Maryland Medicaid Expansion

Size: px

Start display at page:

Download "Maryland Medicaid Expansion"

Godwin Hancock
8 years ago
Views:

1 Maryland Medicaid Expansin Alice Middletn Medicaid Planning Administratin May 14,

2 Overview f MEDICAID CURRENTLY 2

3 Maryland Medicaid Currently In Maryland, Medicaid is als called Medical Assistance (MA) Began in 1966 Mandated Medicaid cverage fr: Lw-incme families with children and thse wh receive Temprary Cash Assistance (TCA) Supplemental Security Incme (SSI) recipients Peple with lng-term services and supprts (LTSS) needs (the aged, blind, and peple with disabilities) Lw-incme Medicare beneficiaries (payment f Medicare premiums, deductibles, and cst-sharing) 3

Supplemental Security Incme (SSI) recipients Peple with lng-term services and supprts (LTSS) needs (the aged,

4 Wh Is Cvered under Medicaid Nw? Families with incmes less than 116% f the federal pverty level (FPL) get health care thrugh the Medical Assistance fr Families (MA4F) prgram. Adults withut dependent children, wh have incmes less than 116% FPL, can get health care thrugh the Primary Adult Care (PAC) prgram. Benefits limited t primary care, mental health, substance abuse, ER, and pharmacy Children in families with incmes belw 300% FPL can get health care thrugh the Maryland Children s Health Prgram (MCHP). MCHP Premium charges a mnthly family premium fr families between 200% and 300% f FPL: - $50 per family with incmes % - $63 per family with incmes % Pregnant wmen with incmes up t 250% FPL are cvered under Medical Assistance. 4

Benefits limited t primary care, mental health, substance abuse, ER, and pharmacy Children in families with incmes belw 300% FPL can get health care thrugh the Maryland Children s Health

5 What Is HealthChice? Under HealthChice, Maryland requires mst Medicaid beneficiaries, including individuals with disabilities and children in fster care, t enrll in 1 f 8 Managed Care Organizatins (MCOs) The MCOs accept full financial risk fr a prescribed benefit package Abut 1/3 f the services are carved ut (such as mental health services, LTSS, dental, and certain drugs) 5

disabilities and children in fster care, t enrll in 1 f 8 Managed Care Organizatins (MCOs) The

6 The Eight HealthChice Prviders Amerigrup Cmmunity Care Cventry JAI Medical Systems Maryland Physicians Care MedStar Pririty Partners Riverside Healthcare United Health Care 6

7 Basics f MEDICAID EXPANSION 7

8 Supreme Curt s Ruling n the ACA Upheld mst f the law, including the individual mandate that everyne must have insurance by cncluding the penalty fr nt having it can be cnsidered a tax Struck dwn the requirement that states expand Medicaid t all peple under 133% FPL Invalidated financial penalties states wuld face fr nt expanding States can still chse t expand Des nt impact Maryland because Gvernr O Malley decided t fully implement health care refrm prir t ruling, regardless f whether it was struck dwn r nt. Therefre, Maryland will expand Medicaid. 8

Invalidated financial penalties states wuld face fr nt expanding States can still chse t expand Des nt impact Maryland because Gvernr O

9 Greater Accessibility t Insurance Applicants will be able t apply nline, by phne, mail, r in-persn at existing and new lcatins. Data frm the IRS, Scial Security Administratin, and ther state and federal data surces will be available; n paper verificatin will be necessary when the infrmatin is already available. In fact, many data fields will pre-ppulate based n available data. 9

Data frm the IRS, Scial Security Administratin, and ther state and federal data surces will be

10 Simplified Eligibility Determinatins Beginning in 2014, many eligibility categries will be cllapsed. Eligibility fr mst peple will be based n Mdified Adjusted Grss Incme (MAGI). This is a federal standard, linked t tax methds. All states will use the same methd. Medicaid (in mst eligibility categries) and the Maryland Health Benefit Exchange (MHBE) will use the same methd. This methd is nt applied t disability and LTSS grups; fr thse grups, the existing rules are used. 10

This is a federal standard, linked t tax methds. All states will use the same methd.

11 Real-Time Determinatins Starting in 2014, eligibility wrkers will use the new eligibility system and web prtal, the Maryland Health Cnnectin, when wrking with the Medicaid ppulatin. Eligibility will be determined in real-time, and individuals will be able t enrll in a Medicaid MCO right away. Peple can still apply in-persn at lcal ffices. Medicaid and the MHBE will jintly utilize a statewide call center called the Cnslidated Services Center and Navigatr/enrllment brkers as shared services fr assistance. 11

Eligibility will be determined in real-time, and individuals will be able t enrll in a Medicaid MCO right away.

12 Number f Enrllees Impact n Maryland Medicaid The expansin is estimated t expand full cverage Medicaid t 190,000 Marylanders by ,200,000 Medicaid Enrllment with and withut ACA 1,000, , , , , Year 12

2020. 1,200,000 Medicaid Enrllment with and withut ACA 1,000,000

13 Medicaid Expansin In 2014, apprximately 88,000 PAC enrllees and 20,000 individuals new t Medicaid will be eligible fr full benefits. Maryland currently prvides childless adults a limited benefits package at a 50/50 match thrugh PAC. In 2014, these enrllees will be autmatically enrlled int full Medicaid. Therefre, it is imprtant t enrll as many peple as are eligible int PAC nw s they will autmatically receive full benefits n January 1, Children in families with incmes belw 300% FPL will still qualify fr Maryland Children s Health Prgram (MCHP). MCHP Premium will still charge families a premium if they are between 200% - 300% FPL. Pregnant wmen with incmes up t 250% FPL will still als be cvered under Medicaid. 13

Therefre, it is imprtant t enrll as many peple as are eligible int PAC nw s they will autmatically receive full benefits n January 1, 2014.

14 % f Federal Pverty Level (FPL) Pregnant Wmen Maryland Medical Assistance Cverage Based n MAGI and APTC/CSR thrugh the Exchange Advance Premium Tax Credits (APTC) & Cst Sharing Reductins (CSR) t Purchase Cverage Thrugh the Exchange MCHP Premium MCHP Medicaid Pverty Level: 1 persn = $11,490 2 persns =$15,510 4 persns = $23,550 As f April 2013 Age (Cverage effective 01/01/14) 14

Cverage Thrugh the Exchange 300 250 MCHP Premium 250 200 185 200 138 MCHP 138 100 Medicaid 100 0 0 1 6 19 65

15 Savings fr Maryland Maryland will receive an enhanced federal match fr newly eligible adults. The federal gvernment will finance 100% f the csts f cvering the Medicaid expansin ppulatin frm 2014 thrugh The funds will then begin t taper dwn until it reaches a 90/10 match in 2020 (90% federal funds, 10% state funds), where it will remain indefinitely. Cnverting PAC frm a 50/50 match rate t the enhanced expansin match rate will save the Medicaid prgram a substantial amunt f mney. Annual savings will decline as the state s share f the expansin cst grws. The cumulative ttal will be $725 millin between 2012 t

The funds will then begin t taper dwn until it reaches a 90/10 match in 2020 (90% federal funds, 10% state funds), where it will remain indefinitely.

16 Alice Middletn Deputy Directr, Medicaid Planning Administratin 16

Health Care Reform: The New Law

Health Care Reform: The New Law Health Care Refrm: The New Law Prfessr Sidney D. Watsn April 7, 2010 On March 23, 2010 President Obama signed int law the Patient Prtectin and Affrdable Care Act (H.R. 3590). On March 29, the President