Health Affairs on NY’s Insurance Exchange

From Health Affairs, an informative article on the development of NY’s health insurance exchange- a key provision of Federal healthcare reform:

With Just Months To Go, New York State’s Health Benefit Exchange Gears Up For Open Enrollment

Harris Meyer1

New York is a deep-blue state that Barack Obama won with 62 percent of the vote in both 2008 and 2012. Even so, the state’s Republican-controlled Senate balked twice at approving a central feature of President Obama’s signature health care reform law: a state health insurance exchange.

 

As a result, Democratic Gov. Andrew Cuomo had to issue an executive order in April 2012 to establish the New York Health Benefit Exchange. “Establishing the health exchange will bring true competition into the health care marketplace, driving down costs across the state,” Cuomo said in a written statement when he issued the order.¹

 

The Affordable Care Act requires an exchange in every state. New York, Rhode Island, and Kentucky are the only states that have established their new federally approved health insurance market by executive order. Thirteen others, plus the District of Columbia, have done so through legislation; Utah is awaiting federal approval of its legislatively created exchange. The remaining thirty-three states declined to set up an exchange on their own; as a result, in those states the federal government will run an exchange by itself or in partnership with the state.

 

Governor Cuomo’s executive order came nearly a year after the New York legislature’s failure to pass legislation. The delay has pushed the Empire State hard up against the deadlines for implementing the health insurance marketplace, which require starting enrollment on October 1, 2013, and coverage on January 1, 2014. Yet, unlike many other states that are struggling to meet the quickly approaching deadlines, New York has the support of nearly all stakeholders, including Republican Senate leaders, as it works to establish a state-run exchange. Since the executive order was issued, the state has by most accounts moved efficiently to get enrollment started on time.

 

“New York is doing the best job one can expect given all the challenges,” says New York Senate Health Committee chair Kemp Hannon (R–Nassau County), who in 2011 backed the bipartisan bill to create an exchange that didn’t pass. “I haven’t heard anyone griping,” he adds. “But we’re building something entirely new, and even Amazon had growing pains at the beginning.”

 

The law’s proponents say it’s crucial for proreform states like New York, California, Maryland, and Oregon to have their exchanges up and running, enrolling people on October 1. Their success would demonstrate that the Affordable Care Act is working and would quiet critics like Sen. Max Baucus (D-MT), who recently warned of a “huge train wreck coming down” on exchange implementation.² President Obama acknowledged that launching the exchanges is “a big, complicated piece of business.”³

 

Nationally, the state exchanges are expected to serve as a key mechanism in extending health coverage to an estimated twenty-seven million uninsured Americans by 2016 and in fostering competition that will curb health care cost growth. Nearly 1.6 million New Yorkers are projected to access coverage through the state’s exchange.

 

“There are a lot of eyes on New York,” says Donna Frescatore, a Cuomo health policy adviser and former state Medicaid director whom the governor appointed executive director of the exchange last July. “We’re a large state, and we have the opportunity to significantly reduce the number of uninsured. There are a lot of very interested folks rightfully asking us good questions…” (For full article click here)

CMS Takes Steps to Ease Medicaid Enrollment

From Kaiser Health News:

Feds make it easier for states to enroll poor under health law

By Phil Galewitz
Kaiser Health News
May 20, 2013

WASHINGTON, D.C. — The Obama administration is making it easier for states to sign up the poor for health coverage — and to help those people stay covered.

On Friday, it informed state officials that they could simplify enrollment in Medicaid, the federal-state program for the poor, to handle the onslaught of millions of anticipated enrollees next year when the health care law expands coverage. The administration said the changes are geared to states that are expanding their programs, but they may also be adopted by others.

At least 22 states have committed to expanding Medicaid, one of the chief ways the law extends coverage to the uninsured, and several more are undecided including Kansas. The Supreme Court made expansion of Medicaid optional, and some Republican-controlled states have opted against it.

Gov. Sam Brownback and the Legislature have shown no desire to expand Medicaid and seem unlikely to approve it this year.

In a letter to state officials, federal Medicaid Director Cindy Mann laid out several ways states might streamline enrollment for adults, including using data people have already submitted to qualify for foods stamps – a practice that a few states permit for children.

“Big deal”

States may also allow adults to stay enrolled in the program for up to a year, even if their income changes, she said.

Allowing adults to stay in the program when their income changes is a “big deal,” said Alan Weil, executive director for the National Academy for State Health Policy. He said it was likely to reduce the large number of people churning in and out of the program, which interferes with their ability to get care. Thirty-two states now use this option for children.

In states moving forward with the expansion, residents with incomes up to 138 percent of the federal poverty level — or about $33,000 for a family of four — will be eligible for coverage. About 13 million people are expected to enroll in Medicaid starting next year, according to the Congressional Budget Office.

In Kansas, expansion could increase enrollment in the program by as many as 240,000, according to various projections — Medicaid, known in Kansas as KanCare — currently provides medical and long-term living assistance services for about 380,000 poor, disabled and elderly Kansans.

Expansion would have a bigger impact in Kansas than in many other states. That’s because the state’s current eligibility criteria exclude all but the poorest adults. Only those with children and incomes less than 32 percent of the federal poverty level — about $6,000 a year for a family of four — can qualify. Implementing expansion would mean that adults in that same family of four could make more than $31,000 a year and qualify.

Employing lessons learned

Mann’s letter outlines several options states can use to streamline enrollment and retention.

“Enrollment strategies that target individuals likely to be eligible for Medicaid, and for whom eligibility information is already in the state’s files, provide important advantages both for uninsured individuals and for states,” she wrote.

To help states deal with the demands of increased enrollment, they will have the option in the first three months of next year to extend the Medicaid renewal period by up to 90 days. That means that if an individual on Medicaid comes up for renewal on Feb. 1, their eligibility could be extended to May.

“This is part of our longstanding, ongoing effort to continue to simplify and streamline enrollment and renewal in Medicaid,” said Donna Cohen Ross, a senior policy adviser at the Centers for Medicare and Medicaid Services (CMS).

Cohen Ross said the administration is employing lessons learned from enrolling children in Medicaid. Louisiana and South Carolina, for instance, have used the food stamp strategy to help sign up thousands of children, but states have not previously had the option for adults.

Similarly, CMS said states can use existing government data to sign up parents whose children were already enrolled in Medicaid.

Kaiser Health News (KHN) is a nonprofit news organization committed to in-depth coverage of health care policy and politics. The Washington, D.C.-based news service is a partner of KHI News Service.

State Health Commissioner Shah Announces Medicaid Redesign is Working

From NYSDOH:

Better Quality, Better Patient Outcomes, Lower Costs – even as Medicaid Enrollment Increases

ALBANY, N.Y. (May 08, 2013) – New York State Department of Health Commissioner Nirav R. Shah, M.D., M.P.H., today highlighted data that shows New York’s efforts to reform and restructure Medicaid are working: Medicaid costs are decreasing as enrollment is increasing, and the quality of the program is also receiving high marks.

Initiatives developed by Governor Andrew Cuomo’s Medicaid Redesign Team (MRT) continue to “bend the cost curve” on services provided to Medicaid beneficiaries, especially in New York City. This improvement is primarily reflected in long term care services, which were the primary cost driver in spending growth before the Governor created the MRT in January 2011.

“New York’s Medicaid program has undergone historic change under Governor Cuomo’s leadership, and all New Yorkers are benefiting from these reforms,” Commissioner Shah said. “Medicaid Redesign initiatives are successfully improving the quality of care and individual health outcomes for Medicaid members, while reducing costs for New York taxpayers. New York has proven that health reform can produce positive results, and we continue to explore ways to further improve Medicaid in New York State.”

MRT initiatives are actually reducing projected Medicaid growth by billions of dollars. Recent data released by the New York State Department of Health shows that prior to implementation of MRT initiatives, total Medicaid spending for all categories of service was on track to rise exponentially, but the new strategies under MRT have bent the cost curve and resulted in estimated savings of $3.2 billion in New York City alone.

MRT initiatives have proven especially effective in curtailing costs and improving the quality of long term care, which previously had been the cost drivers for most of the growth in the Medicaid program. NYC long term care spending was projected to continue to increase in future years, has instead been projected to result in savings of $980 million.

Medicaid program quality is also on the upswing. The New York State Department of Health 2012 Managed Long Term Care (MLTC) Report found that the overall functional ability of 90 percent of MLTC enrollees has remained stable or improved, 85 percent of MLTC plan members rated their health plan as “good” or “excellent”, and 91 percent would recommend their plan to a friend. In addition, a recent study by the National Committee for Quality Assurance (NCQA) analyzed New York State’s Medicaid health care plans against 76 different quality measures and found that when it comes to offering the right type of care for costly health factors like diabetes, childhood obesity, smoking cessation and follow-up care for the mentally ill, New York is a national leader, second only to Massachusetts.

About Managed Long Term Care (MLTC):

Mandatory Enrollment in MLTC Plans (MRT 90) calls for the expansion of MLTC for Medicaid recipients who are also eligible for Medicare (dual eligibles) and currently receiving community-based long term care services. Those currently in receipt of community-based long term care services or new users requesting the services will have the option of enrolling in Partial, PACE, or MAP plans. If recipients do not pick a plan, they will be automatically enrolled in Partial Capitation plans because only the Partial plans’ benefit package is solely covered by Medicaid. PACE and MAP plans include benefits covered by Medicare, thereby excluding these plans as options for mandatorily enrolled individuals.

The implementation is planned for five phases over the course of at least two years (2012 through 2014) beginning in Manhattan. Managed long-term care assists chronically ill or disabled individuals who require health and long-term care services. MLTC plans receive a monthly risk-adjusted capitation payment from New York State Medicaid to pay for a range of health and social services. The benefit package includes home care, personal care, social supports, and transportation services. The costs of skilled nursing facility services are included in the capitation payment, thereby providing a financial incentive for the plans to keep their members healthy and living in the community. Depending on the type of plan, ambulatory care, inpatient, and mental health services may also be included in the benefit package.

MLTC enrollment has steadily increased over the past eight years from approximately 10,000 in 2004 to nearly 70,000 as of November 2012, with the number of plans growing from 16 plans to 38 plans. Currently, 89 percent of the enrollment is in partial capitation plans and highly concentrated in New York City, which accounts for 93 percent of MLTC enrollment.

About the Medicaid Redesign Team:

Governor Cuomo established the Medicaid Redesign Team (MRT) upon taking office in January 2011, bringing together stakeholders and experts from throughout the state to work cooperatively to reform the system and reduce costs. The collaborative process ensured that the action plan outlined in the MRT report has broad support among the health care stakeholder community. Through this collaborative effort, MRT initiatives have transformed the program into a national model that cut costs, puts the patient first, and creates a sustainable model of growth focused on quality of care. More information on the MRT and its initiatives is available at http://www.health.ny.gov/health_care/medicaid/redesign/.

NYC Total Medicaid Spending for All Categories of Service Under the Global Spending Cap, (2003-2012)

• Chart (PDF, 221KB)

Gov Announces $91M for Affordable Housing

Governor Cuomo Announces $91 Million to Build Affordable Housing and Revitalize Communities in All Regions of New York State

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Funding Will Create and Preserve Over 2,000 Units of Affordable Housing in Every Region of the State, Leveraging Hundreds of Millions in Public and Private Resources

Albany, NY (May 7, 2013)

Governor Andrew M. Cuomo today announced $91 million in awards for shovel-ready projects to build affordable housing across the state. The low-interest loans and tax credits will build and preserve 2,060 units of affordable housing and are expected to leverage more than $485 million in grants, loans and private resources.

 

“As New York’s economy gets back on track, today we are announcing awards to partners who, through a rigorous application process, presented worthy, shovel-ready projects across the state — development that will create jobs while building and preserving affordable housing for our residents,” Governor Cuomo said. “By streamlining the application process, New York State is removing barriers that held back economic development for too long and made government inefficient. These funds will leverage hundreds of millions of dollars in private resources, creating valuable partnerships as we work to rebuild communities and create jobs in all corners of the state.”

 

The funds were available through New York State Homes & Community Renewal (HCR)’s Unified Funding Application, a single-source process to apply for several funding streams for affordable, multifamily developments, part of the Governor’s efforts to break down the inefficient and duplicative silos that had previously governed state funding. In total, HCR will make 33 awards, totaling over $91 million in low-interest loans and tax credits that will build and preserve 2,060 units of affordable housing. The projects are expected to leverage over $485 million in grants, loans and private resources.

 

HCR Commissioner/CEO Darryl C. Towns said, “Governor Andrew Cuomo charged state agencies to bring state resources together with local and federal resources in the most productive way. For us, that means working with our partners, including local governments and many of our sister state agencies, to create and preserve affordable housing. We have found impressive projects in each and every region of the state that will make a real difference in local communities.”

 

In this round of funding, applicants competed for: low-interest loans through the Low-Income Housing Trust Fund Program (HTF); Federal Low-Income Housing Tax Credits (LIHTC); the HOME Capital Program; and State Low-Income Housing Tax Credits (SLIHC).

 

Highlights of the awards in each of the state’s ten Economic Development Regions include:

 

Capital Region
Winn Development Company — $4.3 million for Livingston Apartments; adaptive reuse of vacant Livingston Middle School in Albany, transforming it into 103 units of housing for the elderly, including 16 supportive units for the frail elderly. The City of Albany is an investment partner.

 

Central New York
Atonement Housing Corporation — $3.24 million for Joslyn Court III and IV; demolition and new construction of 36 affordable rental units on Syracuse’s south side. The City of Syracuse is an investment partner.

 

Finger Lakes
DePaul Properties, Inc./Betts Housing Partners LLC — $5.7 million for Rochester View Apartments; new construction of 60 rental units in the Town of Henrietta (Monroe County). The project will provide 33 units for low-income individuals with psychiatric disabilities, and 27 units for low-income persons with hearing impairments. Coordinated investment with NYS Office of Mental Health (OMH) and Homeless Housing and Assistance Corporation (HHAC).

 

Long Island
Conifer, LLC — $2.1 million for Wincoram Commons; mixed use new construction of eight commercial units and 98 rental units for low and moderate-income individuals and families. Part of the local redevelopment strategy for the hamlet of Coram, within the Suffolk County Town of Brookhaven, the project was endorsed by the Long Island Regional Economic Development Council and awarded funds from Empire State Development (ESD).

 

Mid-Hudson
Regional Economic Community Action Program, Inc. & Excelsior Housing Group, LLC – approximately $2.9 million for the Mill at Middletown (Orange County); adaptive reuse of a former mill into 42 rental units for low-income individuals and families, with 13 units set aside for persons with special needs, including five units for persons living with AIDS. Coordinated investment with NYS Office of Alcoholism and Substance Abuse Services (OASAS) and the Office of Temporary and Disability Assistance (OTDA).

 

Mohawk Valley
Birchez Associates, LLC & Omni Housing Development LLC — $3.9 million for Birches at Schoharie; new construction of 71 rental units for low- and moderate-income seniors in the Village of Schoharie, a community devastated by Tropical Storms Lee and Irene.

 

New York City
Dunn Development Inc. – Over $1.7 million for Bergen Saratoga Apartments; new construction of 80 rental units for low-income households, including 40 units for those who are or are at serious risk of becoming chronically homeless. Supportive services for these households will be provided by CAMBA, Inc. of Brooklyn. Rental subsidies for half the units will be provided by OMH as part of the NYNYIII agreement with the City of New York.

 

North Country
Georgica Green Ventures, LLC & White Birch Enterprises LLC — $1.85 million for Woolworth Watertown; adaptive reuse of the historical FW Woolworth Building in downtown Watertown (Jefferson County) into a 50-unit rental unit project for low-income households.

 

Southern Tier
Lakewood Development LLC — $3 million for Norwich Shoe Apartments; demolition of four blighted buildings and new construction of 34 rental units for low-income individuals and families, with seven units set-aside for persons with developmental disabilities. Located adjacent to the City of Norwich’s (Chenango County) Business Improvement District, the project is a coordinated investment with Office of People with Developmental Disabilities (OPWDD).

 

Western New York
People United for Sustainable Housing, Inc. — $3.5 million for Mass Ave Community Homes; new construction of 28 rental units and rehabilitation of 18 rental units in 16 buildings in Massachusetts Ave Green Corridor on Buffalo’s West Side. State will partner with PUSH Buffalo.

 

Complete details of all awards are available here: http://www.nyshcr.org/Funding/Awards/UnifiedFunding/2013/awards.pdf

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TODAY Show Features Phoenix House in Piece on Px Drugs

ASAP member Phoenix House, and their client Emily, was recently featured on the TODAY show in a piece on prescription drug abuse. Below is the press release from Phoenix House and a link to the full video:

This morning, NBC’s TODAY Show featured our client, Emily, who bravely shared the story of her addiction to prescription drugs. Prescription drug abuse has skyrocketed in recent years and unfortunately, Emily’s story is not unique. After undergoing surgery to remove a cancerous mass in her chest, she became addicted to prescription painkillers. She was a college student and competitive athlete, but over the next five years, drugs led her down a destructive path: “I’ve lost everything. Something that started with a prescription led me to places I never thought I would go.”

Today, she’s getting her life back on track at our Phoenix House Long Island City Center. Now 25, she will resume her studies next month and plans to pursue a career in human services. “Life without these drugs is amazing,” she says.

We are proud of Emily’s determination to overcome addiction and her courage in sharing her recovery story. Watch the video here to learn more about Emily’s journey

NYT Editorial: HCR Report Card

Below is a succinct and informative editorial on the benefits of healthcare reform to date from the New York Times:

Editorial

Report Card on Health Care Reform

By THE EDITORIAL BOARD

Republican leaders in Congress regularly denounce the 2010 Affordable Care Act and vow to block money to carry it out or even to repeal it. Those political attacks ignore the considerable benefits delivered to millions of people since the law’s enactment three years ago Saturday. The main elements of the law do not kick in until Jan. 1, 2014, when many millions of uninsured people will gain coverage. Yet it has already thrown a lifeline to people at high risk of losing insurance or being uninsured, including young adults and people with chronic health problems, and it has made a start toward reforming the costly, dysfunctional American health care system.

EXPANDING COVERAGE Starting in 2010, all insurers and employers that offer dependent coverage were required to offer coverage to dependent children up to age 26. An estimated 6.6 million people ages 19 through 25 have been able to stay on or join their parents’ plans as result, with more than 3 million previously uninsured young adults getting health insurance. The law requires private health insurers to provide free preventive care, without co-pays or deductibles. Some 71 million Americans have received at least one free preventive service, like a mammogram or a flu shot, and an additional 34 million older Americans got free preventive services in 2012 under Medicare.

Private insurers are now required to cover children with pre-existing conditions, which means that an estimated 17 million such children have been protected against being uninsured.

And more than 107,000 adults have enrolled in a federally run insurance plan for people with pre-existing conditions. The law also bars insurers from canceling policies on sick people; previously, 10,000 people a year had their policies rescinded.

The law appropriated $11 billion over five years to build and operate community health centers, a major factor in increasing the annual number of patients served to 21 million, a rise of 3 million from previous levels. Some $5 billion has been put into a reinsurance program that has encouraged employers to retain coverage for retirees and their families; 19 million people benefited with reduced premiums or cost-sharing.

SAVING CONSUMERS MONEY Private insurers are required by the law to spend at least 80 to 85 percent of their premium revenues on medical claims or quality improvements, or they must pay a rebate to consumers. In 2012, insurers had to pay $1.1 billion in rebates, an average of $151 per family. Although Republicans contend the law will drive up insurance premiums, thus far it seems to have reduced them. Any insurer that wants to increase its premiums by 10 percent or more for people who buy their own policies must justify the increase to state or federal officials. As a result, the proportion of rate filings that sought increases of 10 percent or more fell from 75 percent in 2010 to 34 percent in 2012, and it is expected to be even lower this year. The average premium increase in 2012 was 30 percent lower than in 2010.

The law also provides for prescription drug discounts to Medicare beneficiaries. More than 6.3 million older or disabled people have already saved more than $6.1 billion on prescription drugs since 2010 and will save even more as a gap in coverage, known as the doughnut hole, is filled in by 2020. And the law ended lifetime dollar limits on services covered by private plans, a matter of great importance to people with very high medical costs. Annual limits on what plans will pay are being phased out.

REINING IN HEALTH CARE COSTS Sharp declines in the annual growth rate in overall health care spending and in Medicare’s cost per beneficiary have eased the pressure on federal budgets and on private insurance premiums. The main factor was presumably the recession, which made people reluctant to spend on health care, but it is possible that the focus on reform has led many providers to act more frugally. The law has reduced unjustified overpayments to private Medicare Advantage plans, which enroll more than a fifth of all beneficiaries, and despite fears to the contrary, Medicare Advantage premiums have fallen by 10 percent and enrollment has risen by 28 percent since the law was passed.

BETTER QUALITY OF CARE One of the most promising aspects of the health reform act is its focus on improving quality. The percentage of Medicare patients requiring readmission to the hospital within 30 days of discharge dropped from an average of 19 percent over the past five years to 17.8 percent in the last half of 2012, an improvement due in large part to penalties imposed by Medicare for poor performance and financial incentives paid by Medicare to providers to encourage better coordination of care after a patient leaves the hospital.

A number of pilot programs in Medicare and Medicaid have been started to reward quality, to encourage doctors and hospitals to coordinate care, and to lower costs. If enough of these experiments pan out, they could transform not only Medicare but the entire health care system.

ASAM: On NYSAM, ASAP, FOR-NY Regional Summits as Way to Foster Open Dialogue on Addiction Treatment

ASAM Chapters Foster Open Dialogue on Addiction Treatment.

TU: State Budget Within Reach

Today’s Times Union reports on the ongoing budget finalization process in Albany. While the Governor and leaders from the Senate and Assembly held a press conference last night citing a three way agreement on the overall budget, there are some key details yet to be decided.  Read the full article which covers the budget details that are currently known, including details on raising the state minimum wage, and the renewal of tax rates.

Of particular interest:

“…Speaking to journalists at a separate news conference earlier Wednesday, Cuomo said he was trying to use the budget to leverage agreements about the gun control law as well as a deal to criminalize bath salts, provide college tuition aid to illegal immigrants, and allow New York City officials to close a loophole in marijuana possession laws that is prompting criminal arrests in the police department’s stop-and-frisk program.

“There’s possibilities of other issues that may or may not work out,” Cuomo said. “If they work out, we can pass them along with the budget. If they don’t, we’ll continue to work on them for the rest of the session…”

As Budget Negotiations Near Close, Potential Agreement to Criminalize Synthetic Drugs Being Considered

This morning’s Times Union details the final budget negotiations underway in Albany with a goal of a final budget package to be voted on by the weekend or early next week. The budget negotiation discussions have also included some discussion around an agreement to criminalize the use of synthetic marijuana and bath salts, as part of a larger agreement on New York’s so-called “stop and frisk” arrest policies:

“…There are also the outlines of an agreement to criminalize so-called “bath salts” and synthetic marijuana. It is paired with language to authorize the New York City Council to change drug laws that make possession of marijuana “in public view” an offense subject to arrest rather than a violation akin to a speeding ticket. The present loophole has left mostly young black and Hispanic men processed through the city’s stop-and-frisk program with criminal convictions that advocates say are unjustified…”

ASAP Exec Dir to be Interviewed on Capitol Pressroom Today

Today’s Capitol Pressroom radio show, hosted by Susan Arbetter, will feature an interview with ASAP Executive Director John Coppola. John will be talking about the urgent need to support investments in New York’s substance use disorder prevention, treatment and recovery services. You can listen to the show online at the Capitol Pressroom website.

Update: Click here for a direct link to today’s show (the interview with ASAP begins around the 42 minute mark)