Basic Health Program Workgroup
A "Straw Man" Proposal
- Presentation also available in Portable Document Format (PDF)
November 21, 2013
Office of Health Insurance Programs
NYS Department of Health
Agenda
- Introductions
- Elements of a BHP Proposal
- BHP Modeling
- Next Steps
Eligibility
- New York State resident
- Citizen or lawfully present non–citizen
- Under age 65
- Not eligible for Medicaid or Child Health Plus
- Income between 133% – 200% of FPL unless ineligible for Medicaid due to immigration status
- No access to affordable MEC
- MAGI Income and household size
Enrollment and Continuity of Coverage
- Continuous enrollment: Applicants can enroll all year long.
- Prospective coverage: Coverage is effective on the 1st of the following month with a 15th of the month cut off for applications (as it is in the Marketplace).
- Continuous eligibility (if permitted by CMS/IRS and funded within BHP allocations).
- Renewals will be twelve months from the initial determination.
- Verification follows Exchange rules.
Standard Plans
- Below 150% of FPL – offer Marketplace Standard Plan Silver CSR level (93–95% AV).
- 150 – 200% of FPL – offer Marketplace Standard Plan at Silver CSR Level (86–88% AV).
- Each of these benefit packages needs at least one variation.
- Issue a plan invitation in 2014.
Silver – CSR Versions | ||
---|---|---|
TYPE OF SERVICE | 150 – 200% FPL (AV = 0.86 to 0.88) |
100 – 150% FPL (AV = 0.93 to 0.95) |
Deductible (single) | $250 | $0 |
MAXIMUM OUT–OF–POCKET LIMIT (single) includes the deductible | $2,000 | 1,000 |
COST SHARING – MEDICAL SERVICES | $250 per admission | $100 per admission |
Outpatient Facility | $75 | $25 |
Surgeon | $75 | $25 |
PCP | $15 | $10 |
Specialist | $35 | $20 |
PT/OT/ST Therapies | $25 | $15 |
ER | $75 | $50 |
Ambulance | $75 | $50 |
Urgent Care | $50 | $30 |
DME/Medical Supplies | 10% of cost sharing | 5% of cost sharing |
Hearing Aids | 10% of cost sharing | 5% of cost sharing |
Eyewear | 10% of cost sharing | 5% of cost sharing |
Premium Contributions
Monthly Premiums | Maximum Monthly Premiums | |||
---|---|---|---|---|
Percentage of FLP | Medicaid | CHIP | BHP | (after APTC) |
<150% | $0 | $0 | $0 | $44 (138%) – $57 (150%) |
150–200% | NA | $9 | $30 | $57 (150%) – $121 (200%) |
Trust Fund
- The State shall establish a trust fund to receive federal payments for BHP.
- Trust Fund dollars can only be used to pay plan premiums; excess dollars can be used to reduce consumer premiums and cost–sharing, or to provide additional benefits.
Fund Administrative Costs
- System modifications
- Customer Service Center cost allocation
- Staff cost allocation
Effective Date
- Enrollment begins October 2015; system modifications prevent an October 2014 date.
- Are there advantages to allowing enrollment for Medicaid enrollees and the uninsured outside an open enrollment period? Is it permissible by CMS?
- Can QHP enrollees preserve their APTC if BHP is open for enrollment prior to a QHP open enrollment period?
Contingency
- Program is contingent on CMS approval of the blueprint
- Need flexibility to make modifications required by CMS during Blueprint negotiations
- No new costs to the State
- Must generate savings; and
- Administrative costs must be able to be funded from the savings.
Transition of QHP Enrollees
- QHP enrollees will transition to BHP at open enrollment.
- Medicaid enrollees will transition at renewal.
- How can we maximize coverage retention?
Other Considerations
- End APTC Premium Assistance Program when BHP coverage is effective.
- Immigrants that are eligible for BHP will no longer be eligible for Medicaid.
Urban Institute Modeling
- The Urban Institute will update their model and provide an analysis of BHP:
- Impact on State costs;
- Impact on Marketplace enrollment and premiums; and
- Impact on the uninsured.
Next Steps
- Next Meeting
- No Scheduled Meeting
- Questions? Please contact: Kalin Scott, kid01@health.state.ny.us or (518) 474–8141
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