The Affordable Care Act & Access to Health Care Along the Gulf: A Symposium

“State-Specific ACA Rollout”

Alliance Institute ~ PanAmerican Life Conference Center

November 15, 2013

Robert M. Pugh, MPH Executive Director

Mississippi Primary Health Care Association (MPHCA)6400 Lakeover Road, Suite A

Jackson, MS 39213

About MPHCA and member organizations MS CHCs (Patients and Utilization) BP Deep Water Horizon MS counties (Coastal

Community Health Center patients and utilization)

Overview of ACA/MS Rollout and Insurance Market Place

MS Outreach & Enrollment, funding, staffing and impact/activities

Health Insurance Marketplace websites and other information

Presentation Topics

MPHCA’s MISSION is to support its members in a collaborative effort to advocate for the provision of equal access to quality, comprehensive primary health care services and the elimination of health disparities in Mississippi.

501(c)(6) Nonprofit, Membership Organization (chartered in 1986)

Organizational Members: Community Health Centers (CHCs) ◦ Typically referred to as Federally Qualified Health Centers

(FQHCs)

Other memberships include: Associate Members, Business Members & Individual Members

About MPHCA and Member Organizations

CHC Historical Overview ◦ Proud History ◦ Largest National Network ◦ Record of Achievement ◦ Bipartisan Support

Federal Law Requirements◦ Non-Profit/Public◦ Volunteer Board◦ Comprehensive Services◦ Sliding Fee Scale◦ MUA/HPSA◦ Federal Reporting Requirements◦ Programmatic (Clinical and Financial Performance)

About MPHCA and Member Organizations (cont.)

21 Organizations

Over 1600 FTEs

Approx. 166 Sites

◦ Primary care clinics

◦ OB/GYN, Pediatrics

◦ Dental clinics

◦ School-based clinics

◦ Mobile medical units

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CHCs in Mississippi

Source: 2012 UDS Data

894,772 visits annually Over 249,000 (82%) live at or below 200% FPL Over 128,000 (42%) are uninsured Over 84,000 (28%) are insured through Medicaid Over 50,000 (16%) are privately insured Services provided to special groups:

◦ Over 900 migrant/seasonal farm worker patients/transitional

◦ Over 7,400 military veterans◦ Over 8, 600 homeless patients◦ Over 19,000 school-based patients

Race: 63% African American – 32% White – 5% Other Gender: 60% Female – 40% Male

303,079 CHC Patients in Mississippi

Source: 2012 UDS Data

Source: 2012 UDS State Summary Report

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CHC Utilization by Payor Mix

Uninsured42%

Medicaid 27.8%

Medicare 10.8%

Other Public CHIP 2.4%

Other Public Non-CHIP 0.1%

Private 16.7%

Total Users: 303,079

BP Deepwater Horizon (MS Counties)

Hancock Harrison Jackson

Total Population 45,255 194,029 140,298

Uninsured Adults Under 400% FPL 5,670 25,351 16,394

30,730 patients 83,369 visits 27,713 (90.2%) live at or below 200% FPL 15,362 (50%) are uninsured 8,880 (28.9%) are insured through Medicaid 3,292 (10.7%) are privately insured Services provided to special groups:

◦ 201 migrant/seasonal farm worker patients ◦ 212 military veterans◦ 3,019 homeless patients◦ 643 school-based patients

Race: 38.7% African American – 53.4% White – 7.9% Other Gender: 59% Female – 41% Male

Coastal Family Health Center Patients

Source: 2012 UDS Data

Coastal Family Health Center Utilization by Payor Mix

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Uninsured50%

Medicaid 28.9%

Medicare 8.6%

Other Public CHIP 1.8%

Private 10.7%

Source: 2012 UDS Data Total Users: 30,730

Implementation began formally in 2010 and will continue through 2015 and later

ACA consists of three major partsInsurance coverage reformsInsurance expansionsDelivery system reforms

About ACA

Individual Mandate: purchase coverage or pay penalty, with income-based subsidies up to 400% of poverty (41,000/$88,000) to make coverage affordable

Employer Contribution: offer coverage or pay penalty Medicaid Expansion: all individuals up to 138% of

poverty (major new group: adults) Health Insurance Exchanges: marketplace for

consumers, with competing plans Insurance market reforms, to end discrimination

(gender, pre-existing conditions, MLR, etc) Workforce Training Reforms, especially Primary Care Payment System Reforms, especially Integrated Care

Key Features of ACA

New Funding for Health Centers: $11 Billion over 5 Years (dedicated funding), over and above the $2.2 billion in annual CHC funding $9.5 billion for CHC operations under Section

330 $1.5 billion for Capital over 5 years

Permanent Authorization: Original Sanders language with increasing authorization levels

Health Center-Funding thru ACA

MPHCA ACA presentations to:1) CHCs Members2) State Partner Organizations3) Local Advocacy Groups4) Community-Based Organizations5) Faith-Based Organizations

Insurance Market Place Development1) Mississippi Insurance Department State-Based Exchanged

Development a. 2011 Legislation b. Exchange Advisory Board and Sub-committees Developed c. Exchange Planning & Development Funding d. State-Based Exchange Default/Insurance Commissioner vs.

Governor e).Federally Facilitated Exchange Implementation and QHP

Development

2) Medicaid/QHP (275,000)

MS ACA Roll-Out & Insurance Market Place

Non-Medicaid Expansion1) Total Medicaid Enrollees – 645,134 (as of Sept.

2013)2) Total State Uninsured – approx. 275,0003) Number in coverage gap – 137,8004) Percent in coverage gap below 100% FPL – 89%

MS ACA Roll-Out & Insurance Market Place(continued)

Mississippi QHP

Coverage by County

HRSA Outreach and Enrollment Awards

Outreach and Enrollment Staffing

Outreach and Enrollment Impact

 

FQHC Outreach and Enrollment Supplemental Funding Awards, Staffing and Impact

HRSA awarded the funds through a formula-based supplemental award criteria for eligible section 330 funded health centers.

Health centers receiving outreach and enrollment funding must:

1) Increase the CHC’s Outreach and Enrollment assistance capacity2) Ensure all CHC Outreach and Enrollment assistance workers are trained3) Demonstrate the capacity to conduct “in reach” and “outreach”4) Demonstrate collaboration with other CHCs and providers in their service area5) Comply with all Section 330 Requirements of the PHS Act, as amended

Supplemental Funding Award Criteria & Funding Requirements for CHCs

Allowable use of funds:   Adding a Minimum of 1.0 New FTEs

Pre-award Costs

Hiring of Veterans as O/E Assistance Workers

Fringe Benefits for O/E Assistance Workers

Moveable Equipment and Supplies to Support O/E Assistance Workers

Leasing of Temporary Space

FQHC Use of Outreach and Enrollment Supplemental Funding

Allowable use of funds:

Training in support of the grant

Local travel in support of the grant

Personal computers/laptops

Educational materials

Wireless cards

Technology to Protect Personally Identifiable Information (PII)

FQHC Use of Outreach and Enrollment

Supplemental Funding (cont.)

Non-Allowable use of funds:

Provision of primary health care services or personnel other than O/E assistance workers

To supplant other resources (federal, state, local, or private) intended to support O/E assistance activities

FQHC Use of Outreach and Enrollment Supplemental Funding (cont.)

MPHCA has received $143,724 from HRSA to support its member CHCs in the coordination and execution of their outreach and enrollment activities via:

Ongoing communications about training opportunities

Continued partnerships with state agencies in the development of the overall, state-wide FFE strategy

Coordination with other consumer assistance efforts in the state

Continuing to work with the Qualified Health Plans for Mississippi - Magnolia Health Plan and Humana

Providing training and technical assistance to CHCs

Monitoring and reporting of successes and barriers regarding CHC O/E activities

PCA Outreach and Enrollment Supplemental Funding Award and PCA Support for CHCs

MPHCA Lead Staff Appointed Applied to Become Certified Application Counseling Organization

(CACO) – Certification Obtained late October Provided on-site enrollment training assistance for eleven (11) CHCs Participated in numerous Health Fairs, Town Hall Meetings, Church

and Community Meetings CHCs received CACO Certification 79 CACs Trained, 90% certified Over 1,000 Customers Assisted by Outreach & Enrollment CHC Staffs Conducted Several State Level Meetings and ongoing reporting to

Federal, State and Regional Partners, such as CMS, BPHC, NACHC, MS Dept. of Insurance, UMMC, Oak Hill Baptist Church, Magnolia Health Plan /Ambetter and Humana

Participated in development of Cover MS State Coalition Developed MPHCA O & E Web Page.

MS O&E Activities (As of 11/12/13)

Cover MS O & E Activities

MPHCA O & E Webpage: www.mphca.com/outreach-and-enrollment-resources

www.healthcare.gov www.CoverMS.org www.getcoveredms.org (Navigators)

-Oak Hill Missionary Baptist Church Ministries Incorporated-University of Mississippi Medical Center-Enroll America-Mississippi Health Advocacy Program-Aaron E. Henry Community Health Services Center

University Mississippi Medical Center: www.ummchealth.com/healthplan

Oak Hill Missionary Baptist Church: www.info@getcoveredMississippi.org

www.mid.ms.gov FAQ website: www.healthreformbeyondthebasics.org

Market Place Website & FOAs

Market Place Website & FOAs (continued)

Marketplace Eligibility, enrollment

periods, plans & premiums

Individual Responsibility to have

health coverage

Minimum Essential Coverage

Help paying private health insurance

premiums

Cost sharing reductions

Tobacco surcharge for premiums

Marketplace verification and appeals

Young Adults and Students

Pregnancy

Non Traditional Households

Immigrants

Agricultural Workers

Workers/Families with job-based health

coverage questions

Early retirees

People with variable incomes

Medicare

FAQ Website Categories

Robert M. Pugh, MPH Executive Director

Email: rmpugh@mphca.com

Mississippi Primary Health Care Association

(MPHCA) P.O. Box 11745 l Jackson, MS 39283

Phone: 601.981.1817 l Fax: 601.981.1217www.mphca.com

Contact