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Jamerson.aafp slc 2013
- 1. Health Care Reform in the Commonwealth of Virginia Hunter W. Jamerson Macaulay & Burtch, P.C. Richmond, VA
- 2. Overview of Presentation Indoctrination into Virginia living Medicaid program fundamentals Breakdown of Virginia’s Medicaid Program Virginia’s health reform initiative Medicaid eligibility expansion debate A review of other exemplar states The path forward in Virginia What should family physicians think?
- 3. Welcome to the Commonwealth Red? Blue? Purple? Gerrymandered? Outgoing governor, election on Tuesday Very strong Hospital Association, Health Plan Association, and medical societies Heavy presence of Tea Party organizations and Americans For Prosperity
- 4. 2013 Legislative Session Budget stalemate over transportation and health care reform Enactment of 3-phase health care reform process Creation of the Medicaid Innovation and Reform Commission (“MIRC”) 6 House Members, 6 Senate members, 2 Cabinet Secretaries Majority of the members from each chamber must vote to support eligibility expansion
- 5. Medicaid Program Fundamentals Medicaid is a state program in the form of a state-federal partnership States operate Medicaid programs under federal law and regulations that define the terms and conditions for a state to receive federal matching funds States are entitled to federal Medicaid matching funds on all qualifying expenditures, as defined in: Medicaid state plan, including Any federally-approved waivers that allow expenditures that otherwise would not qualify
- 6. State Decisions but Federal Permission State Medicaid programs are designed and administered by state policy makers, within federal rules Each state Medicaid program is unique State programs vary based on state decisions on: Eligibility, provider payment levels, benefits and limits on benefits, cost sharing, delivery systems, use and types of managed care, quality requirements, special initiatives and innovations Decisions reflect state priorities, fiscal realities, health care systems, traditions and values
- 7. Virginia’s Medicaid Program Frugality through cost controls, public-private partnership, and innovation Initiatives to improve care and control costs through Virginia Medicaid; a few recent examples: Statewide managed care Development of a demonstration plan to integrate and coordinate care for dual Medicaid – Medicare eligible population Development of initiative to coordinate behavioral health services Working toward managed long term services and supports
- 8. Virginia’s Medicaid Program Today 700,000 Medicaid members 80% in managed care, 20% in traditional FFS Seven managed care plans (including 4 provider sponsored plans) All managed care plans are full-risk Existing Medicaid program = 21% of Virginia’s annual budget Cost drivers: FFS, LTC, ABD, Foster Care and Behavioral Health
- 9. Overview Estimate Details Key Assumptions Population Estimate Insurance Coverage of the Non-Elderly in Virginia 2009-2010 Individual 387,500 6% Medicaid 680,400 10% Other Public 369,200 5% Uninsured Employer 4,329,600 64% Uninsured Adults 875,300 13% Uninsured Children 154,700 2% Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2011 and 2012 Current Population Survey (CPS: Annual Social and Economic Supplements). 10
- 10. Overview Estimate Details Key Assumptions Population Estimate Insurance Coverage of the Non-Elderly in Virginia 2009-2010 395,300* 480,000 0-139% FPL > 139% FPL Uninsured Adults 875,300 13% Uninsured 104,700 Uninsured Children 154,700 50,000 0-200% FPL > 200% FPL *It is estimated that 195,000 adults fall between 0 – 100% FPL. Without a Medicaid expansion, these individuals would not be eligible for Medicaid or federal subsidies through the Exchange. Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2011 and 2012 Current Population Survey (CPS: Annual Social and Economic Supplements). 11
- 11. Overview Estimate Details Key Assumptions Population Estimate As a result of the ACA, Virginia estimates currently eligible children will enroll in Medicaid (“woodwork”). If Virginia coo ses to expand Medicaid, an estimated h additional currently eligible children would be expected to enroll in Medicaid and newly-eligible individuals would be likely to take up Medicaid coverage Children - "Initial Woodwork" 74,996 Children - Additional Woodwork "Buzz Factor" 7,500 TPL Adults 5,606 Disabled Adults 1,080 Caretaker Adults 66,204 Childless Adults 175,033 13
- 12. The Medicaid Expansion Debate Concern that federal government might not live up to its commitment for ongoing funding, due to its focus on federal debt Concern about local political backlash Concern about access and lack of providers to serve more Medicaid patients Concern that current Medicaid program can be improved and should be reformed first.
- 14. Virginia’s Health Care Reform Initiative Amendment to the 2013 Appropriations Bill handed down by the Governor during Veto Session Three-phase approach to reforming the existing Medicaid Program Many reforms will require CMS approval Reforms must either be completed or have a plan in place for completion prior to Virginia Medicaid requesting permission to expand
- 17. Status of Phase 1 Reforms Title Access to Veterans Benefits for Medicaid Recipients SFY14-16 Total Savings Minimal at this time Behavioral Health Services SFY14-16 Total Savings ($133,960,168) Progress Timeline/Updates • Assisting veterans to obtain benefits and avoid Medicaid expenditures when services are more appropriately funded by the Federal Government. • To establish the program -DMAS, VDVS and VDSS have together developed an MOU, interagency data transfer and internal procedures to get the program up and running. • Now transferring quarterly data match files with federal government to link applicants with federal services when available • December 2013: Implement strengthened regulations to improve integrity and quality • December 2013: Implement new Behavioral Health Services Administrator (Magellan) 8
- 21. Status of Phase 3 Reforms Title Progress Timeline/Target Date All Inclusive Coordinated Care for LTC Beneficiaries (coordinated delivery for all LTC services) July 2016 Statewide MedicareMedicaid (Duals) Coordinated Care, including children July 2018 12
- 22. Expansion Proposals in Other States Ohio – Governor Kasich has proposed program expansion driven by cost sharing for adults 100-133% of FPL Michigan – Governor Snyder has proposed full expansion through mandatory managed care enrollment and creation of a Health Savings Fund Indiana – Governor Pence has proposed an expansion of the Healthy Indiana Plan to encompass the newly eligible potential Medicaid population; driven by an HSA model
- 23. Expansion Proposals in Other States Arizona – Mandatory managed care for entire population; expansion tied to an 80% federal match sunset clause Iowa – Wellness Plan (ACO/PCMH model within Medicaid) and Marketplace Choice Plan (Exchange premium assistance) Arkansas – Premium assistance through commercial plans, cost sharing, HSAs
- 24. A Virginia Expansion Solution?
- 29. What Should Family Physicians Think? How much of your practice is Medicaid? What impedes you from taking more Medicaid patients? Does the existing program need overhaul before new patients are added? Is Medicaid Expansion a priority for you?
- 31. Questions?