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Health Reform in King CountyHousing Development Consortium
November 13, 2012
Jennifer DeYoung Health Reform Policy Analyst, Public Health - Seattle & King [email protected]
Susan McLaughlinHealth and Human Services Integration Manager, Department of Community and Human [email protected]
Presentation Overview
• Health Reform in King County – Benefits to date
• Access and Outreach Efforts • Delivery System Reforms
– Managed Care– Health Homes
• Health Reform and Housing• Questions
2
The Affordable Care Act: Four Key Strategies
33
Timeline of Key Health Reform Activities Affecting Seattle & King County
4
New Medicaid Managed
Care contracts in
effect
Medicaid beneficiaries with disabilities phased into
mandatory Managed Care
Open enrollment begins for
Exchange & Medicaid
Expansion (Oct 1)
Medicaid Expansion & Exchange Coverage Begins
(Jan. 1)
July2012
January 2013
January 2014
October 2013
March2010
Supreme Court ruling
June 2012
ACA signed into
law
Development of Health Benefit Exchange
Health Homes Initiative for high
risk Medicaid (Nov 1)
Benefits Today: Health Reform in King County
• About 736,000 individuals no longer face lifetime caps on their health benefits
• About 15,000 young adults up to age 26 are covered by their parents’health plans
• About 368,000 individuals have coverage for preventive care with no co-pays or deductibles
Source: Public Health-Seattle & King County, 2012.5
Next 14 Months: A Critical Time for King County to Shape Health Reform
• To gear up for enrollment
• To shape Medicaid delivery system changes focused on high-risk, high-need enrollees
• To influence Exchange policies and Medicaid program changes
6
King County Health Reform Planning Team
• Co-convened by Public Health and Department of Community & Human Services
• Adoption of Framework for an Accountable, Integrated System of Care
• Identification of priority areas of focus
7
King County Health Reform Planning Team Vision (Framework)Create a Transformed System of Care with a Single Point of Accountability for Low-
Income ResidentsThrough person-centered medical home, intensive care management, comprehensive
community hubs, and prevention and wellness.
Priority Areas of Focus for Achieving Vision:
AccessEnsure residents obtain coverage
CapacityEnsure system
of care can provide the
right care at the right time in the
right setting
Delivery System
IntegrationPromote
systems of care that effectively
integrate clinical care, community
prevention, and human services
ResourcesSufficient
resources to achieve the Framework
vision and meet residents’ health and
human service needs
EducationEnsure the safety-net
consumer and provider
community understands how health reform will
impact them
Key Changes Still to ComeHow Will We Get to Expanded Coverage?
9
Medicaid Program
Coverage (up to133% FPL)
Federal Basic Health Option ?
133% - 200% FPL
Employer-sponsored coverage
Exchange(Tax credits & cost sharing subsidies
for those 100-400% FPL)
Individual mandate
FPL = Federal Poverty Level. 133% of FPL is about $15,000 for an individual.9
• Providing input on development of Health Benefit Exchange
• Influencing shape of Essential Health Benefits package
• Developing community-wide enrollment strategy
10
Access
Ensure residents
obtain coverage
Access and Outreach Efforts
Managed Care in King County
11
Health Home Models of Care
• Comprehensive care management including– Intensive/chronic disease management– Transitions management/readmission reduction– Self-management support/patient education– Linkages to community/social support services
• Health Assessment• Coordinated Health Action Plans• Use of Health Information Technology
12
Health Home Structure
• Network of organizations that provide health home services
• Each network has an identified “lead entity” that is responsible for administrative functions
• Bridges all service domains including medical, mental health, chemical dependency, long term services and supports
• May include health plans, community based organizations, clinics, etc.
13
Timeframe/Next Steps
• State will “qualify” health home networks– King County exploring creating a Health Home
Network including PHSKC, DCHS, and AAA• Implementation being phased in regionally• King County implementation November 1,
2013
14
Health Reform and the Housing System
Key areas of opportunity and planning for the Housing System and health reform: 1. Enhanced roles in helping people get enrolled
in and retain health coverage.2. Care coordination & care transition
partnerships with Medicaid managed care organizations.
3. Potential for reimbursement of certain services under Medicaid
1. Enhanced roles in helping individuals get enrolled in and retain health coverage
• Community-wide strategy to assure people get enrolled in Medicaid expansion & Exchange will be crafted.
• Potential for longer-term payoff for housing providers→ greater access to earlier medical & behavioral health care.
2. Care coordination & care transition partnerships for those on Medicaid
• Significant numbers of formerly homeless clients will be on Medicaid and in a managed care plan.
• Over time housing providers will need to cultivate working relationships with all 5 Managed Care Organizations (MCOs).
• Many may be involved in a health home and receiving care coordination & care transition functions • Housing providers will play a critical role as essential
partners in health home networks
3. Potential for reimbursement
• Medicaid Expansion provides a potential source of revenue for people in supportive housing who have clinical service needs
• Health Home Networks provide an opportunity to serve people with the highest needs more efficiently
• Opportunities for WA to propose new ways of approaching healthcare through different state “authorities” or “waivers”
18
Corporation For Supportive Housing
• Develop a “cost case” for supportive housing that demonstrates that housing is healthcare
• Develop a crosswalk of the services provided in supportive housing with one or two possible state waivers
• Keep housing and other stakeholders involved
19
Health Reform Challenges
• Can’t underestimate the work needed to get and keep people covered
• Some will remain uninsured (including undocumented); others will fall off and on
• Lack of capacity in the safety net health system to serve increase in people
• Historic challenges of managed care in providing quality services for individuals with significant behavioral health issues
20
Staying Engaged
• WA State Health Benefit Exchange– http://www.hca.wa.gov/hcr/exchange
• WA Medicaid Expansion– http://www.hca.wa.gov/hcr/me
• WA State Health Care Authority listserv– http://www.hca.wa.gov/
• King County Health Reform Planning Team– http://
www.kingcounty.gov/healthservices/health/partnerships/HealthReform.aspx
21
Questions
22
