NHHPP Waiver Program – What Is It? / What Does It

Mean for Assisters?Tom Bunnell – Policy Consultant

NHHPP Waiver Program – What Does it Mean for Assisters?

Background

Benefits Package

Cost-Sharing

Application and Enrollment – Big Picture

Special MCO Consideration

Enrollment Walk Through

A Few Other Key Issues

Q & A

Background I

NHHPP enacted Mar 27, 2014 / bipartisan compromise Immediate implementation of NHHPP (Medicaid expansion) Sunset at end of calendar year 2016 unless reauthorized Pursuit of “premium assistance” Medicaid Waiver

HIPP Program, Bridge Program, and Waiver Program

Premium Assistance Medicaid Waiver App submitted Dec 1, 2014 / approved Mar 12, 2015 Brave new world – Merging Medicaid with private insurance But NHHPP is still a Medicaid program

Background II

All NHHPP Bridge Program (Medicaid managed care) enrollees must transition to Medicaid-financed QHP coverage on the Marketplace effective Jan 1, 2016

All new NHHPP enrollees must be in a QHP on the Marketplace (except those that are exempt) effective Jan 1, 2016

Every insurance carrier offering a QHP on NH’s FFM in 2016 must offer an NHHPP-compliant Silver level plan

All carriers offering QHPs on NH’s FFM must accept NHHPP participants as enrollees

Benefits Package

The overall benefits package for NHHPP enrollees is exactly the same for the Waiver Program as it has been for the Bridge Program

But the package is separated into two parts for admin purposes: Private insurance Essential Health Benefits (EHB) through QHP Silver Plan Wrap-Around Benefits (satisfying Medicaid EHB) through Medicaid

Medicaid wrap-around benefits: Non-emergency medical transportation (NEMT) Early Periodic Screening Diagnosis and Treatment (EPSDT) Family planning services and supplies Limited adult dental and adult vision services

Enrollees will have one insurance card / seamless

Cost-Sharing

Unique cost-sharing arrangement for Marketplace

Although enrolled in a QHP on the Marketplace, NHHPP enrollees will pay no premiums or deductibles out of pocket Medicaid will pay all premium and deductible expenses for

NHHPP enrollees’ QHP coverage

NHHPP enrollees at less than 100% of FPL will have no co-pay obligations / no cost-sharing Medicaid will be charged for and pay all co-pays

But there will be cost-sharing, in the form of co-pays only, for enrollees from 100% to 138% of FPL

Cost Sharing – Specifics

Co-Pays for Enrollees at 100% to 138% of FPL (subject to an out of pocket cap): Generic Prescription Drugs – $2 Prescription Drugs – $6 Specialty Prescription Drugs – $6 Physician Specialist Services – $8 Complex Imaging (CT/PET Scans, MRIs) – $25 Behavioral Health Inpatient Admission – $50 Hospital Inpatient Admission – $50  

For all such enrollees, cost-sharing on a quarterly basis cannot exceed 5% of income for quarter

Application and Enrollment I

QHP coverage under the Waiver Program begins Jan 1, 2016

New NHHPP applicants can apply for coverage under the program starting Nov 1, 2015 (start of Open Enrollment 3)

Enrollment will remain open year-round for NHHPP applicants

Consumers may apply for the NHHP, select a QHP, and enroll in the program: Through the DHHS online portal / NH EASY  www.nheasy.nh.gov By phone at the DHHS NHHPP hotline, at 1-888-901-4999 In person at a DHHS District Office

Application and Enrollment II

Consumers may also apply for the NHHPP via NH’s federally-facilitated Marketplace / www.HealthCare.gov , but the app file will need to be transferred to DHHS for program enrollment and QHP selection: Need for HIPP and Medically Frail screening

(possible Waiver program exemption) at DHHS Medicaid Wrap-Around enrollment FFM will not yet have the technical capacity to

restrict NHHPP applicant shopping to Medicaid-only QHPs

Bridge Program Transition – Special MCO Consideration

Special Medicaid MCO consideration in NHHPP authorizing statute and Waiver If MCO offers QHP on Marketplace, their NHHPP

Medicaid Managed Care enrollees will be auto-assigned to / auto-enrolled in the MCO’s QHP

Now know that NH Healthy Families (Centene) is offering a QHP on the Marketplace

WellSense (BMC HealthNet) is not

Enrollment Walk-Through – NH Healthy Families

On or about Nov 1 2015, current NHHPP NH Healthy Families’ (NHHF) enrollees will receive a notice from DHHS that they’ve been auto-assigned to the NHHF QHP, effective Jan 1 2016

Consumers will have 30 days to switch to a different Silver level QHP, if they would like.

There is still a question as to when, in this circumstance, the 30 day period kicks in

ISSUE WATCH: Provider networks may be different!

Enrollment Walk-Through - WellSense

WellSense NHHPP enrollees will receive a written notice from DHHS, on or about Nov 1, 2014, of the required transition, and the need to select a QHP for coverage Notice is required to provide guidance on how to select a QHP Notice is required to compare differences between available

plans

The consumer needs to select a QHP Silver Plan within 30 days

If consumer doesn’t choose a QHP within 30 days, s/he will be auto-enrolled in a QHP Follow-up notice will inform enrollee of their auto-assignment

and of the right to select a different QHP within 30 days

Enrollment Walk Through – New Applicants

Enrollment for Marketplace coverage under the Waiver program begins Nov 1, 2015

Anyone who applies and is found eligible on or after Nov 1, 2015: Will be enrolled in Medicaid fee for service, at the outset, until

QHP coverage begins for the enrollee Will be given a choice of plans for Marketplace coverage

beginning Jan 1, 2016 or 30 days after notice of NHHPP eligibility, whichever occurs later

If an applicant does not choose a QHP within 30 days of being found eligible, s/he will be auto-assigned to a Silver level QHP

Upon notice of auto-assignment, the enrollee will have 30 days to select a different plan if s/he wants

Enrollment Walk Thru – Medically Frail

An applicant or enrollee can self-certify, at any time, that s/he is medically frail and opt out of Marketplace coverage / is exempt from the Waiver program

Medically frail person must then elect to enroll in either the Medicaid managed care Alternative Benefit Plan or the standard Medicaid benefit

Other Issues

Retroactive Coverage

Grievances and Appeals

NHHPP Reauthorization NHHPP sunsets Dec 31, 2016 unless

reauthorized by Legislature and Governor Large coalition advocacy effort engaged to

ensure that the program is reauthorized