1. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Colorado Department of Health Care Policy & Financing February 6, 2013

2. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources Our Mission: 2

3. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Who we Serve In October 2012: – 660,000 Medicaid clients – 85,000 children and pregnant women in CHP+ 3 60% of Medicaid clients are children 20 and under 30% of births in Colorado are paid by Medicaid

4. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Health In Colorado

5. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Health Reform Implementation Timeline 2010 Some insurance market changes—no cost-sharing for preventive services, dependent coverage to age 26, no lifetime caps Pre-existing condition insurance plan Small business tax credits Premium review 2011-2013 No cost-sharing for preventive services in Medicare and Medicaid Increased payments for primary care Reduced payments for Medicare providers and health plans New delivery system models in Medicare and Medicaid Tax changes and new health industry fees 2014 Medicaid expansion Health Insurance Exchanges Premium subsidies Insurance market rules— prohibition on denying coverage or charging more to those who are sick, standardized benefits Individual mandate Employer requirements Interactive Timeline: http://healthreform.kff.org/timeline. aspx http://healthreform.kff.org/timeline. aspx

6. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Improving Value in Medicaid: $280 million in savings over 10 years Enhancing value-based services Increasing effectiveness in care delivery Reforming payment systems to reward value instead of volume Leveraging health information technology to improve quality and efficiency of care Redesigning administrative infrastructure and reducing fraud, waste and abuse 6

7. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Accountable Care Collaborative Improve health outcomes through a coordinated, client-centered system The Department reduced Medicaid health costs by $20 million Returned nearly $3 million to state and federal taxpayers since its inception Indicators- ACC Clients Hospital Readmissions 8.6% reduction Emergency Room Utilization.23% increase High-Cost Imaging3.3% reduction 7

8. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Payment Reform Courtesy: Colorado Health Institute 10

9. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Medicaid Expansion: The Right Choice for Colorado Maximizing enhanced federal funding is the best option for Colorado o Allows provider fee dollars to stretch further with the enhanced federal matching funds o The Medicaid expansion is expected to have no impact on the state General Fund Expansion allows Medicaid to cover more than 160,000 additional Coloradans o Expansion allows us to cover more people with the right services at the right time and drive value in the system o In 2013, 133 percent of the FPL was $31,321 for a family of four and $15,282 for an individual o Supports Colorado’s health and economy by helping people stay healthier over the long term

10. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Income Eligibility 10 1 This overview does not reflect all Medicaid eligibility categories based on both health status (disability) and income. 2 ACA eligibility is set at 133% FPL; however, law provides for a 5% income disregard, effectively raising eligibility to 138%. This is included in modeling. 3 AwDC expansion in progress; it currently covers 10,000 individuals at 10% FPL with a wait list of 9,000.

11. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 758,000 160,000 220,000 160,000 Health Insurance Status after Implementation

12. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Cost of Expansion 12 Preliminary 10-YEAR ESTIMATE* Caseload and Cumulative Expenditure Projections, 2013-2022 (Representing Net Change, Costs in Millions) 09-1293ACA**Total Caseload 1 220,30059,500271,000 Total Cost$11,709.7$2,039.2$13,548.3 State Share: Provider Fee/ Other 2 $1,267.3$128.3$1,395.6 State Share: GF/Other 2 $0 ($179.5) Federal $10,382.3$1,910.9$12,280 *This is a preliminary estimate of caseload and expenditures and does not include administrative costs or effects of other programs. **The total estimates column above takes into account calculations for eligible but not enrolled individuals and changes to the CHP+ costs and caseload. 1 An estimated more than160,000 Coloradans will be enrolled as a result of the expansion. This is difference between 271,000 (above) and an estimated 110,200 parents and adults without dependent children currently authorized under the provider fee. 2 As federal funding tapers, we anticipate savings, provider fees and other public funding will cover the additional caseload.

13. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Movement between Medicaid and the Exchange FINDING BETTER IMAGE OF GRAPH Courtesy: Colorado Health Institute

14. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing >$92,200 for a family of four; >400% of FPL  Job-based coverage, or  Full-cost coverage in the exchange $65,150-$92,200; 300-400% of FPL  Job-based coverage, or  Subsidized exchange coverage: premiums capped at 9.5% of income $46,100-$69,150; 200-300% of FPL  Job-based coverage, or  Subsidized exchange coverage: premiums and copays to 250% $30,657-$46,100; 133-200/250% of FPL CHP+ Job-based coverage, or Subsidized exchange coverage: premiums and copays <$30,657 for a family of four; < 133% FPL Medicaid Children and pregnant women Adults (non-disabled adults, not eligible for Medicare) Family Income Coverage Options by Income Citation: The Center for Public Policy Priorities ( www.cppp.org )

15. Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Questions Lorez Meinhold Deputy Executive Director/ Community Partnership Office 1570 Grant Street Denver, CO 80203 (303) 866-5868 lorez.meinhold@state.co.us