chip advisory council 04 15 20 presentation w sk edits ... … · &29,' &+,3...

Children’s Health Insurance Program (CHIP)

Advisory Council Meeting

April 15, 2020

Agenda

• Welcome and Introductions

• COVID-19 CHIP Coverage and Guidance

• State Based Exchange

• CHIP by the Numbers

• Marketing Updates

• Policy Update

• Quality Assurance Updates

• Closing and Wrap-Up

2

Welcome and Introductions

3

COVID-19 and CHIP

Achievements to Date

• Waive copays for testing and treatment for COVID-19.

• Issued direction that families are not losing coverage.– Data fix to ensure continuation of coverage.

– Policy guidance 2020-05.

4

COVID-19 and CHIP

Achievements to Date

• Application Processing– CHIP is continuing to process applications.

– Reporting income changes and reassessment.

• CHIP Call Center– The CHIP Call center is responding to consumer inquiries.

– Callers should not experience a difference in their customer service experience.

5

COVID-19 CHIP Coverage and Guidance

• CHIP Disaster Relief State Plan Amendment– What is the Disaster Relief State Plan Amendment

– Flexibility descriptions• COVID-19 copay waiver

• Premium payment delays

• Renewal Due Date extension

• Self-Attestation

6


Guidance to Date

• Continuation of Coverage• MCOs are not terminating enrollees for failure to provide

renewal information, failure to pay premiums, failure to provide information regarding disability, or whereabouts unknown.

• Families are still responsible for premium payments.

• Families who experience financial hardship during this time should be assessed to see if income changes lower their premium payment or are appropriate for transfer to MA.

• MCOs are to work with families on payment plans for premiums

7


Guidance to Date

• Waiver of COVID-19 Copays• MCOs are waiving copays related to the testing, screening

and treatment of COVID-19

• Waiver of Prior Authorizations• MCOs are waiving prior authorizations related to the

testing, screening and treatment of COVID-19

• Early Refills Available• MCOs are authorizing enrollees to receive early refills of

non-opioid prescriptions

• Member Services• MCOs continue to serve members and take member

inquires during this time

8


Guidance to Date

• Self-Attestation• Applicants may utilize self-attestation of eligibility

information if they cannot provide documentation

• MCOs and CHIP will continue to review available electronic databases to verify eligibility information at application and renewal

• Applications and renewals must be signed to utilize self-attestation

• Enrollment prior to first premium payment• Children are being enrolled in CHIP at eligibility

• Premium payments still apply but may be collected after initial enrollment

9

State Based Exchange

Zachary ShermanExecutive Director,

Health Insurance Exchange Authority

Pennsylvania Health Insurance Exchange Authority

Pennsylvania Health Insurance Exchange AuthorityExecutive Director Zachary ShermanApril 15, 2020

Meeting Agenda

1. Exchange Authority Overview and Critical Milestones

2. Uninsured Data

Exchange Authority | 12


Overview of the Exchange Authority

13

2014: HealthCare.Gov (FFE) and state-based exchanges (SBE) launched to varying degrees of success

Initial availability of federal grant funding and enhanced matching funds for Medicaid programs led to large system integration approaches in many states

A few states failed to go-live effectively and transitioned back to the FFE

Many states, including PA, assessed the implementation risk as too high and deferred operational management to the federal government

2015 - 2018: States slowly began to transition from the FFE to SBE or a hybrid approach using the federal platform (SBE-FP)

Idaho successfully transitioned to a SBE from the FFE in 2015, declining to integrate with Medicaid or operate a small business exchange

AK, NM, NV and OR became SBM-FPs

2019 - 2020: Led by Nevada, more states decided to begin transitioning to SBEs

NV procured a vendor solution for technology and customer service and went live for Open Enrollment in November 2019

NJ, NM, OR and PA are transitioning to a SBE and taking similar approaches to NV with their procurements

History of State-Based ExchangesThe evolution of State-Based Exchanges over time


The mission of the Pennsylvania Health Insurance Exchange Authority is to improve the accessibility and affordability of individual market

health coverage for Pennsylvanians.

Our goal is to serve Pennsylvania’s individual health insurance market customers without disruption, operate a state-based exchange and support the needs of consumers purchasing health insurance while ensuring the stability and affordability of the health and dental offerings available through the Exchange Authority.

Who is the Exchange Authority?


A seamless transition A vendor solution that will stand up fully-functioning exchange technology

platform and customer service center on-time and on-budget

Successful conversion of existing customers to the state exchange system

Limited technical and operational disruption and change to community and insurer partners as well as the Department of Human Services

Higher quality access and customer service Accountability to Pennsylvanians looking to access subsidized and unsubsidized

individual market health insurance

Data reporting that is accurate and timely, and can respond to all stakeholder needs

Flexibility to accommodate changing operational and customer needs

Ability to better serve PA families churning between individual market and Medicaid

Lower costs and lower premiums Operation of the exchange at a significantly lower cost than current

Healthcare.Gov price-tag

Reduction of individual market premiums in 2021 by 5-10% through reinsurance

Strategic Goals

PHIEA | 16

Successful Implementation and Operations

Measures of Success

Strategic Goals

To date we have:

Been working diligently with our technology platform and customer service vendor

Begun testing the enrollment and eligibility system design

Engaged stakeholders – consumer advocates, producers, medical and dental insurers, legislators, business and community groups, Exchange Assister, etc.

Begun developing our brand

Established much of the infrastructure necessary to operate a new, self-sustaining entity

Progress against GoalsWhere we are today


Critical Milestones


JANDECNOVOCTSEPAUGJULJUNMAYAPRMARFEB2020 JAN

Call CenterRepresentative Training Begins

OEP Begins!

Call CenterOperational

Exchange Assisters and

Broker Training

2021 Plans Loading

Public Brand Launch

Customers are Auto-Renewed

Insurer Integration Starts 2/14

Launch of Outreach & Education Workgroup and Broker Workgroup

Medicaid Integration Complete 6/30

2021 Coverage Begins

Stakeholder and Customer OutreachPlatform

Call Center/training

Stakeholder Engagement continues


Overview of Pennsylvania’s Uninsured Population

19

There are over 12.5 million residents in the Commonwealth of Pennsylvania in 2018

Insured: 11.9 million (Through employer or government programs)

Uninsured: Nearly 700,000 (5.5% of the state’s population)

Adjusted to exclude uninsured undocumented immigrants and uninsured individuals with PA German ancestry, there are an estimated 607,000 uninsured residents, 4.8% of the population

Characteristics of the 607,000 uninsured and likely to be eligible and interested in enrolling

Income

28% are below 138% of the federal poverty level (FPL)

53% are between 138-400% of FPL

19% are at or above 400% of FPL

Demographics

67% identify as White alone (not Hispanic or Latinx)

14% identify as Hispanic or Latinx, nearly twice percent of population (7.6%)

14% identify as Black or African American, disproportionately higher than percent of population (11%)

Overview of the Uninsured in PA

Exchange Authority | 20Source: SHADAC analysis of the United States Census Bureau's American Community Survey (ACS).

52.0%

6.2%

15.4%17.5%

8.9%

54.6%

5.6%

14.6%

19.7%

5.5%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Employer Sponsored Individual Market Medicaid/CHIP Medicare Uninsured

Health Insurance by Coverage Type

United States Pennsylvania

Current Health Coverage LandscapeThe vast majority (94.5%) of PA residents had health insurance; over 60% through commercial insurance and ~34% through government programs


64,000

28,000

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

Number Uninsured by Group

Undocumented Immigrants German Ancestry

Uninsured and Unlikely to EnrollUndocumented immigrants are ineligible for exchange coverage; Amish and Mennonite populations have historically not enrolled in exchange coverage


34.9%

19.4%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

Uninsured as a Percentage of Population

Undocumented Immigrants German Ancestry

Source: SHADAC analysis of the United States Census Bureau's American Community Survey (ACS).

699,000

607,000

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

Number Uninsured Unadjusted vs. Adjusted

Uninsured Adjusted Uninsured

Uninsured and Likely EligibleAdjusted to exclude undocumented immigrants and residents with German ancestry, the likely eligible uninsured rate is 4.8%


5.5%

4.8%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

Percent Uninsured Unadjusted vs. Adjusted

Uninsured Adjusted Uninsured

Source: SHADAC analysis of the United States Census Bureau's American Community Survey (ACS).

167,000

317,000

113,000

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

<138% of thepoverty

threshold

138% to 399%of the poverty

threshold

At or above400% of the

povertythreshold

Total Uninsured by Income

Uninsured By IncomeThe majority (53%) of the uninsured are eligible for subsidized coverage through the Exchange; uninsured rate is highest for Medicaid eligible; kids in low-income households are 1.5x likelier to be uninsured


7.4%

6.4%

2.2%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

<138% of thepoverty threshold

138% to 399% ofthe povertythreshold

At or above400% of the

poverty threshold

Uninsured as a Percentage Total Population by Income

Notes: Uninsured has been adjusted to exclude uninsured undocumented immigrants (likely ineligible for ACA coverage) and uninsured individuals who indicate Pennsylvania German ancestry. Civilian noninstitutionalized population.Sources: SHADAC analysis of the United States Census Bureau's American Community Survey (ACS).Pennsylvania Partnerships for Children, State of Children’s Health Care – October 2019

Emphasis on Financial Assistance Individuals between 100-400% of the Federal Poverty Level (FPL) are eligible for advance premium tax credits (APTC) through the exchange

Exchange Authority | 25Source: ASPE – Coverage year 2020

Salary

317,000 uninsured individuals are eligible for financial assistance.

$17,236 $23,336

$29,435 $35,535

$49,960

$67,640

$85,320

$103,000

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

Single 2 3 4

100% FPL 138% FPL 400% FPL

Household Income by FPL

5.0%

4.1%

8.8%

10.4%

8.4%

6.4%

4.7%

0.4% 0.3%0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

Under 6years

6 to 18years

19 to 25years

26 to 34years

35 to 44years

45 to 54years

55 to 64years

65 to 74years

75 yearsand older

PA Uninsured by Number and Percentage

Uninsured Percentage Uninsured Number

Age Demographics of the UninsuredFive percent of children under six years of age are uninsured; Approximately 124,000 children under 19 are uninsured statewide


40 Percent of Pennsylvania’s Uninsured Kids Live in Five CountiesLancaster, Allegheny, Berks, Chester and Philadelphia counties have the highest uninsured rate for children


Source: Pennsylvania Partnerships for Children, State of Children’s Health Care – October 2019

Where do the uninsured live?Five counties (Chester, Delaware, Lancaster, Montgomery and Philadelphia) in the southeast make up 36.6% of the uninsured


Notes: Uninsured has been adjusted to exclude uninsured undocumented immigrants (likely ineligible for ACA coverage) and uninsured individualswho indicate Pennsylvania German ancestry. Civilian noninstitutionalized population.Source: SHADAC analysis of the United States Census Bureau's American Community Survey (ACS).

WAY2,433

WYO1,065

LAC7,958

ELK814

VEN2,909

FOR94 CAME

114 PIK2,549LYC

5,372

SUL409

MER5,827 CLI

2,437CLA2,593

LUZ12,778JEF

2,648COL2,273

CEN6,767

CLE3,528

MONROE9,062

NORTHUMBERLAND3,996

BUT5,623

ARM2,667

MONTOUR749UNI

3,457CAR2,381

LAW3,810

NORTHAMPTON11,655SCH

6,219IND6,071

SNY3,871BEA

6,327MIF4,458

LEH16,924

BLA5,373

HUN1,795

CAMB4,991

JUN1,989 BER

19,483

WES11,221

ALL43,514

DAU12,106PER

3,334BUC

18,851LEB10,296

WAS6,992

MONTG21,022

BED2,932

CUM10,993 LAN

52,785

FRA12,027

SOM4,305

CHE20,651

YOR19,802FUL

858

FAY5,860

PHI104,860

ADA4,569

DEL22,836

GRE1,568

ERI12,149

BRA3,442TIO

2,682

WAR1,744

SUS2,451MCK

1,592 POT1,023CRA

6,693

<5k

5-10k

10-20k

20-50k

>50k

Legend

Where are the highest uninsured rates?Lancaster County’s uninsured rate is the highest; several Central PA counties have higher than average rates


Notes: Uninsured has been adjusted to exclude uninsured undocumented immigrants (likely ineligible for ACA coverage) and uninsured individuals who indicate Pennsylvania German ancestry. Civilian noninstitutionalized population.Source: SHADAC analysis of the United States Census Bureau's American Community Survey (ACS).

WAY5.1

WYO3.9

LAC3.8

ELK2.7

VEN5.6

FOR2.9 CAME

2.4 PIK4.6LYC

4.8

SUL6.8

MER5.4 CLI

6.3CLA6.7

LUZ4.1JEF

6.1COL3.5

CEN4.3

CLE4.7

MONROE5.4

NORTHUMBERLAND4.5

BUT3.0

ARM4.1

MONTOUR4.2UNI

8.7CAR3.8

LAW4.4

NORTHAMPTON3.9SCH

4.6IND7.2

SNY9.6BEA

3.8MIF9.7

LEH4.7

BLA4.4

HUN4.3

CAMB3.8

JUN8.2 BER

4.7

WES3.2

ALL3.6

DAU4.5PER

7.3BUC3.0LEB

7.5

WAS3.4

MONTG2.6

BED6.1

CUM4.6 LAN

9.9

FRA7.9

SOM6.1

CHE4.0

YOR4.5FUL

5.9

FAY4.5

PHI6.7

ADA4.5

DEL4.1

GRE4.5

ERI4.5

BRA5.7TIO

6.6

WAR4.4

SUS6.0MCK

4.0 POT6.1CRA

7.9

<3%

3-5%

5-7%

7-8%

>9%

Legend


Questions?

30

THANK [email protected]


CHIP by the Numbers

CHIP Enrollment

33

178,000

179,000

180,000

181,000

182,000

183,000

184,000

185,000

186,000

187,000

Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20

180,970

181,385

182,971

183,564 183,431

184,333

184,812

183,072

184,912

185,553

185,959 186,093 186,191

CHIP Enrollment

MG18C Children

CHIP Enrollment Ages 0 to 4 TOTAL

July 2019 27,957

August 2019 28,121

September 2019 28,191

October 2019 27,939

November 2019 28,076

December 2019 28,069

January 2020 28,130

February 2020 28,250

34

MG18C Children TOTAL

July 2019 1,430

August 2019 1,558

September 2019 1,339

October 2019 1,742

November 2019 1,314

December 2019 1,575

January 2020 977

February 2020 1,040

• MG18C refers to MA Children age 0-4 that remain in MA until their renewal date when their family is over the MA income limits.

CHIP Successful Renewals

35

84%

94%97%

94% 95%

52%

72% 73%75%

85%

49%

65%69%

73%

83%

48%

66%70%

75%

84%

0%

20%

40%

60%

80%

100%

120%

Free Sub1 Sub2 Sub3 At Cost

CHIP Successful Renewals

Dec-19 Jan-20 Feb-20 Mar-20

Processing Times for CHIP Applications

36

Customer Calls to the CHIP Call Center

37

1-800-986-KIDS Calls Received

4,485 4,525

3,888

4,571

5,377

4,227

0

1000

2000

3000

4000

5000

6000

7000

September 2019 October 2019 November 2019 December 2019 January 2020 February 2020

38

CHIP Call Center Metrics (continued)

38

Apply Over the Phone:Completed Applications

567543

518

432447

518

020406080

100120140160180200220240260280300320340360380400420440460480500520540560580

August 2019 September 2019 October 2019 November 2019 December 2019 January 2020

Policy Updates

Policy Updates

40

Quality Assurance Updates

Encounter Data Validation

EQR Technical Reports

42

Quality Assurance (QA) Updates

Questions?

43

Closing and Wrap Up

• Topics of discussion for next meeting?

• Next Advisory Council meetings:• Wednesday, October 14, 2020

44

chip advisory council 04 15 20 presentation w sk edits ... … · &29,' &+,3...

Documents