Medicaid and Health Insurance, Carrie Banahan - SLC 2015
•Download as PPTX, PDF•
1 like•439 views
Carrie Banahan, Kentucky Health Benefit Exchange, presented on KYNECT: Kentucky's Healthcare Connection at the State Legislative Conference on November 6, 2015.
Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (11)
Similar to Medicaid and Health Insurance, Carrie Banahan - SLC 2015
Similar to Medicaid and Health Insurance, Carrie Banahan - SLC 2015 (20)
More from American Academy of Family Physicians
More from American Academy of Family Physicians (20)
Recently uploaded
Recently uploaded (20)
Medicaid and Health Insurance, Carrie Banahan - SLC 2015
- 1. Carrie Banahan Executive Director November 6, 2015
- 3. Kentucky at a Glance • 120 Counties • Median Household Income $43,399 • 4.3 million Kentuckians • 1.3 million served through Medicaid • State Based Exchange (kynect) 100,000 members served
- 4. Medicaid at a Glance • 1.3 Million Members • $9 Billion Budget • Managed Care Delivery System • ACA Changes Medicaid Expansion Behavioral Health Delivery System Expanded Provider Network State Based Exchange – kynect Streamlined Eligibility and Enrollment
- 5. Expansion Background • Workforce Capacity Study http://healthbenefitexchange.ky.gov/Documents/KY%20Cap%20Study%20Summar y%2005_23_13%20vFINAL.pdf • Initial Report Completed March 2013 • Recommendations Included: • Improve licensure data quality and reporting • Expand limited services clinics • Whitepaper http://governor.ky.gov/healthierky/Documents/Medicaid ExpansionWhitePaper.pdf
- 6. Decision to Expand Medicaid • Positive Economic Impact • Significant Cost Associated with Not Expanding • Right Decision for Kentuckian’s Health • Goals: Reduce the number of uninsured Improve the health status of the state Boost the economy
- 7. Medicaid Enrollment since 2012
- 8. The 2013 white paper estimated that 147,634 newly eligible members would enroll by the end of state fiscal year (SFY) 2014, with total enrollment increasing to 187,898 by the end of SFY 2021. The 2013 whitepaper anticipated a decrease in the uninsured rate, but did not contain a quantifiable estimate. Stressed individuals with insurance are healthier. Rate of uninsured estimated at 20.4%, The 2013 whitepaper projected a net positive impact of $841.3 million to the state budget from SFY2014 to SFY2021 as a result of expanding Medicaid eligibility. The 2013 whitepaper did not have projections for uncompensated care but stressed that hospitals would be forced to take on additional financial burdens with reductions in DSH. The 2013 whitepaper estimated that a total of 17,000 new jobs would be added to the Kentucky economy through SFY 2021 as a result of expansion. The 2013 whitepaper predicted Medicaid expansion would have a net positive cumulative impact of $15.6 billion between SFY2014 and SFY2012 Medicaid expansion enrollment increased by 375,175 by the end of calendar year (CY) 2014, with the expansion population representing 8.5% of the total state population. Compared with all other states, Kentucky experienced the second largest decrease in its uninsured rate; the uninsured rate dropped from 20.4 percent in 2013 to 11.9 percent in mid-2014. The net difference between expanding and not expanding is now projected to have a positive $919.1 million impact on the state budget from SFY2014 to SFY2021. Uncompensated care costs for Kentucky hospitals were $1.15 billion lower during the first three quarters of CY2014 compared with the same period in CY2013. Revised estimates indicate the state will recognize the creation of approximately 40,000 new jobs as a result of expansion. Between SFY2014 and SFY2021, Medicaid expansion is now estimated to have a net positive cumulative impact of $30.1 billion on Kentucky’s economy. Enrollees Uninsured rate Avoided costs Uncompensated care Job creation Cumulative impact on state economy 2013 Predictions 2015 Facts and Projections Kentucky Medicaid Expansion
- 9. Expansion Demographics • Average age = 38 • Evenly distributed between males and females • Health Status – High Cholesterol – Diabetes – COPD – Asthma – Depression
- 10. Overview of Selected Preventive Services *Based Medicaid Claims Data Preventive Services for Medicaid Expansion More Screenings = Better Health 17,000 screened for colorectal cancer 26,000 received mammograms 34,000 screened for cervical cancer 46,000 screened for diabetes 13,000 received treatment for substance abuse 80,000 had preventive dental visits 1 – Calendar Year 2014
- 11. Cancer Screening *Based Medicaid Claims Data Comparison of Expansion and DSH Payments in 2014
- 12. Billed Charges for Uncompensated Care
- 13. Medicaid Expansion Payments to Providers Payments from 1/2014 through 6/10/2015 Hospital $ 918,685,939 Pharmacy $ 487,054,134 Physician, FQHC, Primary Care, etc. $ 416,767,441 Other $ 119,947,655 Dental $ 44,605,246 Behavioral health $ 29,808,286 Medical equipment $ 24,810,524 Total $ 2,041,679,225 13 Medicaid Expansion Payments to Providers
- 14. • Implemented November 1, 2011 - $375M GF Savings - $1.3B Savings over 3 years • 5 MCOs Serving Medicaid Members – Anthem – Coventry/Aetna – Humana – Passport – WellCare • Must provide medically necessary services as outlined in Medicaid regulations with approvals from CMS (federal) • Flexibility regarding prior authorizations, rates and structure of contracts • Flexibility to create value-added services • Does not serve Medicaid members in long term care facilities or 1915(c) waivers Medicaid Expansion Payments to Providers Managed Care Overview
- 15. KY MEDICAID POPULATION Kentucky Medicaid Population
- 16. Kynect Overview
- 17. Overview: The Marketplace kynect Kentucky Health Benefit Exchange Deloitte IT vendor OATS IT Support Staff Department for Medicaid Services DCBS Eligibility Workers Kynectors IPAs Navigators Department of Insurance Xerox Call Center
- 18. Overview: kynect Governance Executive • Governor of Kentucky • Secretary, Cabinet for Health and Family Services • Office of the Kentucky Health Benefit Exchange Advisory • Exchange Advisory Board • Subcommittees: • Health Plans • SHOP • Agent/Navigator • Education/Outreach Management • kynect Program • HBE Steering Committee • Administrative and Technology Services • Change Control Board • IV&V
- 19. Insurance Market
- 20. • No more than 4 plans per metal level • No benefits in excess of EHB • Must offer Silver, Gold, Child-only & Catastrophic • Quality Improvement Strategy (QIS) Narrative Required Market Organizer Insurance Market Three Additional Issuers entering the individual market 2016 Individual Market: 5 issuers SHOP Market: 4 issuers Dental: 5 issuers 2015 Individual Market: 3 issuers SHOP Market: 4 issuers Dental: 5 issuers 2014
- 21. kynect Insurer Participation 2014-2016 Individual Plans 2014 • Anthem • Humana • Kentucky Health Care Cooperative 2015 • Anthem • Humana • Kentucky Health Care Cooperative • Caresource • WellCare 2016 • Anthem • Humana • Caresource • WellCare • Aetna • UHC of Kentucky • Bluegrass Family Health Small Employer Group (SHOP) Plans • Anthem • Bluegrass Family Health • UHC of Kentucky
- 22. 22
- 23. Outcomes
- 24. • From 20.4% to 9.8% • 52 % reduction in the rate of uninsured Kentuckians Second Largest Decrease in Uninsured in the Country Outcomes
- 25. • From 20.4% to 9.8% • 52 % reduction in the rate of uninsured Kentuckians Second Largest Decrease in Uninsured in the Country Outcomes
- 26. Impact: Prior to the ACA
- 27. Impact: After the ACA
- 28. • Successful IT Infrastructure • Significantly more insured • Individuals using healthcare • Decrease in uncompensated care • Increased competition After Two Open Enrollment Periods End Result This puts the Marketplaces in a very unique position to begin to really encourage quality and cost-effectiveness of health care in the individual and small group markets.
- 30. Retail Store • 7,592 visitors • 5,938 applications for new coverage Two Locations in 2015 • Lexington • Louisville Success in 2014
- 31. Shopping 3.0
- 32. Rate Overall Health Rate Overall Health
- 34. Kentucky at a GlanceKentucky at a GlanceSummary of Information
- 36. Estimated Cost of Specific Medical Treatments
- 37. Mobile & Tablet Apps
- 38. • Bringingthehealthbenefitexchangeinto“thehands”of individual consumers, agents, assisters, employers, and communities! • Enrollment Start to Finish – Users will be able to login/create an account, complete an application, and enroll in a plan via the mobile and tablet app. • New Intuitive Process – Users will be presented with a new conversational flow that will provide them with a streamlined process including contextual help along the way. • Target Audiences – There will be increased functionality for all user; citizens, kynectors, and agents. • SHOP Functionality – SHOP functionality for employers, kynectors, and agents will be included in the tablet app. Overview Mobile & Tablet Apps
- 39. Mobile & Tablet Apps
- 40. Mobile & Tablet Apps
Editor's Notes
- Market Organizer v. Clearinghouse v. Active Purchaser State manages plan choices by limiting the number or type of plans that an insurer can offer but doesn’t selectively contract with issuers
- Flip chart
- In 2013, our state ranked 40th in the percentage of people who lacked health insurance, at 20.4 percent. In just one year, we dropped to just 9.8 percent uninsured, catapulting us to 11th best in the country. Our decision to expand Medicaid and enact a state-based health insurance exchange, kynect, have helped hundreds of thousands of Kentuckians find affordable health care, many for the first time.
- In 2013, our state ranked 40th in the percentage of people who lacked health insurance, at 20.4 percent. In just one year, we dropped to just 9.8 percent uninsured, catapulting us to 11th best in the country. Our decision to expand Medicaid and enact a state-based health insurance exchange, kynect, have helped hundreds of thousands of Kentuckians find affordable health care, many for the first time.