The Idaho Private Option

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1 The Idaho Private Option Exploring Options for Medicaid Reform, Taxpayer Relief & Improved Public Safety Richard Armstrong Director Department of Health and Welfare April 2014

2 Today s Discussion 1. Private Option: A free market approach to provide medical coverage to low-income people through insurance exchange policies instead of government-provided coverage. 2. Medicaid: The vision vs. today s reality Idaho legislative discussions 2

3 Current Landscape of Coverage Through Exchange Original Affordable Care Act Offered tax credits to people earning between % of poverty. Required all states to enroll people earning less than 138% of poverty into their Medicaid programs. Supreme Court Ruling Tax credits remain for people earning % of poverty. States do not have to enroll low-income in Medicaid. Impact on Idaho Citizens People earning >100% poverty can get a tax credit. People earning <100% get nothing. 3

4 Low-income Options 77,000 Able-bodied Idaho adults with no insurance coverage options 130,000 Idaho adults purchase insurance policies w/tax credit $11,775 50% FPL Annual Income/Federal Poverty Level $23, % FPL $47, % FPL < $94, % FPL Family of Four Family of four insurance cost = $670/month Currently, family earning $11,775 (50% FPL) pays $670/month Same family earning $47,100 (200% FPL) pays $247/month Options Preserve government s role as safety net by not expanding traditional Medicaid Extend tax credit to all people below poverty to purchase private market insurance Level the playing field; everyone purchases the same healthcare coverage 4

5 Traditional Medicaid vs. Today s Reality Children w/special Health Needs People with Disabilities Low-income Elderly 68,000 people 179,000 people Idaho Medicaid 247,000 People Low-income, Pregnant Women Adults w/children Low-income, Healthy Children 5

6 Traditional Medicaid vs. Today s Reality Idaho Medicaid has grown from 37,000 people and an annual budget of $143 m. in 1990, to an estimated 247,000 people and a $2 billion budget today. Medicaid expanded to many low-income groups children, pregnant women, adults with children because there were no alternatives. 72% of Medicaid s enrollment now serves people who are eligible based on their income; they are not disabled, elderly or have special health needs. Allowing people to purchase private market health insurance restricts Medicaid coverage to its original intent a safety net for extremely vulnerable citizens. 6

7 Idaho Demographic Profile for Private Option For people with incomes below 138% of poverty; $15,860 for single adult/$32,500 for family of 4. Idaho adult uninsured= 20% to 25% Idaho projects 104,000 uninsured adults <138% of poverty; 77,000 <100% poverty Eligible participants shop in the portal to select and enroll in a high quality, affordable health plan that meets their specific needs at a competitive price. 7

8 The Private Option: A Free Market Approach Purchase qualified health plans from the insurance exchange for low-income adults who are not eligible for Medicaid. Use federal dollars to pay for premiums. Approved by CMS as demonstration projects in Arkansas and Iowa, with Pennsylvania nearing approval. All are pilot projects that cannot cost more than traditional Medicaid coverage. 8

9 Private Option Plans State pays insurer directly for premium costs. Premium payments are 100% federally funded until 2017, at which time state begins paying a 5% share. State share of premium costs increases in subsequent years, capping at 10% in Plans are silver metal level; there must be an option of two plans for participants to choose from. State applies medically fragile screening process. 9

10 Advantages of Private Option Significantly increases marketplace enrollees, better leveraging economies of scale: Encourages private carrier entry Expands service areas and access Results in more competitive pricing Reduces churn between Medicaid coverage and health plans on the exchange. 10

11 Advantages of Private Option Reduces cost shifting due to uncompensated, indigent care. Increases payments to providers for existing uninsured patients they currently treat. Could expand the number of providers participating in the state s payment and delivery system reform. 11

12 Medical Indigency: A Broken Program Program pays for post-incident care for individuals who cannot pay medical costs over a 5-year period. Counties pay first $11,000 in claims, with state paying remainder. SFY 2013 state/county combined costs = $53 m. Costs expected to escalate to $92 M. by Caseload = 5,300; avg. claim = $26,600 12

13 Costs of Indigency Program and ACA Requirements Offset by Private Option Independent actuarial analysis estimates state could save 90-95% of state and county indigency costs with Private Option coverage SFY indigent savings = $425.3 m. Estimated additional Medicaid costs due to ACA requirements and woodwork effect = $171.3 million SFY impact of Private Option that factors in both costs and savings = $102.9 m. savings State could save more than $100 million by 2020 while insuring 104,000 people through free market approach with Private Option 13

14 Questions?

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