Health Insurance Exchange Summit West November 4, 2013

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1 Health Insurance Exchange Summit West November 4, 2013 Rene Mollow, Deputy Director Health Care Benefits and Eligibility Department of Health Care Services

2 California History 2010 Patient Protection and Affordability Care Act (ACA) enacted at federal level Assembly Bill 1602 (Perez, Chapter 655) and Senate Bill 900 (Alquist, Chapter 659) jointly enacted the ACA and created Covered California Assembly Bill 1296 (Bonilla, Chapter 641) established the Health Care Eligibility, Enrollment, and Retention Act Assembly Bill X1 1 (Perez, Chapter 3) and Senate Bill x1 1 (Hernandez and Steinberg, Chapter 4) enacts the Medicaid ACA provisions and additional coordination efforts between the Department of Health Care Services and Covered California.

3 Mission and Vision Covered California Covered California is an independent public entity within state government with a five member board appointed by the Governor and the Legislature MISSION Increase insured Californians Improve health care quality Lower costs Innovative, competitive marketplace Choice and value VISION Improve the health of all Californians Access affordable care Provide high quality care

4 Mission and Vision Department of Health Care Services The Department of Health Care Services is the single state agency which administers California s Medicaid program known as Medi Cal MISSION Provide Californians with access to affordable, high quality health care, including medical, dental, mental health, substance use treatment services, and long term care VISION Preserve and improve the physical and mental health of all Californians CORE VALUES Integrity, Service, Accountability, and Innovation

5 Coordination Snapshot: Eligibility Benefits Marketing 9

6 Eligible if: A U.S. Citizen, U.S. National, or a noncitizen who is Lawfully Present in the U.S.; For Medi-Cal, immigration status only effects the scope of service (e.g. emergency room only or pregnancy only ) A California Resident; AND Not incarcerated, other than incarceration pending the disposition (judgment) of charges. Except Medi-Cal Inmate Eligibility Program

7 Eligible for Premium Assistance and Cost-Sharing Subsidies in Covered California if: Purchase coverage through Covered California; Under certain income requirements; AND Not eligible for Minimum Essential Coverage (i.e. Medi-Cal, Medicare, or coverage through an employer that is affordable).

8 What are you eligible for? 138% FPL Low or No Cost Medi-Cal Covered California Over 138% FPL to 400% FPL Over 138% FPL to 250% FPL Over 250% FPL to 400% FPL Adults: Covered California Premium Assistance + Enhanced Benefits* *Must enroll in a Silver-level plan to receive enhanced benefits Covered California Premium Assistance with Standard Benefits Children: Low or No Cost Medi-Cal* Up to 266% FPL Over 400% FPL Option for Covered California with Standard Benefits and Prices

9 The Essential Health Benefits

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11 Covered California Health Plan Essential Health Benefits Standard Benefit Design All Covered California Health Plans cover the same health care services Benefit plans have different levels of cost sharing with the consumer through copays, deductibles, and coinsurance

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13 How to use the Shop and Compare Tool At home on your computer On your tablet from the Apple or Google app store On your phone from the Apple or Google app store

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16 Key Tips for Success Establish common mission and/or vision Have buyoff of key policy makers Governor, Legislature, Administration Statutory/regulatory requirements Create executive management collaboration with key players: Project management Joint meetings policy, technical Engagement of key leaders within each organization Issue resolution processes Establish process for effective decision making resolve to the mutual interest of both parties; flexibility is critical Collaborate with key external partners from day one Create and maintain effective lines of communication critical to hear issues, identify potential solutions; avoid repeating past mistakes; and use joint messaging wherever possible Keep sight of the end goal at the forefront of all that undertaken