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State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
State to State Exchange on
Health Insuran...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
Agenda
1:30-1:35pm Welcome
Anne Gauthier,...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
Overview of Key Design Issues
Sonya Schwa...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
Design Issue #1: Overall Vision
• Sub-sta...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
Design Issue #2: Governance
• New or exis...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
Design Issue #3: Eligibility and
Enrollme...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
Design Issue #4: Tools to Achieve
Afforda...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
Design Issue #5: Stakeholder Engagement
•...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
Today’s Expert Panel
Trish Riley
Director...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
WHAT IS THE OVERALL
VISION OF YOUR EXCHAN...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
One Exchange
• Administrative efficiencie...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
Regional Exchanges
The ACA prescribes tha...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
Administrative Agreements
States do not h...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
WHAT WILL THE
GOVERNANCE STRUCTURE BE?
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
Maine’s Exchange Governance Options
1. No...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
Maine’s Exchange Governance Options
2. Ex...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
Maine’s Exchange Governance Options
3. In...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
Exchange Governance
Options concerning
ex...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
WV Exchange Governance
Governance Proposa...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
HOW WILL YOU COORDINATE
ELIGIBILITY AND
E...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
PROPOSALS FOR GOVERNOR-ELECT & NEW LEGISL...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
Eligibility/Enrollment
• Re-Think Medicai...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
Eligibility and Enrollment
HIX Eligibilit...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
Options
• Use Federal IT/Early Innovator
...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
WHAT TOOLS CAN YOU
EMPLOY TO ACHIEVE
AFFO...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
• Impact of national plans?
• Robust mark...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
• Negotiate with plans for
exchange premi...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
Exchange Planning Grant TIMELINE
Jane Cli...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
HOW WILL YOU ENGAGE
STAKEHOLDERS?
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
Stakeholder Involvement
Governor
Governor...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
Stakeholder Engagement
• Address producer...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
Stakeholder Strategy
• Will have HIX requ...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
Questions and Answers
Please submit your ...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
www.nashp.org
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
www.SHAPaccess.org
State-developed resources:
• State-Specific Overview Analyses
• Health Reform Work Plans,
Timelines, and Progress Reports
...
State to State Exchange on Health Insurance Exchanges
Webinar: November 22, 2010
Please feel free to contact the SHAP team...
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State to State Exchange on Health Insurance Exchanges

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Transcript of "State to State Exchange on Health Insurance Exchanges"

  1. 1. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 State to State Exchange on Health Insurance Exchanges Supported by the Health Resources and Services Administration Monday, November 22, 2010 This event will begin at 1:30pm Eastern Please hold until Anne Gauthier starts the conference The audio portion of this web event can be accessed by dialing 800-269-3762
  2. 2. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 Agenda 1:30-1:35pm Welcome Anne Gauthier, Senior Fellow, NASHP 1:35-1:50pm Overview of Key Exchange Design Issues Sonya Schwartz, Program Director, NASHP 1:50-2:35pm Interview About Current Exchange Thinking Trish Riley, Director, Maine Governor’s Office of Health Policy and Finance Jane Cline, Commissioner, West Virginia Office of Insurance 2:35-2:55pm Question and Answer with Audience 2:55-3:00pm Wrap Up
  3. 3. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 Overview of Key Design Issues Sonya Schwartz Program Director, NASHP
  4. 4. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 Design Issue #1: Overall Vision • Sub-state, state, regional, or federal option? • One exchange or two (one for small business, one for individuals) ? • Allow all plans to participate or select plans that meet certain standards?
  5. 5. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 Design Issue #2: Governance • New or existing state executive branch agency under the Governor? • Quasi public entity governed by a Board? • State-established non- profit?
  6. 6. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 Design Issue #3: Eligibility and Enrollment Systems • One system or interface that links separate systems? • Who will develop it and where will it sit? • How does it link to Medicaid, CHIP and other programs? • How do states develop the information technology resources?
  7. 7. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 Design Issue #4: Tools to Achieve Affordability • Exchange as market organizer or active purchaser? • Rewarding or encouraging high value plans or delivery system reforms? • Use tools to prevent adverse selection?
  8. 8. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 Design Issue #5: Stakeholder Engagement • Use the governing entity as a tool for involving stakeholders? • Hold public hearings on major decisions? • Opportunities for public comment on proposals? • Feedback loop?
  9. 9. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 Today’s Expert Panel Trish Riley Director, Maine Governor’s Office of Health Policy and Finance Jane Cline Commissioner, West Virginia Office of Insurance
  10. 10. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 WHAT IS THE OVERALL VISION OF YOUR EXCHANGE?
  11. 11. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 One Exchange • Administrative efficiencies • Intersection of individuals / self-employed / small business – Will subsidy eligible & employed in small business join as individuals? • Purchasing clout Trish Riley Draft recommendations to new Governor & Legislature re: Exchange
  12. 12. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 Regional Exchanges The ACA prescribes that an Exchange may operate in more than one State if— (A) each State in which such Exchange operates permits such operation; and (B) the Secretary approves such regional or interstate Exchange. • Benefits • Create larger risk pools • Create larger markets • Admin. economy of scale • Portability across borders • Barriers: • Risk Pool dynamics • State regulator autonomy • State Mandated Benefits • Governance • Risk Adjustment Jane Cline
  13. 13. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 Administrative Agreements States do not have to share risk pools or even borders to work together on the health insurance exchange Adjacent and non adjacent states may find great savings, particularly on IT infrastructure, by entering into compacts to share exchange administrative functions • Benefits • Leverage down vendor costs • Share best practices • Share maintenance cost • Barriers: • State autonomy • Exchange strategy coordination • State procurement laws Jane Cline
  14. 14. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 WHAT WILL THE GOVERNANCE STRUCTURE BE?
  15. 15. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 Maine’s Exchange Governance Options 1. Non-Profit? Pros • Least influenced by political environment • Most nimble as it will not be constrained by state procurement agencies and HR rules • Potentially better able to compete for highly skilled staff • It’s not government so some may trust it more • Traditionally private functions may be easier to carry out Cons • Hardest entity to ensure that state priorities are being carried out • May be difficult to coordinate across state and federal agencies • Difficult entity for sharing confidential information • Government still remains responsible for carrying out ACA, yet Governor and legislature have least accountability here Trish Riley
  16. 16. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 Maine’s Exchange Governance Options 2. Existing Government Agency? Pros • Ensures state priorities and goals are being met • Easiest coordination with federal and other state agencies • Greatest opportunity to ensure transparency and accountability to state • Confidential information more easily shared across state agencies • Director appointed by Commissioner or Governor Cons • Agency led by Commissioner that serves at the pleasure of the Governor • No diverse governing board to assist with technical and policy issues • Don’t want to create new agency and Exchange functions may get lost or downplayed in existing agency • May carry stigma as governmental agency • Most influenced by political environment • Less nimble as it must follow state procurement and HR laws Trish Riley
  17. 17. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 Maine’s Exchange Governance Options 3. Independent / Quasi- State Agency? Pros • Better site for state priorities • Easier to coordinate with federal and state agencies • Better accountability and more transparency • Can appoint governing board composed of people with technical expertise • Board appointed by Governor and Legislature • Executive Director to serve at pleasure of the Board • Flexibility from some state procurement and HR laws • May be better able to interact with private sector than government agency Cons • Sharing of confidential information may be problematic • May carry stigma with consumers (individuals and businesses) as governmental agency • May be somewhat influenced by political environment • Less able to ensure accountability and transparency to state government than full governmental entity • Executive and Legislative branches of government have less control than over a state agency; more than over a non-profit Trish Riley
  18. 18. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 Exchange Governance Options concerning exchange governance: • State Agency • Nonprofit created by State • Federal Regardless of governance, state entities must be engaged: • Governor’s Office • Insurance Regulator • Medicaid • CHIP • Social Services • Public Health Jane Cline
  19. 19. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 WV Exchange Governance Governance Proposal Recommended that HIX exist within the State’s insurance regulator Recommended that HIX have board and that this board have autonomy to make policy decisions independent of the regulator Recommendation Rationale • State Authority • Accountability to citizens • Administrative streamlining • Regulatory Continuity • Board supported but independent • Effective model already exists Jane Cline
  20. 20. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 HOW WILL YOU COORDINATE ELIGIBILITY AND ENROLLMENT?
  21. 21. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 PROPOSALS FOR GOVERNOR-ELECT & NEW LEGISLATURE Medicaid in an Exchange Environment 400% FPL 138% Medicaid / DHHS Integrated Eligibility System 0% Exchange “Front Door” PROPOSALS FOR GOVERNOR- ELECT & NEW LEGISLATURE Trish Riley
  22. 22. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 Eligibility/Enrollment • Re-Think Medicaid & Subsidies • Single front-door for subsidies, 0% – 400% FPL - MAGI • Behind the scenes cascade into DHHS integrated delivery system • No wrong door – Can access subsidies / exchange via DHHS as well • Build on current capacity A. Medicaid Eligibility • Integrated system with social services • Needs some modernization to comply with ACA • Needs to continue for Medicaid populations B. Dirigo Health Agency • Website & calculator • Subsidy eligibility & determination • Link to Medicaid • (www.dirgohealth.maine.gov) • Developed added Exchange capacities via SHAP grant (Vouchers) Trish Riley
  23. 23. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 Eligibility and Enrollment HIX Eligibility Role Exchange must inform individuals of eligibility for state’s Medicaid, CHIP, and federal subsidies. Exchanges must also determine eligibility for mandate exemption HIX Enrollment Role Exchange must establish a way to apply for enrollment in Medicaid, SCHIP HHS will provide single streamlined form that may be used in applying for all applicable state health subsidy programs Jane Cline
  24. 24. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 Options • Use Federal IT/Early Innovator • Have eligibility/enrollment for public plans take place in current system with HIX MOU • Develop two eligibility/enrollment doors (one public plans, one HIX) • HIX develop new IT system as single entry point • Hybrid of various options Strategy • Work with stakeholders • Determine core functions • Maximize federal resources • Administratively and operationally efficient • Ensure seamless and simple for consumers • Do not compound confusion- thoroughly test Eligibility and Enrollment Systems Jane Cline
  25. 25. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 WHAT TOOLS CAN YOU EMPLOY TO ACHIEVE AFFORDABILITY?
  26. 26. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 • Impact of national plans? • Robust marketplace – Patient Centered Medical Homes • Payment Reform Workgroup • Demos Affordability Trish Riley
  27. 27. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 • Negotiate with plans for exchange premiums • Allow market competition to drive plan premiums • Through economy of scale, perform insurance administrative functions more efficiently • Leverage exchange pool for lower provider payments • Place price of using producer/ navigator on the consumer • Limit number of plans available and drive down premiums through auction of plan slots Mechanism for Cost Saving? Jane Cline
  28. 28. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 Exchange Planning Grant TIMELINE Jane Cline
  29. 29. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 HOW WILL YOU ENGAGE STAKEHOLDERS?
  30. 30. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 Stakeholder Involvement Governor Governor’s Office of Health Policy & Finance Senior Level Health Reform Implementation Steering Committee Subcommittees with Agency Staff Legislature Joint Select Committee on Health Reform Opportunities and Implementation Advisory Council on Health Systems Development (Advises Legislature and Governor) Funded in part by HRSA SHAP Grant Trish Riley
  31. 31. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 Stakeholder Engagement • Address producer concerns • Engage consumers at every level (individual, small group, large group) • Use focus groups to reach underserved demographics • Don’t forget providers • Must get buy-in from Governor • Must communicate with constituent state agencies like CHIP, Medicaid • Engage Legislature • Engage carriers in regulator/issuer meetings Jane Cline
  32. 32. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 Stakeholder Strategy • Will have HIX request for comment running concurrent to stakeholder meetings • After stakeholder meetings will develop community of interest groups to focus on specific exchange issues • Will have focus groups to ensure that consumer input incorporated into plan • Continuously engage stakeholders on their own turf (quarterly/ annual meetings) • Setting up website to allow consumers to see process behind HIX planning and research • Launching statewide stakeholder meetings over next two months Jane Cline
  33. 33. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 Questions and Answers Please submit your questions through the chat function
  34. 34. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 www.nashp.org
  35. 35. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 www.SHAPaccess.org
  36. 36. State-developed resources: • State-Specific Overview Analyses • Health Reform Work Plans, Timelines, and Progress Reports • Coordinators and Coordinating Bodies • Fiscal Analyses • Proposals for Federal Funding • State Laws, Rules, and Regulations • State Implementation Websites Share your implementation resources with us! Send to statereforum@nashp.org Check out Priority 1 for state exchange resources! Over 50 state exchange resources from 18 states now available. www.statereforum.org
  37. 37. State to State Exchange on Health Insurance Exchanges Webinar: November 22, 2010 Please feel free to contact the SHAP team with any questions. Thank You Anne Gauthier Senior Fellow agauthier@nashp.org Kathy Witgert Program Manager kwitgert@nashp.org Christina Miller Research Assistant cmiller@nashp.org Sonya Schwartz Program Director sschwartz@nashp.org Chris Cantrell Research Assistant ccantrell@nashp.org
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