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Published byKate Milles Modified over 8 years ago
Health Care Reform Implementation: What does it mean for Community Health Centers? QI/PCMH Roundtable 3/14/2013
New System of Coverage Under Health Reform Employer Sponsored Coverage – Not much will change EXPANDED Public Program: -Medicaid, Medicare, CHIP -NEW Federal Basic Health Option NEW Exchange: - Individuals & Small Businesses - Subsidized & Unsubsidized
What Happens to Today’s Uninsured in 2014? NOTE: 270,000 currently uninsured seen at CHCs
Projected CHC Enrollment Opportunity Uninsured Patients in CHCs Statewide in 2010 ~ 267,000
Health Coverage for Immigrant Adults In 2010, 217,000 undocumented; 4% of state’s 5.9 million residents under 65 yrs. – Not eligible for Medicaid – Not subject to individual mandate – Barred from purchasing insurance in the Exchange (ACA sec. 1312(f)(3)) – Remain eligible for emergency care under Medicaid – Pregnant women still covered Legally Present Resident Aliens: D d
Healthplanfinder: The Enrollment Superhighway Assisted, easy-to-use process for all interested in coverage Seamless “one stop” shop where “apples to apples” comparisons can be made Simpler eligibility rules Efficient, technologically advanced systems with telephonic, internet and in- person options Strong navigator program to assist individuals seeking coverage
Benefits for Newly Eligible Medicaid Adults Called Alternative Benefit Plan (aka Medicaid Benchmark) Benefits for new adults must: – Cover all 10 essential health benefits as defined for Medicaid (may be different for Exchange) – Meet mental health parity (currently applies to private plans and Medicaid managed care, but not fee-for-service) – Cover non-emergency medical transportation – Cover Early Periodic Screening, Diagnosis and Treatment Benefits for new adults may: – Align with existing Medicaid benefits package – Differ for different eligibility groups
Some Issues to Consider How will CHCs educate front-line staff and providers about new coverage opportunities? How can CHCs help their uninsured patients enroll in coverage? How can MLCHC retain current patients once they have insurance coverage? Does MLCHC have the capacity for new patients?
Where Does Quality Fit? Health Benefits Exchange provide quality measures per health plan
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