ESI Premium Assistance: Experience in Other States

1
ESI Premium Assistance Experience in Other States

• Don Dickey
• Joint Fiscal Office
• August 8, 2006

2
Savings Potential of ESI

• By Nov. 15 HAOC/JFC must vote on releasing
  implementation funds for ESI program based on AHS
  report and plan (Act 191, sec. 13)
• A key question potential savings from requiring
  VHAP enrollees to obtain ESI coverage through
  their employer, if they have access
• To create savings
• A significant number of VHAP enrollees must have
  access to ESI through their employer
• The employees share of premium (plus wrap and
  admin overhead) must cost less than would be paid
  under Medicaid

3
AHS Survey

• Act 191 passed with a consensus estimate of the
  number of eligible VHAP enrollees and the
  per-member savings for FY08 - FY10
• AHS Survey of VHAP enrollees will improve
  accuracy of data and validity of assumptions
• How many VHAP enrollees have access to ESI?
• What are current costs for those enrollees, and
  potential savings if shift to ESI?
• Survey to be completed by Oct. 15

4
JFO Report on Other States

• Other states experience with ESI programs also
  informs assumptions about enrollment and cost
  savings
• JFO report to be completed by Oct. 1
• JFO has talked with program officials in many
  states
• Each program different, but some common themes
  emerge

5
Other States Enrollment Experience

• Only a handful of states have significant
  enrollment in ESI premium assistance
• In each of those states, enrollment is much lower
  than was originally estimated
• Lower enrollment lower savings
• Enrollment is also small in comparison to each
  states overall Medicaid population
• Of 14 active programs, only 5 had enrollment
  greater than 1 of Medicaid nondisabled adults
  and children

6
Premium Assistance Programs with Highest
Enrollment (July 2006)
Excludes family members who are ineligible for
Medicaid/SCHIP benefits but who receive coverage
incidental to family coverage purchased for an
eligible family member. Also excludes
individuals who lack access to ESI coverage, but
receive premium assistance to purchase coverage
in the individual market. Excludes Medicaid
beneficiaries who are disabled and elderly.
7
Barriers to Success

• Difficulty of identifying and investigating
  individual eligibility
• Complexity of coordinating coverage with
  employers
• Shifting nature of beneficiaries Medicaid status
  and employment status
• Dynamic nature of employer-sponsored insurance

8
Key Themes from Leading States

• Rhode Island Massachusetts
• Pennsylvania Iowa Oregon
• Enrollment of adults at the VHAP income
  eligibility range (0-185 FPL) has been far lower
  than expected
• Even in successful states, enrollment tends to
  level off at lower than expected participation

9
1. Enrollment of adults at VHAP income
eligibility range (0-185 FPL) has been low
10
2. Enrollment in Rhode Island, Pennsylvania, and
Iowa has remained in the same range in recent
years.

• Enrollment is Massachusetts and Oregon is growing
  slowly

11
Impact of HIFA Initiative

• HIFA Initiative (August 2001)
• Designed for states seeking 1115 waivers to
  expand adult/child coverage
• Fast-track federal review if proposals conform to
  HIFA application template
• HIFA goal promote ESI as a coverage vehicle
• CMS requires states to include an ESI component
• States given greater flexibility with
  cost-effectiveness and wrap around
• None of the 12 HIFA states has yet to achieve
  significant enrollment in premium assistance

12
QUESTIONS?

• Looking Ahead...
• JFO report on other states Oct. 1
• BISHCA Survey Oct. 15
• Decision on release of funds Nov. 15

13
Highest Enrollment in Premium Assistance Programs
(July 2006)
This column excludes family members who are
ineligible for Medicaid/SCHIP benefits but who
receive coverage incidental to family coverage
purchased for an eligible family member. It also
excludes individuals who lack access to ESI
coverage, but receive premium assistance to
purchase coverage in the individual market.
14
12 HIFA Waiver States Enrollment in 2006

• 4 states with greatest enrollment in ESI premium
  assistance
• Oregon (10/02) 5,535 individuals (3,000 adults
  / 2,535 children)
• Illinois (9/02) 4,925 individuals (fewer than
  prior to HIFA waiver)
• New Jersey (1/03) 770 individuals (280
  adults / 490 children)
• Utah (2/02) 75 individuals
• 3 states still too early in implementation, but
  anticipate small enrollment
• Idaho (11/04) Expect only 1,400 children
  capped at 1,000 adults
• Virginia (8/05) 1,600 (mostly from previous
  SCHIP premium assistance program
• Michigan (1/04) Anticipate low enrollment
• 5 states not implemented CMS-approved premium
  assistance program
• California (1/02) Completed feasibility study
• Arizona (12/01) Completed feasibility study
• Colorado (9/02) Completed feasibility study
• Maine (9/02) Report to legislature on premium
  assistance in 2006. No action taken.
• New Mexico (8/02) Concluded that premium
  assistance models would not be viable.