Washington Apple Health. Washington Coalition of Medicaid Outreach Amy Johnson, Eligibility Policy and Service Delivery September 25, 2015

Transcription

1 Washington Apple Health Washington Coalition of Medicaid Outreach Amy Johnson, Eligibility Policy and Service Delivery September 25, 2015

2 Washington Apple Health Agenda Enrollment and Renewals Update Global Waiver Apple Health Updates Apple Health Reminders Share Your Apple Health Story Resource and Contact Info

3 Enrollment and Renewals Update 3

4 4

5 Apple Health MAGI Renewals Auto-Renewal: Automatic renewal after federal hub data-match Data-match finds household under the Medicaid standard No data-match found and household income on file under the Medicaid standard No additional information needed by recipient Recertified for twelve months Manual: Data-match finds household above Medicaid standard Individual must manually complete their renewal 5

6 Apple Health MAGI Renewal Rates Auto-Renewal Averaging 66% monthly (Dec 2014 Sept 2015) Total Renewed Timely Averaging 85% monthly (Dec 2014 August 2015) Total Renewed After 90 Day Period Averaging 92% monthly (Dec 2014 May 2015) 6

7 Estimated MAGI Renewals Month Total Assistance Units October ,044 November ,915 December ,916 Renewals are ramping up again, with our largest workload beginning in December and lasting through February 7

8 Global Waiver 8

9 What is a Section 1115 waiver? The federal government grants a waiver to allow states to do something under Medicaid that they couldn t ordinarily do under Medicaid rules. Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects under the Medicaid and CHIP programs that demonstrate and evaluate potential program changes that improve care, increase efficiency, and reduce costs. 9

10 What populations will the waiver cover? The Medicaid Transformation waiver covers all Apple Health (Medicaid) beneficiaries. Additionally, Washington will establish a new eligibility criteria and limited benefit package for individuals who are at risk for future Medicaid use because they need some long-term services and supports (LTSS) but do not currently meet Medicaid financial eligibility criteria. 10

11 What will happen to people s existing benefits? Apple Health clients existing benefits will remain in place. No one's benefits will be cut. Washington intends to better tailor its LTSS benefits to meet the varying needs of its aging population by offering two additional limited benefit packages the benefit described in the previous question, and a benefit that will provide supports to unpaid family caregivers. The State will revise the functional eligibility criteria for nursing home services so that only those clients with the most serious needs qualify for institutional care; however, anyone currently receiving this level of care will continue to be served. 11

12 What the Medicaid Transformation waiver does for Washington state Provides flexibility and expenditure authority to achieve our vision for a Healthier Washington. Allows us to test, scale, and spread successful models of care. Supports providers in building capacity. Builds connections within communities that allow for the right care, at the right place, at the right time, with the right provider. 12

13 Creating healthier communities and sustainable health systems by: Building healthier communities through a collaborative regional approach Ensuring health care focuses on the whole person Improving how we pay for services 13

14 Healthier Washington includes Medicaid Transformation 2014 Legislation House Bill 2572 Senate Bill 6312 Medicaid Transformation Potential demonstration project within Medicaid SIM Grant: $65 million over 4 years from the federal government 14

15 A transformed system = transformed lives Current System Transformed System Fragmented clinical and financial approaches to care delivery Disjointed care and transitions Disengaged clients Capacity limits in critical service areas Individuals impoverish themselves to access long term services and supports (LTSS) Inconsistent measurement of delivery system performance Volume-based payment Integrated systems that deliver whole person care Coordinated care and transitions Activated clients Optimal access to appropriate services Timely supports delay or divert need for Medicaid LTSS Standardized performance measurement with accountability for improved health outcomes Value-based payment 15

16 1,900,000 1,800,000 1,700,000 1,600,000 1,500,000 1,400,000 1,300,000 1,200,000 1,100,000 1,000, , , , , , , , , ,000 0 Washington has increased its Medicaid enrollment by 44%... More than 548,000 adults added through Medicaid expansion. Apple Health Enrollment June 2013 to May }

17 and the enrollees and their needs are different Before the Affordable Care Act, 60% of enrollees were children; now the majority of enrollees (55%) are adults. 22% of the new adult enrollees have a mental health diagnosis. 14% have a substance use disorder. And, while the new adult group has lower hospital admission rates than other non-disabled adults, their inpatient stays average 50% longer. Data provided by Research and Data Analysis, DSHS, June

18 There will soon be many more people age 65+ in our state... Source: Washington State Department of Social and Health Services, Research and Data Analysis Division 18

19 and their health care needs may increase as they age By 2035, the number of people age 75 or older will have risen by roughly 150%. Between 2010 and 2040, we anticipate a 181% increase in Medicaid clients over age 65 with Alzheimer s. 70% of people who reach the age of 65 are likely to need long term supports and services at some point in their lives. Biennial expenditures by the state for long term supports and services are currently $3.4 billion or 6 percent of all general fund spending. Data provided by Research and Data Analysis, DSHS, June

20 Goals: Triple Aim Reduce avoidable use of intensive services - such as acute care hospitals, nursing homes, psychiatric hospitals, and traditional long-term services and supports. Improve population health - with a focus on the prevention and management of diabetes and cardiovascular disease, obesity, smoking, mental illness, and substance abuse for Medicaid enrollees and communities. Accelerate the transition to value-based payment - so providers are paid for higher quality and improved health outcomes. Ensure that Medicaid cost growth is two percentage points lower than national trends. 20

21 Federal Requirements Five-year demonstration project - With year zero as opportunity for planning and startup. CMS must not spend more federal dollars with the waiver than they would have spent without the waiver Evaluation of waiver hypotheses - Technical assistance from CMS on evaluation design. Transformation must be sustainable after the demonstration period ends - The State and its partners must develop plans to sustain Medicaid transformation after federal waiver investments end. 21

22 Timeline 22

23 Stay informed Join the Healthier Washington Feedback Network: Send comments and questions about Medicaid Transformation to: Learn more about the Medicaid Transformation waiver at: n.aspx 23

24 Apple Health Updates 24

25 Post-Eligibility Review Update Less than 20% of the Medicaid population requires a post-eligibility review (reported family income is under Medicaid standard, but data match finds the family income to be over the Medicaid standard) Currently focusing on families active on N01(Family coverage) and N05 (Adult coverage) HCA completing roughly 10,000 reviews monthly 25

26 Post-Eligibility Review Update Current Results 32% of case are found to be correct; 22% are found incorrect; and 46% are already closed or failed to respond to a request for information New audit tool is in the works! Tool will decrease processing time and simplify process 26

27 Apple Health Churn Enrollment April 2015 May 2015 June 2015 July 2015 QHP to Medicaid (enrollees) QHP to Medicaid (percent) Medicaid to QHP (enrollees) Medicaid to QHP (percent) 1, % 0.58% 0.58% 0.61% 1,021 1, , % 0.09% 0.05% 0.07% 27

28 AEM Process Update Training Training webinar was delivered on 6/10 Covered updates for the AEM process for MAGI and Classic Medicaid Recorded webinar and presentation slides available HCA Training & Education web page: Significant decrease in processing time as of May

29 Open Enrollment Coming Soon! HBE Open Enrollment November 1, 2015 to January 31, 2016 For those applying for or renewing QHP coverage for

30 Apple Health Year-round Enrollment Washington Apple Health year-round enrollment! Apply for, renew or report changes for Apple Health coverage 30

31 Apple Health Reminders 31

32 Reporting Income in Healthplanfinder Ensure that you are assisting the client in reporting their correct gross monthly income on their Healthplanfinder application. Gross monthly income is the income earned before any taxes and deductions are taken out. 32

33 Reporting Income in Healthplanfinder Clients who are less than forthcoming in reporting their income will be audited through a post eligibility review and will be required to provide verification of their actual income. Reporting income that is not true or inaccurate is insurance fraud. 33

34 Designating an AREP for Apple Health Authorized Representative (AREP) A person or organization that is authorized by an applicant or recipient to act on behalf of him or her for Apple Health eligibility purposes. An AREP may: Obtain information needed to determine the applicant s or recipient s eligibility for Apple Health programs; and Obtain other information related to Apple Health coverage such as certification periods, renewals, changes, etc. 34

35 Responsibilities of an AREP Have a good-faith belief that the information he or she provides to the agency is correct. Act responsibly in assisting with an application and renewal of eligibility and other ongoing communications with the agency, while acting on behalf of the client. Report changes in circumstances as required under WAC

36 How to Designate an AREP Online application in Healthplanfinder Paper application HCA P MAGI HCA Classic AREP form DSHS (shared DSHS/HCA form) 36

37 Organizations as an AREP If a department within an organization is designated as an AREP for a client, other individuals within that department may also act as an AREP for that client. Individuals from other departments within that organization may not act as an AREP. Example: King County Public Health is a large organization with many departments. While any employee from the Access and Outreach department may be authorized to act as an AREP for a client, individuals from other departments within their organization (such as the West Nile Virus program) would not be authorized to act as an AREP for that client. 37

38 Share Your Apple Health Story 38

39 Share Your Apple Health Story Can you help? We re looking for individuals in Washington whose lives have changed for the better because they have Washington Apple Health coverage under the new MAGI eligibility families, children, pregnant women, and adults (especially younger adults). The Health Care Authority and the Health Benefit Exchange (which operates are working together to build a collection of these stories. 39

40 Share Your Apple Health Story With individuals permission, their testimonials could be featured on the Healthplanfinder or Health Care Authority website or in HCA s printed materials, or their stories and photos could appear on the Health Benefit Exchange corporate site under Share Your Story. 40

41 Share Your Apple Health Story The first step for anyone who is willing to publicly share their experience is to fill out the Share Your Story form at get-involved/share-yourstory/. 41

42 Resource & Contact Info 42

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44 Resource Information HCA Medical Assistance Customer Service Center HCA Medical Eligibility Determination Services us/contactus.aspx Cross-Agency Customer Support Center Desk Aid: 44

45 Additional Medicaid Resources HCA Training & Education Resources Cross-agency Desk Aid r_referrals.pdf HCA Community-Based Specialists _Contact.pdf Questions? Contact Us 45

46 Questions? 46