1. The Road Forward: Simple Seamless Path to Affordable Coverage Vikki Wachino Director, Children and Adults Health Programs Group Center for Medicaid and CHIP Services October 19, 2011 1

2. Medicaid, CHIP and Exchange Coverage: Income Eligibility Levels 138% FPL 250% FPL 400% FPL CHIP/Medicaid for Children FPL Varies by State Medicaid/CHIP Children Medicaid Adults Qualified Health Plan with Premium Tax Credits-138%-400% FPL Cost-sharing reductions between 138% - 250% FPL Qualified Health Plans without Financial Assistance

3. Scope of the Three Proposed Rules

4. Source: KCMU/Urban Institute analysis of 2010 ASEC Supplement to CPS. Covering the Low-Income Uninsured is a Key To Success 66% 19% 81% Insured Uninsured 50 million Americans are Uninsured 42% Adults Children 52% of Uninsured Have Income < 138% FPL 33% <138% FPL 139-399% FPL 400%+ FPL

5. Seamless, Streamlined Eligibility and Enrollment

6. Our Goal: Better Care, Better Health, Lower Costs Per Capita Cost Experience Of Care Population Health

7. Simple, Seamless and Affordable Coverage Medicaid Eligibility NPRM  Expanding access to affordable coverage with significant federal support  Simplifying Medicaid & CHIP  Establishes a seamless system of coverage across insurance affordability programs

8. Building on State Success  Louisiana: Renews without a paper form in most instances and uses existing data from other databases to determine eligibility Reduced the percentage of children losing coverage at renewal to less than 1%  Utah: E-Find system streamlines the verification process by using existing information about applicants from a “data warehouse” of multiple databases to determine eligibility  Wisconsin: The ACCESS system allows people to apply for and enroll in coverage online and set up a personal account to report changes and renew coverage Cuts the time it takes to apply for coverage in half

9. Simplifying Medicaid & CHIP  Simpler Income Rules (MAGI)  Consolidates eligibility categories into four main groups  Following State lead, modernizes eligibility verification rules to rely primarily on electronic data  Federal government will perform some of the data matches for States, relieving administrative burden  Renewals every 12 months If eligibility can be renewed based on available data, no return form is needed

10. Medicaid Eligibility Groups Affected by Proposed Simplification Number of Eligibility Groups pre-ACA Number of Eligibility Groups Proposed after Simplification Number of Medicaid Eligibility Groups ± Certain optional eligibility groups for certain children currently covered by some States are not affected by the proposed simplification.

11. Coordination: A Seamless System of Coverage  Coordinated policies and processes across Medicaid, CHIP and the Exchanges Income rules State residency Verifications  Exchanges would conduct eligibility determinations for premium tax credits, Medicaid, and CHIP following the State Medicaid agency rules

12. Challenges to Continuity of Care Continuous Health Coverage

13. Concentration of Medicaid Spending 5% 25% 50% 54% 5% 1% Source: Medicaid Statistical Information System Claims Data for FY 2008 Percent of Total Medicaid Spending Percentile of Medicaid Population (ranked by spending)

14.  Primary care provider increase (2013)  Accountable Care Organizations  Medical and health homes  Bundled payments to integrate care  Global payment demonstrations  No payment for HACs  Center for Medicare and Medicaid Innovation Center  Office of Medicare and Medicaid Coordination New Tools: Delivery System and Payment Reform

15. Achieving a High Performing Medicaid Program  Simplified, accurate, customer-friendly, data driven eligibility/renewal processes that are coordinated with the Exchange  Access to person-centered, high quality, integrated care with options for continuity of coverage with plans on the Exchange  Continuing improvements in quality and cost throughout the health care system  Based on consumer experience, stakeholder input, data, and collaboration