Healthy Indiana Plan 2.0 - PDF document

Healthy Indiana Plan 2.0 1 Hoosier Innovation: Health Savings Accounts 1992: Hoosier pioneers medical savings accounts 2003: Tax advantaged HSAs authorized by Congress Indiana offers health savings accounts to state employees 2008: HIP coverage begins Submit HIP 2.0 waiver HIP 2.0 coverage begins Medical Savings Accounts promote costconscious health care decisions Indiana saves an average of 10.7% in health care costs annually, Healthy Indiana Plan (HIP) integrates consumerism with Medicaid HIP 2.0 builds on HIP:Expand consumerismEncourage personal responsibilityCover more Hoosiers ��2 &#x/MCI; 86;&#x 000;&#x/MCI; 86;&#x 000;In 2013, 420,000 Hoosiers were enrolled in HSAs. This represents 9% of insured individuals higher than the national average. HIP Success HIP improves health care utilization Lowers inappropriate emergency room use by 7% compared to traditional Medicaid 60% of HIP members receive preventive care populations 80% of HIP members choose generic drugs, compared to 65% of commercial populations HIP results in high member satisfaction 96% of enrollees satisfied with HIP coverage 83% of HIP enrollees prefer the HIP design to copayments in traditional Medicaid 98% would enroll again HIP promotes personal responsibility 93% of members make required POWER account contributions on time 30% of members ask their healthcare provider about the cost of services State of the Uninsured in IndianaSHADACHealth Insurance Analysis. (2011). American Community Survey data. Retrieved from www.nationalhealthcare.in.gov. Office of the Assistant Secretary for Planning and Evaluation. (2013). 2013 Poverty Guidelines. Retrieved from http://aspe.hhs.gov/poverty/13poverty.cfm . 348,900105,466160,998215,21450,713Uninsured Hoosiers, 2010 Under 100% FPL 100-138% FPL 139-200% FPL 201-399% FPL 400%+ FPL How do the Federal Poverty Levels translate to annual income? FPLIndividualFamily of 4Under 100%$11,490 $23,550138%$11,49015,970$23,55032,734200%$15,97123,094$32,73547,335399%$23,09545,959$47,33694,199400%+耀 $45,960耀 $94,200TOTAL UNINSURED = 881,291 Indiana Uninsured: 13.6% in 2010Coverage Gap HIP 2.0 Structure Replaces traditional Medicaid for nondisabled adultsThree pathways to coverageHIP LinkNEWdefined contribution plan that helps pay for employersponsored health insuranceHIP Plus:Current program with enhanced benefits including dental and visioneduced nonpayment lockout period: 6 months instead of 12 monthsOnly option for individuals above 100% FPLHIP Basic:Allows individuals elow 100% FPL who do not make POWER account contributions to maintain coverage New Affordable Contributions FPLMonthly IncomeSingle IndividualMonthly Contribution22%to $487to $973to $1,342&#x-1.8;&#x-1.8;6 &#x/MCI; 81;&#x 000;&#x/MCI; 81;&#x 000;&#x/MCI; 76;&#x 000;&#x/MCI; 76;&#x 000;Employers & Foundations may assist with contributionsHIP 2.0 POWER Account Contributions HEALTHY INDIANA PLANVERSION 2.0 HIP Plan Comparison HIPLinkHIP PlusHIP BasicMedically FragileCovered GroupsOptional for individuals with access to costeffective employersponsored insuranceException: Medically fragileIncome up to 138% FPLConsistentPOWER account contributionsIncome below00% FPLFail to make POWER account contributionHigh cost individualsincluding substance abuse & significant mental health issuesVery low income parents Pregnant womenCostsharingEnhanced POWERaccount can be used for premiums, copayments, or deductiblesPOWER account contributionsNo Other Copayments, except:Nonemergency ED visit: $25payments for allservices:Moreexpensive than HIP Pluspayments or POWER accountcontribution Exception: Pregnant women are exempt from costsharingBenefitsEmployer Plan BenefitsComprehensive medicalbenefits incl. maternityVision& dental benefitsIncreased service limitsComprehensivedrug benefitComprehensive medicalbenefits incl. maternityLowerservice limitsLimited drug benefitComprehensive medicalbenefits incl. maternityCurrent Medicaid benefits as required by federal lawEnhanced behavioral healthservices Ensuring Access for all Medicaid Participants to Improve Outcomes Maintain Medicare payment rates to support a highquality provider network in HIP including higher payments for maternity care to improve birth outcomes Increase provider reimbursement in the current Medicaid program to ensure access for the most vulnerable Hoosiers aged, blind, disabled and children Family Coverage option: Parents can enroll their children in employer sponsored coverage or Marketplace plans 9 HIP 2.0 Gateway to Work All individuals who complete the application for HIP coverage will be connected to job training and job search programs offered by the State of Indiana Maintaining Financial Sustainability HIP 2.0 sustainable & will not increase taxes for HoosiersHIP 2.0 will continue to utilize HIP Trust Fund dollars Indiana hospitals will help support costs to expand HIP 2.0 Waiver specifies HIP 2.0 continuity requires:Enhanced federal funding Hospital assessment program approval 11 Hospital Assessment Fee (HAF) BackgroundHAF authorized in 2013Assessed against all licensed acute hospitals and private psych hospitalsDesigned to increase hospital inpatient and outpatient reimbursement to align with Medicare payments ratesState maintains 28.5% of HAF to cover Medicaid costsHAF Board oversees assessment formula2 Hospital Association Members2 State Appointees State & IHA Term SheetAnnual Cigarette Tax Revenues are used first for HIP expansionStarting in 2017, recalculate HAF fund such that State HAF portion is sufficient to cover:Cost of HIP expansion, including all administrative costs with capCost of increasing provider reimbursement in current Medicaid program to 75% of Medicare rates.Annual Contribution of $50M to Medicaid programDivert HCI funding$12M to HIP Trust Fund & together with current Trust Fund balance assures 1year of operational costs 13 Total Cost of HIP Expansion (State and Federal) SFYSFYSFYSFYSFYSFYTOTALFederal Portion $2,949.7 $3,066.7 $3,160.4 $16,463.4 State Portion TOTAL Cost of HIP 2.0 $3,568.9 $17,925.5 14 HIP 6 Year State BudgetSFY 2015 Cigarette Tax Revenue$ 676MRevenue$ 959MTotal Revenue$1,635MCOSTSHIP Expansion Costs Admin & Provider Rate Increase in Medicaid)$1,462MContribution to Medicaid & HIP Trust Fund$ 173MTotal Costs$1,635M Current & Projected HAF SFYSFYSFYSFYSFYSFYTOTALProjected HAFcurrent programNew HAF Projected Average Monthly Enrollment Next Steps Potential HIP expansion in 2015, based on timing of federal approvalSubmit waiver to CMS in Finalize waiver public inputPost HIP 2.0 waiver for public comment