The Impact of Health Care Reform on Community Health Centers in Colorado. Kristen Pieper Policy Manager Colorado Community Health Network

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1 The Impact of Health Care Reform on Community Health Centers in Colorado Kristen Pieper Policy Manager Colorado Community Health Network

2 Presentation Topics Background information on CCHN, Colorado CHCs, and PPACA How Will Health Care Reform Impact Colorado CHCs? CHCs and the Medicaid Expansion CHCs and the Exchange CHC Challenges and Opportunities

3 What is CCHN? The Colorado Community Health Network (CCHN) is the membership association of the 18 federally qualified Community Health Centers (CHCs) in Colorado Since its inception in 1982, CCHN has made significant strides in ensuring that Colorado s low-income residents have access to affordable, high quality, primary health care

4 What is CCHN? CCHN: 1. Educates policy makers and stakeholders about the unique needs of CHCs and their patients; 2. Provides resources to ensure that CHCs are strong organizations; and 3. Supports CHCs in maintaining the highest quality care.

5 The 5 Pillars of CHCs 1. Serve all patients regardless of ability to pay for services; 2. Are located in high-need areas; 3. Provide comprehensive primary health care to patients; 4. Are governed by community boards 51% of board members must be patients; and 5. Operate as nonprofits or public agencies with a mission to provide health care to low-income, working families

6 Colorado CHCs Colorado CHCs provide a health care home to more than 600,000 of their community members over 1 in 10 people in the state 18 CHCs operate 152 clinic sites in 37 counties, and care for patients living in 59 of Colorado s 64 counties

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8 Colorado CHCs In 2012, Colorado CHCs provided more than 2 million medical, dental, and mental health visits Colorado CHCs care for: 1/3 of all Medicaid enrollees 1/4 of all Children s Health Insurance Program (CHIP) enrollees 1/3 of all the state s low-income uninsured

9 PPACA The Patient Protection and Affordable Care Act (PPACA), signed into law in March 2010, created the Health Center Trust Fund, expanded Medicaid eligibility, and established a framework for health insurance exchanges The Health Center Trust Fund provided $11 billion over 5 years to expand CHC operational capacity to serve about 20 million new patients Because of budget reductions, some of the trust fund has been used to backfill CHC annual appropriations

10 How Will Health Care Reform Impact Shifts in payer mix Colorado CHCs? Many currently uninsured Colorado CHC patients will gain Medicaid coverage 2012 Patient Mix Uninsured 39% Private 10% Medicare 7% CHP+ 4% Medicaid 40%

11 How Will Health Care Reform Impact Colorado CHCs? CHCs have a special interest in contracting with Exchange plans to ensure seamless care, and mitigate interruptions in care as Coloradans churn between Medicaid and Exchange plans Determine role in supporting patient enrollment Finances, billing, and other staffing needs

12 Medicaid Expansion On Jan. 1, 2014, all individuals under age 65 with incomes at or below 133% FPL will be eligible for Medicaid Supreme Court ruling stated that the federal government cannot require states to participate in the Medicaid expansion Federal government pays 100% of costs for newly eligible through 2016 Gradually reduced to 90% in 2020

13 CHCs and the Medicaid Expansion Senate Bill : Expand Medicaid Eligibility was signed by Governor Hickenlooper on May 13 Benefit design conversations happening between stakeholders and the Department of Health Care Policy and Financing CCHN wants the most robust benefits package possible while protecting CHC services and payment, and ensuring continuity of care for patients

14 CHCs and the Medicaid Expansion Colorado CHCs are the medical home for approximately 192,000 low-income uninsured Coloradans 113,000 of which CCHN estimates will be eligible for Medicaid in 2014 Governor s Office estimates that 160,000 people will be newly eligible for Medicaid CHCs already care for 71% of the estimated 160,000 individuals who will move into Medicaid in 2014

15 The Functions of the Exchange Provide individuals and small business employees with access to enrollment in Qualified Health Plans (QHPs) Certify QHPs and ensure compliance Operate a Small Business Health Options Program for small businesses Determine eligibility for premium tax credits and cost sharing reductions Operate a call center and website, and provide inperson assistance Establish navigator program Determine role of agents and brokers

16 Colorado s State-Based Exchange Senate Bill : Health Benefit Exchange established Connect for Health Colorado, formerly the Colorado Health Benefit Exchange Connect for Health Colorado launched a new website (www.connectforhealthco.com) and marketing campaign on May 6 Open enrollment begins Oct. 1, coverage in QHPs begins Jan. 1, 2014

17 CHCs and the Exchange: EHBs The Essential Health Benefits (EHBs) are the minimum requirements for coverage that plans offer in the individual and small group markets, both inside and outside the Exchange CHC services are not an EHB, but CHCs provide many of the services that qualify as EHBs

18 CHCs and the Exchange: EHBs Required categories are: Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral and vision care

19 CHCs and the Exchange: EHBs The federal government has proposed a benchmark approach as a transition for 2014 and 2015, to be reevaluated in 2016 If selected benchmark plan does not provide coverage in one or more of the EHB categories, it must be supplemented Colorado chose the largest small group plan, Kaiser Ded/CO HMO 1200D, for the EHB benchmark plan with the CHIP pediatric dental benefit

20 CHCs and the Exchange: Contracting with ECPs QHPs must have a sufficient number and geographic distribution of Essential Community Providers (ECPs) to ensure access for low-income, medically underserved individuals ECPs include CHCs and other 340B-eligible entities House Bill : Health Insurance Alignment Federal Law, signed by the Governor on May 13, gives the Insurance Commissioner the necessary authority to regulate health insurers with respect to the new requirements of PPACA

21 CHCs and the Exchange: Contracting with ECPs Exchange plans must pay CHCs a rate no less than their Medicaid Prospective Payment System (PPS) rate CHCs may agree to payment rates other than those under the Medicaid PPS, as long as the mutually agreed upon rates are at least equal to the generally applicable payments for ECPs Specific standards, enforcement, and monitoring of ongoing compliance are the responsibility of the Exchange

22 CHCs and the Exchange: Navigator Program Connect for Health Colorado s Connect for Health Assistance Network will fund and certify Assistance Sites across Colorado that can deliver local, in-person education and assistance with applying for and enrolling in health insurance coverage A majority of Colorado CHCs have applied to be Regional Hubs, Assistance Sites, and/or Health Coverage Guides Applications were due April 19 Funding will be disbursed July 1, and will continue through Dec. 31, 2014

23 CHCs and the Exchange: Other Funding Support On May 9, the Department of Health and Human Services announced an outreach and enrollment supplemental funding opportunity of $150 million for CHCs, with the possibility of $3 million in funding for Colorado CHCs Funding is meant to supplement and complement other outreach and enrollment work (navigator program, Medicaid, CHIP, etc.) Applications were due May 31

24 CHCs and the Exchange CCHN estimates that approximately 22,000 currently uninsured CHC patients will gain private insurance coverage in 2014 The Colorado Health Institute estimates that in 2016, 390,000 Coloradans will be uninsured statewide CCHN estimates that approximately 55,000 current CHC patients will be uninsured in 2014

25 CHC Challenges and Opportunities Determine role in supporting patient enrollment Contract with Exchange plans Understand changes and communicate them to patients Help patients understand benefits and how to use them Keep existing patients, attract new patients Get reimbursed for services provided Learn to bill new insurers Capacity Provider and physical space

26 Thank you! Questions? Kristen Pieper Policy Manager, CCHN (303)

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