New York Health Coverage and Enrollment

1,015 views
971 views

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,015
On SlideShare
0
From Embeds
0
Number of Embeds
298
Actions
Shares
0
Downloads
5
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

New York Health Coverage and Enrollment

  1. 1. Paving a Health CoverageEnrollment Superhighway:Bridging the Gap to 2014and Beyond in New York NASHP  Briefing   February  3,  2011   Beth  Osthimer   Division  of  Coverage  and  Enrollment   Office  of  Health  Insurance  Programs  
  2. 2. New York Health Coverage andEnrollment: 2011 Public  coverage-­‐  5  million   Employer-­‐  based-­‐10.5   million   Uninsured-­‐  2.7  million   2
  3. 3. New York Health Coverage andEnrollment: 2014 Increase  Medicaid   enrollment  by  about  25%   Add  Exchange  coverage  for   over  one  million  more  New   Yorkers  (700,000  subsidized)   3
  4. 4. New York : Key Challenges  30+  year  old,  mulUple  legacy   eligibility  and  enrollment  systems   encompassing  health  and  human   services    Jointly  administered  by  state/  58   local  districts-­‐  variaUon,  costs    Budget  constraints   4
  5. 5. New York : Key Challenges  Technical  infrastructure  to  support   a  more  uniform,  automated,   consumer-­‐friendly  administraUon   of  health  coverage  programs  by   2013    Align  and  integrate  public  and   Exchange/subsidized  opUons    Building  the  plane  while  we  fly     5
  6. 6. New York : Strategies to Help Bridge the Gap  Leverage  Medicaid  Enterprise   assets,  federal  funding  for   technical  infrastructure  to  support   integrated  health  coverage   eligibility  and  enrollment    90/10  match  -­‐  key     SoluUons  have  to  move  us  in  the   right  direcUon-­‐  2014  and  beyond   6
  7. 7. New York : Strategies to Help Bridge the Gap  Statewide  Call  Center      Telephone  Renewal  supported  by   HEART  rules  engine      State  Medicaid  AdministraUon     7
  8. 8. State Medicaid Administration:Background   June  2010-­‐  LegislaUon  required   Commissioner  of  Health  to  develop  plan  to   assume  Medicaid  administraUon  from   counUes  within  5  years.       November  30  2010  Report-­‐  first  step,   strategic  direcUon,    recommendaUons,  many   more  discussions  with  stakeholders  before   final  comprehensive  plan.   8
  9. 9. State Medicaid Administration:Recommendations   Short  term  –  e.g.  consolidaUng  health  plan   contracts  for  Medicaid  and  FHPlus  (waiver)     Longer  term-­‐  e.g.  centralizing  eligibility   determinaUons  as  move  forward  under  ACA     Issues  for  discussion  include  transiUon  of   personnel,    local  presence  to  assist   consumers-­‐parUcularly  most  vulnerable,   personal  care  services,  long  term  care,     financing  related  to  administraUon,  etc.   9
  10. 10. State Medicaid Administration:Going Forward   Offers  opportunity  to  improve  efficiency,   uniformity     Raised  frequently  during  stakeholder   engagement  process  of  Medicaid  Redesign   Team  (MRT).     Reasonable  to  expect  that  implementaUon  of   many  of  the  recommendaUons  in  the   November  30  report  will  become  part  of     broader  Medicaid  Redesign  effort.     1 0
  11. 11. Elimination of Enrollment Barriers HelpsPave the Way : Key Challenge is EligibilitySystems  Self  declaraUon  of  income/   residency  at  renewal    12  month  conUnuous  enrollment   for  most  adults   Automated  Eligibility    No  resource  test  for  most   Medicaid  beneficiaries    No  finger  imaging  requirement    No  face-­‐to-­‐face  interview   1 1
  12. 12. No High Volume , Consumer OrientedEligibility and Enrollment ExperienceUnder ACA Unless:  Underlying  rules  are  simple  and   aligned  across  all  public/private (subsidized)  opUons    Have  resources  ,technical   infrastructure  to  support   automated    processes  for   eligibility,  verificaUon  and   communicaUon/noUficaUons   1 2
  13. 13. Federal Actions Needed toHelp Bridge the Gap  Key  rules  early  in  2011-­‐  e.g.  MAGI      Same  rules  to  apply  across   Medicaid,  CHP  and  Exchange/ subsidies    Finalize/fund  NPRM  for  new   eligibility  and  enrollment  systems   (90/10).   1 3
  14. 14. Federal Actions Needed toHelp Bridge the Gap  Align  audit  requirements  (MEQC,   PERM)  with  ACA  rules  and  systems    Establish  “federal  hub”  elements,   components,  processes  for  state   access   1 4

×