Delaware HRSA State Planning Grant

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Delaware HRSA State Planning Grant Alice
Burton, Director AcademyHealth December 2, 2004
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Presentation

• HRSA pilot grants are helping states to further
  develop coverage strategies
• Broad range of state initiatives meet different
  needs
• You are not alone - there are resources to help
  states move through planning and policy analysis
  process

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HRSA Update

• Fiscal Year (FY) 2004, HRSA has awarded more than
  13 million through
• 9 new state planning grants
• 17 continuation planning grants
• 9 pilot project planning grantswhich are new
  this year.

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Pilot Project Planning Grants

• Pilot grants are providing funds to states that
  have already developed policy options through
  state planning grant funds to enable them to
• Plan for the implementation of a specific policy
  option(s) on which consensus has been reached
• Test a particular option in one or more areas
  and/or for a specific population in the state or
  territory and
• Implement a plan that will cover a significant
  portion of the uninsured.

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Pilot Project Planning Grants, cont.

• Nine FY2004 Recipients
• Connecticut, Delaware, Georgia, Illinois,
  Indiana, Kansas, Oklahoma, the U.S. Virgin
  Islands, and West Virginia

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Connecticut Pilot Grant

• Two different approaches
• -Provide premium assistance targeted to
  low-income workers in firms that already offer
  coverage and
• - Implement a small employer health insurance
  subsidy pilot targeted to small firms that do
  not currently offer coverage.

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Georgia Pilot Grant

• Will implement separate pilots in four
  communities.
• Exploring several options, including a
  three-share pilot program and another pilot that
  will partner with commercial insurers to reduce
  costs to a target population.

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Indiana Pilot Grant

• The project team intends to create a small
  business pool coupled with an employer/employee
  buy-in and premium-assistance program.

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Illinois/Kansas/Oklahoma Pilots

• INDIANA - looking into contracting with an
  actuary to develop a three-share program in two
  counties.
• KANSAS - exploring the option of reinsurance and
  planning a pilot to modify how to model tax
  credits to employers.
• OKLAHOMA - considering creating a small group
  purchasing pool with their grant funds.

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U.S. Virgin Islands Pilot Grant

• Plans to develop an association health plan as a
  purchasing collaborative. In the process, they
  will develop a comprehensive Preferred Provider
  Organization (PPO) network, implement effective
  disease management in the PPO, increase Medicaid
  enrollment, and continue to analyze the costs of
  uncompensated care.

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West Virginia Pilot Grant

• Developing options to offer affordable health
  insurance to the pre-Medicare population (aged 50
  to 64), specifically those who have lost and are
  at risk of losing their retiree benefits.

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Strategies to expand coverage

• Expanding Medicaid and SCHIP to new populations
• New models for Medicaid/SCHIP and private sector
  partnerships
• Making new private insurance options more
  affordable
• Mandates
• Comprehensive (access, cost and quality)
  approaches

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New options for Medicaid coverage

• SCHIP (1997)
• 1115 waivers and HIFA (2001)
• Breast and Cervical Cancer (2000)
• 50 states (including DC)
• Ticket to Work Working individuals with
  disabilities (2001 Medicaid expansion)
• 32 states, some states with no income limit

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States with expanded coverage for parents through
Medicaid
AK
WA
ME
MT
ND
MN
OR
VT
NH
ID
WI
SD
NY
MA
MI
CT
WY
RI
IA
PA
NE
NJ
NV
OH
IN
MD
IL
DE

UT
WV
CO
KS
VA
CA
MO
KY
NC

TN
AZ
OK
NM
AR
SC
0 49 FPL 50 - 99 FPL 100
199 FPL 200 FPL no new
enrollment or capped enrollment
MS
AL
GA
LA
TX
FL
Program not implemented
HI
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States that cover childless adults through
Medicaid
AK
WA
ME
MT
ND
MN
OR
VT
NH
ID
WI
MA
SD
NY
MI
CT
WY
RI
IA
PA
NE
NJ
NV
OH
IN
MD
IL
DE
UT
WV
CO
KS
VA
CA
MO
KY
NC

TN
AZ
OK
NM
AR
SC
no coverage under 100 FPL 100
199 FPL 200 FPL and greater no new
enrollment or capped enrollment
MS
AL
GA
LA
TX
FL
Program not implemented
HI
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New approaches to benefits and cost sharing

• Fewer benefits for higher income groups
• Primary care programs
• Pharmacy Plus Rx only benefits
• Cost-sharing

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One states example of redesigning Medicaid
benefits for new populations
Medicaid SCHIP Benefits
Inpatient Services Outpatient Services
Physician Specialty Services Prescription
Drugs OT, PT, ST, DME Supplies (prosthetics
orthotics) Lab X-ray Emergent Urgent
Care Home Health Mental Health Substance Abuse
(limits for adults)
Increased Benefits
Expansion Benefits
Inpatient Outpatient Services Physician
Specialty Services Prescription Drugs OT, PT,
ST DME Supplies (prosthetics orthotics) Lab
X-ray Emergent Urgent Care Home Health Mental
Health Substance Abuse
Podiatry Dental Optometry Eyeglasses Long Term
Care - ICFMR/Nursing Home/Pre-PACE Personal Care
Home Nursing for Children EPSDT Early
Intervention Nutrition Targeted Case
Management Hospice Transportation Lodging
No Annual Maximum
100,000 Annual Maximum
Some limits on services offered
Service limits based on medical necessity
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Private sector partnerships

• Meet a broad set of policy political goals
• Current models pay the employees contribution
  for qualifying employer sponsored insurance when
  it is cost-effective
• 14 states, just over 50,000 enrolled out of over
  50 million enrolled in Medicaid and SCHIP
• Newer models create a new product, targeting
  working uninsured
• Target either employer or employees

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What is the problem you are trying to solve?
Small portion of workers decline ESI.
SOURCE Kaiser Comissionon Medicaid and
Uninsured, Key Facts, December 2003
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Making new private insurance options more
affordable Healthy New York

• Eligibility Small firms w/ low-wage workers, low
  income self-employed, uninsured workers w/o
  access to ESI
• Reduced premiums through
• Stop-loss fund state pays 90 claims 5k-75k
• Streamlined benefits, in-network only
• High cost-sharing
• Commercial insurance product that state requires
  all HMOs to offer

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Making new private insurance options more
affordable West Virginia

• Eligibility Firms w/2-50 employees
• Minimum employer contribution of 50, 75 of
  eligible employees must participate
• Allows carriers to access State Employees'
  reimbursement rates and drug purchasing plan

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New benefit designs

• Limited benefits (mandate-lite)
• Continued interest despite low enrollment
• Popular benefits often drive rates
• High deductible health plans
• Consumer directed health plans

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Mandating health insurance

• Employer mandates
• Several states have considered, only 1 with law
  on the books
• Hawaiis Prepaid Health Care Act 30 years old
  this year
• Californias Health Insurance Act of 2003
  defeated in 2004 referendum
• Individual mandates
• States have talked about, but none have enacted

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Comprehensive Models Maines Dirigo Health

• Voluntary program addressing cost, quality and
  access
• Dirigo Health Insurance (DHI)
• Offered to small business (lt50 workers),
  self-employed, workers without offered coverage,
  low-income in large firms
• MaineCare (Medicaid) expansion
• 200 FPL for parents 125 FPL for childless
  adults sliding scale subsidies to 300 FPL

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Maines Dirigo Health

• Cost containment
• CON moratorium
• Voluntary limits on operating margins
• Required electronic claims submission by 2005
• Price disclosure
• Savings offset payment on carriers from UC
  savings (capped at 4)
• Maine Quality Forum created
• Enrollment begins October 1, 2004 Anticipated
  start date January 1, 2005

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Help available from AcademyHealth
RWJFs State Coverage Initiatives Program
(SCI)
TA
AcademyHealth State Health Policy Group
STATES TERRITORIES
Contract with HRSA to provide TA to SPGs
TA
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• State Coverage Initiatives (SCI)
• Initiative of The Robert Wood Johnson Foundation
• Direct Technical Assistance (TA) available to all
  states
• Meetings
• Small group consultations on specific issues
• Publications
• Statecoverage.net
• Grants

• SPG Contract with HRSA
• Site visits
• Share lessons from other states
• Options development
• Guidance for advisory committees
• Final report guidance
• Maintain Web page with SPG reports

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How Can We Help?

• AcademyHealth is available over the phone or
  onsite for assistance
• Ongoing support Thinking through preliminary
  ideas, lit. searches, contacts in other states,
  suggestions on experts, etc.
• Kicking off policy process for steering committee
  
• Education of steering committee on coverage
  options, other state SPG activities
• Facilitation of stakeholder meetings to decide on
  coverage options
• Assistance with evaluating options and narrowing
  recommendations

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http//statecoverage.net

• State Reports
• State Coverage Matrix
• About Coverage
• Grants - HRSA SPG page
• SCI Publications
• St_at_teside monthly e-newsletter

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