Expanding Coverage Under the ACA: Status Update and Why It Matters to Hospitals Brian Tabor, VP January 21, 2014

Coverage Under the ACA Two-pronged approach to expanding coverage –Medicaid is critical, but Marketplaces are also critical to ACA’s goals of reducing the uninsured CBO estimates 7 M will be enrolled through the Marketplaces in 2014 –13 M by 2015 –Between M in subsequent years Milliman estimated as many as 650,000 Hoosiers by 2017 could be enrolled through marketplace 2

2016: Health Insurance Expanded to 26M 3 Source: Congressional Budget Office, Feb projections

4 Why Coverage Matters

5 American Health Line, and-Insight/Infographics/Medicaid-Expansion-Map, accessed 7/26/13http:// and-Insight/Infographics/Medicaid-Expansion-Map

State of the State: Jan 14 "Traditional Medicaid is not a system we need to expand. It’s a system we need to change. The Healthy Indiana Plan is the right place to start. The Healthy Indiana Plan is consumer-driven healthcare that moves people from emergency rooms to primary care and encourages low- income Hoosiers to take more ownership of their own healthcare decisions. Let me be clear, we will continue to work in good faith with federal officials to expand our Healthy Indiana Plan. I will oppose any expansion of our health insurance system that condemns vulnerable Hoosiers to substandard health care or threatens the fiscal health of our state.“ Governor Mike Pence Governor still set to meet with Sec. Sebelius in February IHA will be meeting with administration next week 6

Coverage Expansion HB 1309: Medicaid matters. (Clere) Co-Authored by Reps. T. Brown, Lehman, and C. Brown Assigned to the Committee on Public Health –Mandates that the state negotiate with HHS to obtain a Medicaid expansion effective January 1, –Establishes the Indiana Affordable Care Study Committee. –Creates tax refund offsets to fund out-of-pocket amounts owed by individuals under a Medicaid expansion waiver program. –Provider rates under a Medicaid expansion waiver program set not less than Medicare, or 130% of Medicaid rates for services not covered by Medicare. – Adds services to HIP: Medicaid rehabilitation option, chiropractic, and optometric. 7

Coverage Expansion (con’t.) HB 1356: State health insurance exchange. (C. Brown) Assigned to the Committee on Insurance –Requires Dept. of Insurance to create a state-based exchange. SB 369: Implementation of the federal ACA. (Tallian) Assigned to the Committee on Appropriations –Expands Medicaid as provided under the ACA, effective July 1, –Requires Dept. of Insurance to create a state-based exchange. SB 370: Payment of premiums under Medicaid. (Tallian ) Assigned to the Committee on Appropriations –Requires FSSA to apply to HHS for a demonstration waiver or State Plan amendment to allow FSSA to pay premiums to purchase for individuals up to 138% of FPL coverage under a qualified health plan through an exchange operated in Indiana. 8

Medicaid Expansion Report Findings An expansion of Indiana’s Medicaid program under the Affordable Care Act using HIP as a vehicle would result in: 406,717 new enrollees in Indiana through 2020 $10.5 billion in funding from the federal government $108 million in state and local tax revenue each year Coverage Expansion Member Resources Backgrounder Talking Points Fact Sheet Expansion Illustration PowerPoint Media Activity Report

Why Is the Gap So Large? 11 Indiana’s Medicaid eligibility has been very restrictive for many years Childless adults not eligible Relatively low income qualification for poor families $4,698 for family of three

Healthy Indiana Plan (HIP) September 2013: CMS approved 1-year extension of HIP through December 31, 2014 Eligibility for HIP changed from 200% FPL to 100% FPL (100% FPL and below qualify for premium assistance in the Marketplaces) –35,058 Current HIP Enrollees (as of 8/31/2013) At or below 100% FPL: 24,593 Above 100% FPL: 10,465 56,278 on HIP waiting list (non-caretaker adults) 12

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