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Preserving Mission in a Changing Environment. Payment Reform Coverage Expansion Delivery System Redesign Regulation Reform Affordable Care Act (ACA) Healthcare.

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Presentation on theme: "Preserving Mission in a Changing Environment. Payment Reform Coverage Expansion Delivery System Redesign Regulation Reform Affordable Care Act (ACA) Healthcare."— Presentation transcript:

1 Preserving Mission in a Changing Environment

2 Payment Reform Coverage Expansion Delivery System Redesign Regulation Reform Affordable Care Act (ACA) Healthcare Reform Fundamentals

3 A Tangled Safety Net Medical EducationalSocial

4 What happens to the uninsured in Texas?

5 % of Federal Poverty Level Unsubsidized – In or Out of Exchange Sliding Scale Health Insurance Subsidies, through Exchange 400% FPL CHIP 200% FPL CHIP 200% FPL CHIP Current Medicaid 185% FPL Current Medicaid 133% FPL Current Medicaid 100% FPL Current Medicaid 185% FPL Current Medicaid 74% FPL 12% FPL NEW Optional Medicaid 133% FPL NEW Optional Medicaid 133% FPL Old CHIP NEW Medicaid 133%, (Really 138% due to use of Modified Adjusted Gross Income) Health Insurance Exchange, Sliding Scale Subsidies Available for 100%- 400% FPL Health Insurance Exchange, Sliding Scale Subsidies Available for 100%- 400% FPL Health Insurance Exchange, Sliding Scale Subsidies Available for 100%- 400% FPL Health Insurance Exchange, Sliding Scale Subsidies Available for 100%- 400% FPL Health Insurance Exchange, Sliding Scale Subsidies Available for 100%- 400% FPL Health Insurance Exchange, Sliding Scale Subsidies Available for 100%- 400% FPL Unsubsidized – In or Out of Exchange Unsubsidized – In or Out of Exchange Unsubsidized – In or Out of Exchange Unsubsidized – In or Out of Exchange Unsubsidized – In or Out of Exchange Unsubsidized – In or Out of Exchange Unsubsidized – In or Out of Exchange Health Insurance Exchange, Sliding Scale Subsidies Available for 100%- 400% FPL Healthcare Coverage Post ACA Implementation FPL LevelIndividualFamily of 3 12%$1,340$8, %$11,170$19, %$14,856$25, %$44,610$76,360

6 What happens to the 6 million uninsured Texans? Source: Texas Health and Human Services, March 8, 2013.

7 What does insurance coverage look like in Texas in January 2014?

8 Where to Find Insurance Who Will Find Insurance Federal Marketplace Small Group, Individual MedicaidPoor Pregnant Women, Poor Children, SSI Commercial Insurance Employer Coverage 61% Americans unaware of the Marketplace

9 Federal Marketplace Mental health and substance use benefits are essential benefits Limits on mental health and substance abuse must meet parity requirements Preventive services include behavioral health

10 Federal Marketplace 46 plans in Harris County Platinum, Gold, Silver, Bronze “Silver” Plan premiums range from $122 to $428 per month, based on age

11 Texas is one of 25 states not expanding Medicaid. Anticipate greater number of children in the program due to eligible but not enrolled. STAR Health

12 The platform for Medicaid in Texas is Managed Care. If you bill Medicaid, it will be through contracts with health plans. STAR Health

13 Commercial Insurance Eliminated in 2014: pre- existing condition exclusions for adults; annual limits and waiting periods more than 90 days. Job-based insurance qualifies as minimum essential coverage Many ACA changes in effect prior to 2014 including parity and preventive services

14 What does it mean for your organization?

15 Who do you serve that will become eligible under the Marketplace? Who do you serve that will become Medicaid if an expansion does occur in the future? Are your services reimbursable under the Benchmark Plan or Medicaid? How well do you conduct third party contracting and billing? What’s the Impact to Your Organization?

16 How do organizations in your community support each other during this transition? Where does the needed expertise lie among your partners? Where do you need to bring in outside expertise for technical assistance? What is the role of the collaborative?

17 What does it mean for people we care about? Coverage Integration Parity Financial Security Health

18 https://www.healthcare.gov Melissa Rowan Healthcare Policy Director Texas Council of Community Centers ext 109


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