Medicaid Expansion under the Affordable Care Act Denver HIV Resources Planning Council Meeting September 5, 2013 1 Colorado Department of Health Care Policy and Financing Our Mission: Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 2 Colorado Department of Health Care Policy and Financing Overview • Expansion Population Groups • Expansion Benefits (ABP/EHB) • Churn and Building Seamlessness • Service Delivery: ACC Program • AwDC and Other Initiatives • Ryan White and Medicaid 3 Colorado Department of Health Care Policy and Financing The Expansion Population (Adults) 42 CFR 435.119 created a new adult group: • • • • • Age 19-64 Not pregnant Not receiving Medicare A or B Not mandatorily covered by Medicaid Income below 133% of federal poverty “Newly eligible” = not eligible Dec 2009 (42 CFR 433.204(a)(1)) 4 Colorado Department of Health Care Policy and Financing Individuals Exempt From Mandatory Enrollment in ABP (42 CFR 440.315)  Pregnant women  Individuals who qualify for Medicaid based on being blind or disabled  Dual eligibles  Terminally ill hospice patients  Inpatients in hospitals, nursing homes, and intermediate care facilities  TANF/Section 1931 parents and caretakers  Medically frail individuals  Former foster care children  Individuals who qualify for long-term care services based on their medical condition  Individuals who only qualify for emergency care  Individuals who qualify based on spend down 5 Source: Lorez Meinhold Colorado Department of Health Care Policy and Financing Who is Newly Eligible in CO? and and and = non-expansion parents = expansion population Exchange 133%FPL AwDC Parents 133%FPL Medically frail Medically frail 100%FPL 60%FPL 10%FPL 0%FPL 0%FPL Colorado Department of Health Care Policy and Financing Alternative Benefits Plan 42 CFR 440.300-390 Alternative Benefits Plan (ABP) must: • Cover 10 essential health benefits (EHBs) • Meet mental health parity/ substance abuse equity requirements • Provide EPSDT for 19-20yo • Provide NEMT • 42 CFR 440.345 10 EHBs (45 CFR 156.110) • • • • • • • Ambulatory patient services Emergency services Hospitalization Maternity and newborn care MH and SUD services Prescription drugs Rehabilitative and habilitative services and devices • Laboratory services • Preventive and wellness services and chronic disease management • Pediatric services, including oral and vision care (peds only) Source: Lorez Meinhold Colorado Department of Health Care Policy and Financing Health Insurance Status after Implementation 758,000 160,000 220,000 160,000 8 Colorado Department of Health Care Policy and Financing Extent of Coverage Shifts: National Data 35% Churn in 6 Months Adults < 200% FPL = 2 Million People 25 M 0M 31M Medicaid Churn Exchange 16 M 20 M 20 M Medicaid Churn Exchange 9 Colorado Department of Health Care Policy and Financing Three Pillars of Promoting Seamlessness • Eligibility • Providers • Benefits 10 Colorado Department of Health Care Policy and Financing Single, Streamlined Application 1Pursuant 11 to the National Voter Registration Act of 1993, 42 USC Sec. 1973 GG-5 Colorado Department of Health Care Policy and Financing Medicaid’s Accountable Care Collaborative (ACC) Statewide Data and Analytics Contractor (SDAC) Regional Care Collaborative Organizations (RCCOs) Primary Care Medical Providers (PCMPs) Colorado Department of Health Care Policy and Financing RCCO Map 13 Colorado Department of Health Care Policy and Financing Benefits of the ACC • Client care is coordinated • Easier access to specialists • The RCCO can help clients/families access resources and supports beyond primary medical care. 14 Colorado Department of Health Care Policy and Financing Adults without Dependent Children (AwDC) Waiver Expansion • Authorized by H.B. 09-1293 and federal 1115 Demonstration waiver • Enrollment began for June 2012 • Eligibility for AwDC up to 10% FPL • Limited Funding = Limited Enrollment • All AwDC enrollees in the ACC delivery system • Waiver will end December 31, 2013 Colorado Department of Health Care Policy and Financing Medicaid Initiatives • ACC Payment Reform Initiative (H.B. 12-1281) • Reprocurement of Behavioral Health Services • State Innovation Models (SIM) Award • State Demonstration to Integrate Care for MedicareMedicaid Enrollees • New Benefits for Adults: – Substance Use Disorder benefit – Limited dental benefit for adults Colorado Department of Health Care Policy and Financing Part A/MAI Service Categories Category Covered by Medicaid? Outpatient Ambulatory Care Yes AIDS Pharmaceutical Assistance Yes Notes Medical Case Management Maybe Under ACC Program Oral Health Care Limited New dental benefit for adults Mental Health Services Yes Through managed care (BHOs) Early Intervention Services No Substance Abuse Services Yes Housing Services No Emergency Financial Assistance No Food Bank/ Home Delivered Meals No Medical Transportation Services Home Health Care Yes – limited Through managed care (BHOs) Link Yes Colorado Department of Health Care Policy and Financing Bringing Ryan White beneficiaries into Medicaid: Ryan White/RCCO Coordination Workgroup • Members: Department staff, RCCO representatives, Part A representative, Part B representative • Identification and education of beneficiaries • Education and enrollment of providers • Care coordination • Maintaining existing provider-client relationships Colorado Department of Health Care Policy and Financing Selected HCPF Stakeholder Groups ACA Implementation Meetings • Eligibility/enrollment preparations for 2014 • Contact: [email protected] ACA: Movement between Public & Private Coverage • Seamless coverage – providers, eligibility, benefits in 2014 • Contact: [email protected] ACC Program Improvement Advisory Committee • Advisory structure for the Accountable Care Collaborative • Contact: [email protected] Adults without Dependent Children • Waiver program for childless adults • Contact: [email protected] Full Benefit Medicare/Medicaid Enrollees • Demonstration waiver preparations for dually eligible clients • Contact: [email protected] Colorado Department of Health Care Policy and Financing Other Questions? Leslie A. Weems, MSW Medicaid Reform Specialist (303) 866-3393 [email protected] colorado.gov/hcpf Learn more about health reform in Colorado: http://www.colorado.gov/healthreform Colorado Department of Health Care Policy and Financing