1. The Delaware Landscape Barbara DeBastiani, RN, MS Delaware Liaison Mid-Atlantic Association of Community Health Centers September 23, 2011

2. Key Bills Passed in 2011 Medical Marijuana Civil Unions for Same Sex Couples Continuation of the needle exchange program in the City of Wilmington Multiple bills requiring the permanent revocation of the license of any Delaware licensed health care provider convicted of a felony sexual offense

3. Funding for Health Centers Although the state projected a budget shortfall for FY 12, a $365 million surplus was “found” in the spring resulting in pay increases for state employees, tax cuts, and funding for one time projects. Budget shortfall for FY 13 is projected at $109.8 million. Grant in aid which provides direct funding to Delaware health centers allocated $153,720 to the three health centers, a 10% decrease from the previous year.

4. Legislation Related to Health Care Reform Bringing Delaware code in line with provisions of the Affordable Care Act. Raising the age children may be covered by their parent’s or parents’ health insurance to the age of 26. Prohibiting the denial of coverage to children under the age of 19 due to pre-existing conditions. Recommended vaccinations, health screenings and children’s wellness visits must be covered for all new health plans starting with plan years beginning on or after Sept. 23, 2010

5. Health Care Reform in Delaware

7. Health Care Costs in Delaware - $6.5 billion was spent on personal health care in Delaware in 2008 – highest point in 10 years. - $7,485 per person in Delaware - Average rate of increase is 5% per year.  Largest share of spending is on: Hospital care at 39% Physicians at 25.4% Prescription drugs at 14.8%

8. Who Are the Uninsured in Delaware? 23% - under the age of 19 54% - male 69% - white 59% - own or are buying their home 21%- live alone 80% - are above the poverty line 34%- with household income over $50,000 59% - are working adults 9% - are self-employed 21% - are non citizens

9. Health Insurance Exchanges Delaware Health Care Commission is lead agency Have held meetings with multiple stakeholders including FQHCs over the past several months to obtain input on how the exchange might be structured Contracted with Public Consulting Group to assess Delaware capabilities and costs, IT infrastructure, governance

10. Health Insurance Exchanges Commission is recommending the Exchange be a quasi state entity Delaware will likely create it’s own Exchange to maintain control over the market regulated by DE law Could share some administrative functions across state lines

11. Health Insurance Exchanges Commission is wrapping up the first year planning grant and is applying for a Level 1 implementation grant Big issues facing Delaware include: 1. The IT demands for an Exchange and connectivity with Medicaid 2. How to create value in an exchange when federal funds dry up in 2015

12. Primary Care Medical Homes The Commission is just beginning work on PCMH There is work occurring on PCMH within Delaware Health and Social Services and the Medical Society of Delaware. The Commission believes PCMH is an important element of the ACA but is unsure of the role it will play statewide – perhaps a coordinating role?

13. Delaware Health Care Commission This year transferred the Delaware Health Information Network to a quasi state entity Transferred the Community Healthcare Access Program to Public Health and linked it to the Screening for Life program Was very specific in saying that the Commission has not backed away from support of Delaware FQHCs

14. Accountable Care Organizations Delaware hospitals are disappointed in the framework established for ACOs to date Current and proposed regulations expose potential ACO members to significant revenue risk Delaware is taking a wait and see posture Should ACOs become more attractive, Delaware CHCs would be welcome ACO providers