costs of
    uncompensated care.

11
West Virginia Pilot Grant
  • Developing options to offer affordable health
    insurance to the pre-Medicare population (aged 50
    to 64), specifically those who have lost and are
    at risk of losing their retiree benefits.

12
Strategies to expand coverage
  • Expanding Medicaid and SCHIP to new populations
  • New models for Medicaid/SCHIP and private sector
    partnerships
  • Making new private insurance options more
    affordable
  • Mandates
  • Comprehensive (access, cost and quality)
    approaches

13
New options for Medicaid coverage
  • SCHIP (1997)
  • 1115 waivers and HIFA (2001)
  • Breast and Cervical Cancer (2000)
  • 50 states (including DC)
  • Ticket to Work Working individuals with
    disabilities (2001 Medicaid expansion)
  • 32 states, some states with no income limit

14
States with expanded coverage for parents through
Medicaid
AK
WA
ME
MT
ND
MN
OR
VT
NH
ID
WI
SD
NY
MA
MI
CT
WY
RI
IA
PA
NE
NJ
NV
OH
IN
MD
IL
DE

UT
WV
CO
KS
VA
CA
MO
KY
NC

TN
AZ
OK
NM
AR
SC
0 49 FPL 50 - 99 FPL 100
199 FPL 200 FPL no new
enrollment or capped enrollment
MS
AL
GA
LA
TX
FL
Program not implemented
HI
15
States that cover childless adults through
Medicaid
AK
WA
ME
MT
ND
MN
OR
VT
NH
ID
WI
MA
SD
NY
MI
CT
WY
RI
IA
PA
NE
NJ
NV
OH
IN
MD
IL
DE
UT
WV
CO
KS
VA
CA
MO
KY
NC

TN
AZ
OK
NM
AR
SC
no coverage under 100 FPL 100
199 FPL 200 FPL and greater no new
enrollment or capped enrollment
MS
AL
GA
LA
TX
FL
Program not implemented
HI
16
New approaches to benefits and cost sharing
  • Fewer benefits for higher income groups
  • Primary care programs
  • Pharmacy Plus Rx only benefits
  • Cost-sharing

17
One states example of redesigning Medicaid
benefits for new populations
Medicaid SCHIP Benefits
Inpatient Services Outpatient Services
Physician Specialty Services Prescription
Drugs OT, PT, ST, DME Supplies (prosthetics
orthotics) Lab X-ray Emergent Urgent
Care Home Health Mental Health Substance Abuse
(limits for adults)
Increased Benefits
Expansion Benefits
Inpatient Outpatient Services Physician
Specialty Services Prescription Drugs OT, PT,
ST DME Supplies (prosthetics orthotics) Lab
X-ray Emergent Urgent Care Home Health Mental
Health Substance Abuse
Podiatry Dental Optometry Eyeglasses Long Term
Care - ICFMR/Nursing Home/Pre-PACE Personal Care
Home Nursing for Children EPSDT Early
Intervention Nutrition Targeted Case
Management Hospice Transportation Lodging
No Annual Maximum
100,000 Annual Maximum
Some limits on services offered
Service limits based on medical necessity
18
Private sector partnerships
  • Meet a broad set of policy political goals
  • Current models pay the employees contribution
    for qualifying employer sponsored insurance when
    it is cost-effective
  • 14 states, just over 50,000 enrolled out of over
    50 million enrolled in Medicaid and SCHIP
  • Newer models create a new product, targeting
    working uninsured
  • Target either employer or employees

19
What is the problem you are trying to solve?
Small portion of workers decline ESI.
SOURCE Kaiser Comissionon Medicaid and
Uninsured, Key Facts, December 2003
20
Making new private insurance options more
affordable Healthy New York
  • Eligibility Small firms w/ low-wage workers, low
    income self-employed, uninsured workers w/o
    access to ESI
  • Reduced premiums through
  • Stop-loss fund state pays 90 claims 5k-75k
  • Streamlined benefits, in-network only
  • High cost-sharing
  • Commercial insurance product that state requires
    all HMOs to offer

21
Making new private insurance options more
affordable West Virginia
  • Eligibility Firms w/2-50 employees
  • Minimum employer contribution of 50, 75 of
    eligible employees must participate
  • Allows carriers to access State Employees'
    reimbursement rates and drug purchasing plan

22
New benefit designs
  • Limited benefits (mandate-lite)
  • Continued interest despite low enrollment
  • Popular benefits often drive rates
  • High deductible health plans
  • Consumer directed health plans

23
Mandating health insurance
  • Employer mandates
  • Several states have considered, only 1 with law
    on the books
  • Hawaiis Prepaid Health Care Act 30 years old
    this year
  • Californias Health Insurance Act of 2003
    defeated in 2004 referendum
  • Individual mandates
  • States have talked about, but none have enacted

24
Comprehensive Models Maines Dirigo Health
  • Voluntary program addressing cost, quality and
    access
  • Dirigo Health Insurance (DHI)
  • Offered to small business (lt50 workers),
    self-employed, workers without offered coverage,
    low-income in large firms
  • MaineCare (Medicaid) expansion
  • 200 FPL for parents 125 FPL for childless
    adults sliding scale subsidies to 300 FPL

25
Maines Dirigo Health
  • Cost containment
  • CON moratorium
  • Voluntary limits on operating margins
  • Required electronic claims submission by 2005
  • Price disclosure
  • Savings offset payment on carriers from UC
    savings (capped at 4)
  • Maine Quality Forum created
  • Enrollment begins October 1, 2004 Anticipated
    start date January 1, 2005

26
Help available from AcademyHealth
RWJFs State Coverage Initiatives Program
(SCI)
TA
AcademyHealth State Health Policy Group
STATES TERRITORIES
Contract with HRSA to provide TA to SPGs
TA
27
  • State Coverage Initiatives (SCI)
  • Initiative of The Robert Wood Johnson Foundation
  • Direct Technical Assistance (TA) available to all
    states
  • Meetings
  • Small group consultations on specific issues
  • Publications
  • Statecoverage.net
  • Grants
  • SPG Contract with HRSA
  • Site visits
  • Share lessons from other states
  • Options development
  • Guidance for advisory committees
  • Final report guidance
  • Maintain Web page with SPG reports

28
How Can We Help?
  • AcademyHealth is available over the phone or
    onsite for assistance
  • Ongoing support Thinking through preliminary
    ideas, lit. searches, contacts in other states,
    suggestions on experts, etc.
  • Kicking off policy process for steering committee
  • Education of steering committee on coverage
    options, other state SPG activities
  • Facilitation of stakeholder meetings to decide on
    coverage options
  • Assistance with evaluating options and narrowing
    recommendations

29
http//statecoverage.net
  • State Reports
  • State Coverage Matrix
  • About Coverage
  • Grants - HRSA SPG page
  • SCI Publications
  • St_at_teside monthly e-newsletter

30
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