Medicaid, BHP, and CHIP: Current Issues in ACA Implementation Eliot Fishman, PhD Director, Children and Adults Health Program Group Center for Medicaid & CHIP Services Melissa Harris Director, Division of Benefits and Coverage Disabled and Elderly Health Programs Group 1

Implementation Alternative Benefit Plans CHIP and BHP Topics to be Covered 2

Implementation

States will begin reporting enrollment numbers for the new adult group after March 31, State progress on eligibility and enrollment can be found in the Medicaid & CHIP Monthly Applications and Eligibility Determinations report. Data are collected on types and quantities of submitted applications and eligibility determinations. How CMS is Reporting on Eligibility & Enrollment SOURCE: /Downloads/Medicaid-CHIP-Monthly-Enrollment-Report-Nov-2013.pdf 4

States Moving Forward on Expansion DC DE Expanding Medicaid For 2014 Not expanding Medicaid to date So far, 25 states and DC have indicated they will expand Medicaid to low-income adults in 2014 – discussions continue to evolve.

6 Process and Coverage Improvements To date, half the states expanding Medicaid to low- income adults; other states in discussion All states implementing new MAGI rules, new systems, new applications, new verification policies, coordination with Marketplace Continuity of coverage through modernized renewals and coordination between Medicaid and the Marketplace

Upcoming reports to Congress will provide details about states’ reporting on core measure sets for children and adults. Highlights: – The number of states reporting on children’s measures has increased since last year’s report – CMS has asked states to voluntarily report uniform adult quality measures for the first time in FY2014 and has provided grants to 26 states to assist them in collecting data Quality Measurement SOURCE: Care/Downloads/2013-Ann-Sec-Rept.pdf 7

Medicaid.gov On Medicaid.gov, data can be easily located on a variety of topics, including: Eligibility Outreach & Enrollment Quality of Care Data can be found in multiple formats, such as reports, charts, and maps. SOURCE: Topics/Quality-of-Care/Downloads/2013-Ann-Sec-Rept.pdf 8

Alternative Benchmark Plans

10 Medicaid ABP Benefit Design Foundation for Essential Health Benefits (EHB): Step 1: States must select a coverage option from the choices found in section 1937 of the Act. Step 2: States must determine if that coverage option is also one of the base-benchmark plan options identified by the Secretary as an option for defining EHBs. If so, the standards for the provision of coverage, including EHBs, would be met, as long as all EHB categories are covered. If not, states must select one of the base-benchmark plan options identified as defining EHBs. Step 3: Select a base benchmark plan to define the EHBs.

11 Considerations for States Implications of benefit alignment between the ABP and the underlying state plan: – Ease of administration – No need to identify individuals who are medically frail – Benefit uniformity across all Medicaid populations Implications of different benefits between the ABP and the underlying state plan – Straightforward alignment with commercial product – Necessitates process for identifying individuals who are medically frail and counseling them on benefit options

12 Medical Frailty: Definition, Screening Process, and Benefits Definition: “Individuals with disabling mental disorders (including children with serious emotional disturbances and adults with serious mental illness), individuals with chronic substance use disorders, individuals with serious and complex medical conditions, individuals with a physical, intellectual or developmental disability that significantly impairs their ability to perform 1 or more activities of daily living, or individuals with a disability determination based on Social Security criteria or in States that apply more restrictive criteria than the Supplemental Security Income program, the State plan criteria.”

Determination or Screening Process Benefits for Medically Frail Individuals Individuals in the new adult group, if determined to be medically frail, will receive the choice of ABP defined using EHBs or ABP defined as state’s approved Medicaid state plan Medical Frailty: Screening Process and Benefits 13

CHIP and BHP

15 CHIP Coverage Issues Requirement of certification for pediatric coverage offered through the Exchange as comparable to CHIP Efforts underway to analyze nature of CHIP benefits and cost-sharing Maintenance of Effort (MOE) requirement for states to maintain eligibility standards ACA requires that children <133% FPL move from separate CHIP to Medicaid coverage

BHP will be an option for states in the 2015 coverage year. States will have the option to cover individuals between 133% and 200% FPL who would otherwise receive tax credits through the Exchange. By March 31, 2014, we hope to publish final regulations, payment methodologies, and the tool (“Blueprint”) by which states can apply to gain approval. Basic Health Program (BHP) 16