New York Health Benefit Exchange
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1 New York Academy of Medicine New York s Emerging Health Exchange: What will it mean for cost, access and quality of care? Donna Frescatore Executive Director New York Health Benefit Exchange February 28, 2013
2 What is an Exchange? Organized marketplace Easily compare health plan options Makes available tax credits and cost-sharing subsidies Easily enroll in qualified health plans Two programs Individual Exchange Employer Exchange, which is called the Small Business Health Options Program, or SHOP
3 Functions of the Exchange Eligibility and Enrollment toll-free telephone hotline internet web portal for eligibility determination and enrollment Individuals SHOP electronic means to calculate the actual cost of coverage after individual tax credits and cost sharing reductions certify individuals as exempt from individual responsibility
4 Functions of the Exchange Certify Qualified Health Plans (QHPs) Make available qualified health plans and qualified dental plans to qualified individuals and employers Assign a quality rating and actuarial value to each qualified health plan offered through the Exchange Require QHPs to offer essential health benefits Ensure adequacy of plan networks
5 Implementation Impact of Exchange and Reforms in NY Full Implementation One million people will gain insurance Exchange enrollment is estimated to be 1.1 million people: Individual Exchange (58%) SHOP Exchange (42%) 450, ,000
6 Enrollee Characteristics, by Income Individual Exchange SHOP Exchange 14% 8% Under 138% FPL % FPL 12% 13% % FPL 40% 12% 24% 41% % FPL Above 400% FPL 13% 23% Source: Urban Institute, Characteristics of Nonelderly New Yorkers Likely to Enroll in the Health Insurance Exchanges Under the Affordable Care Act, February 2013.
7 Enrollee Characteristics, by Language Individual Exchange SHOP Exchange 37% English Other 35% 63% 65% Note: Includes enrollees over 5 years of age. Source: Urban Institute, Characteristics of Nonelderly New Yorkers Likely to Enroll in the Health Insurance Exchanges Under the Affordable Care Act, February 2013.
8 Enrollee Characteristics, by Language English Individual Exchange Spanish Chinese Hindi and related French 2% 2% 3% 2% 1% 9% Korean Russian Other 18% 63% Note: Includes enrollees over 5 years of age. Source: Urban Institute, Characteristics of Nonelderly New Yorkers Likely to Enroll in the Health Insurance Exchanges Under the Affordable Care Act, February 2013.
9 Impact of Exchange and Health Reform in NY Premiums decline in small group and individual market in all scenarios modeled $2.6 billion in federal tax credits per year for individuals and small businesses further reduce the cost of coverage
10 Illustration of Tax Credits for Individuals Source: Kaiser Family Foundation Subsidy Calculator Assumes Premium of $5,400/Year 2014 Income % FPL Estimated Annual Tax Credit Estimated Monthly Premium Percent of Income Single $17, % $4,742 $ % Single $28, % $2,565 $ % Single $40, % $ 954 $ %
11 SHOP the Value Propositions Choice Employers and Employees regard expanded choice as a key advantage to using the exchange. Administrative Simplicity The exchange provides monthly billing to employers among other administrative simplifications. Tax Credits The exchange will be the exclusive place to access small business tax credits in Defined Contribution 76% of respondents believe this feature helps predict costs. 11
12 Key Accomplishments to Date Awarded nearly $370 million in federal funds for Exchange establishment activities Established and convened five Regional Advisory Committees Conducted background research on key policy decisions Contracted with a System Integrator to build IT system Contracted with customer services organization Invited Health Plans to Participate in the Exchange Invited organizations to apply to be In-Person Assistors/Navigators Received conditional certification from HHS in December 2012
13 Exchange Policy Study Simulation Modeling Simulation Modeling: Coverage Impacts on a Sub-State Level Insurance Markets Market Merger & Group Size Reinsurance/Risk Adjustment Benefit Standardization Health Savings Accounts Policy Question How does the ACA impact coverage and costs in New York? What are the demographic characteristics of the uninsured who will enroll through the Exchange? What changes will need to be made in New York s insurance markets to align with the ACA? Should the Individual and small group markets be merged? Should small group be defined as 50? Should New York administer reinsurance and risk adjustment or defer to federal administration? Should plan offerings on the Exchange be standardized? Should Health Savings Accounts be offered on the Exchange? Completed studies available at: /resources
14 Exchange Policy Study Essential Health Benefits Medicaid Benchmark Benefits Continuation of: Healthy New York and Family Health Plus Employer Buy-In Basic Health Plan Small Business Health Options Program (SHOP) Third Party Assisters Health Disparities Policy Question What types of service should be covered by small group and individual insurance policies? What benefits should be covered for newly eligible adults in Medicaid? Should these programs be continued in 2014? Should New York opt for the Basic Health Plan for people up to 200 % of federal poverty level? How should the SHOP Exchange be designed to bring value to small business? What should be the role of brokers, agents and chambers of commerce in the Exchange? How can the Exchange be designed to help address health disparities? Completed studies available at: /resources
15 Goals Health Plan Invitation Released January 31, 2013 Offer comprehensive affordable, coverage in all areas of the State Balance innovation with reasonable choice Make it easy for consumers to compare options Ensure health plans have adequate networks Monitor health plan quality, utilization of services, and consumer satisfaction Preserve consumer protections, as defined in federal and state law and regulation Ensure consistency with the outside market 15
16 IPA/Navigator RFA Released February 13, 2013 Goals Ensure that all types of organizations permitted in federal rules are eligible to compete Provide grants to a diverse group of organizations that will provide high-quality enrollment assistance, in a manner that is linguistically and culturally appropriate to the populations being served One-Stop consumer assistance for Exchange, Medicaid and Child Health Plus coverage Ensure availability of assistors in all counties of the State Have IPA/Navigators ready to provide assistance at open enrollment, October 1,
17 Executive Order Issued - April 2012 NY completes HHS Design Review - October 2012 NY submits Blueprint to HHS November 2012 NY receives conditional certification from HHS to operate a state-based Exchange -December 2012 HHS conducts design review April 2013 Health Plans Selected for participation in July 2013 In-Person Assistor/Navigator Program begins September 2013 Customer Service opens for business September 2013 Applications accepted October 2013 Coverage starts January 2014 Exchange Timeline 17
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