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How Can Your State Select Good Plans for Its Health Insurance
Exchange?
November 11, 2010
Mission Statement
To represent and strengthen not-for-profit, safety net health plans as they work with providers and caregivers in their communities to improve the health and well being of vulnerable populations in a cost-effective manner.
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ACAP has 52 member plans representing over 7M Medicaid lives
in 25 States – 25% of all Medicaid managed care lives
ACAP Plans
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Affinity Health Plan (NY)Alameda Alliance for Health (CA)AlohaCare (HI)AmeriHealth Mercy Health Plan (PA)Amida Care (NY)Boston Medical Center HealthNet (MA)CalOptima (CA)CareOregon (OR)CareSource Michigan (MI)CareSource (OH)CenCal Health (CA)Children’s Community Health Plan (WI)Children’s Mercy Family Health Plan (KS)Children’s Mercy Family Health Plan (MO)Colorado Access (CO)Commonwealth Care Alliance (MA)Community Health Choice (TX)Community Health Group (CA)Community Health Network of Connecticut (CT)Community Health Plan (WA)Contra Costa Health Plan (CA)Cook Children’s Health PlanDenver Health Medical Plan (CO)Driscoll Children’s Health Plan (TX)Elderplan & Homefirst (NY)
El Paso First Health Plans (TX)Health Plan of San Mateo (CA)Health Plus (NY)Health Services for Children with Special Needs (DC)Horizon NJ Health (NJ)Hudson Health Plan (NY)Inland Empire Health Plan (CA)LA Care Health Plan (CA)Maine Primary Care Association (ME) **MD Community Health Systems (MD) *MDwise (IN)Metropolitan Health Plan (MN)Monroe Plan for Medical Care, Inc. (NY)Neighborhood Health Plan (MA)Neighborhood Health Plan of Rhode Island (RI)Network Health (MA) Prestige Health Choice (FL)Priority Partners (MD)San Francisco Health Plan (CA)Santa Clara Family Health Plan (CA)Texas Children’s Health Plan (TX)Total Care (NY)Univera Community Health (NY)University Physicians Health Plans (AZ)UPMC For You (PA)Virginia Premier Health Plan, Inc (VA)VNS CHOICE (NY)
*Associate Member ** Incubator PlanPlans in Italics are original CHC plans
Medicaid Plans Need to Be in the Exchange• On average, 40 percent of the nation’s low income
subsidized Exchange population will have the following characteristics: – Previously enrolled in Medicaid/CHIP
– Previously enrolled in a premium subsidy program for low-income populations
– Previously uninsured (with our without family members in Medicaid)
• Family Cohesion
• Knowledge of Needs of Low-Income Populations
SNHPs Should Be Allowed in the Exchange• Currently cover over 25% of all Medicaid Lives
• High Quality Plans
– 5/10 top Medicaid Plans are ACAP Members
• Strong link to providers
– Most affiliated with CHCs, Safety Net Hospitals, children’s hospitals
• Profits go back to Community
– IT support, programs for uninsured
• Mission to serve low income populations
• Greater choice for consumers
• Experience working with government
Commercial Concerns with SNHPs Wellpoint Letter to CA legislators CA AHA concerns re: pricing
Medicaid Plans Should Not Be Required to Enter the Exchange Not all SNHPs will have the capital for
reserves or operations Some plans may have enough on their plate
with the Medicaid expansion
How Can the Exchange be Structured to Best Serve Subsidized Populations
• Deeming of Medicaid plans as Qualified Health Plans initially– Allow transition period for accreditation, licensing,
reserves
• Simplify enrollment into Exchange– “Nudge” Medicaid enrollees into same plan in
Exchange
– Allow easy opt-out
• Robust risk adjustment system
How Can the Exchange be structured to Best Serve Subsidized Population
Quality Rating System should be risk adjusted to reflect diversity of subsidized population
Standardized Benefits to enhance comparability for consumers
Contact information
Meg Murray, CEO, 202-204-7509, [email protected]
Deborah Kilstein, Director of Quality Management and Operational Support , 202-341-4101, [email protected]
Andrea Maresca, Director of Policy, 202-204-7510, [email protected]
www.communityplans.net
