Colorado Department of Health Care Policy and Financing

Colorado Department of Health Care Policy & Financing

Colorado Department of Health Care Policy and Financing

2

Improving health care access

and outcomes for the peoplewe serve while demonstrating sound

stewardship of financial resources

Our Mission:

Colorado Department of Health Care Policy and Financing

Health In Colorado• 22% of adults obese; 14.2% kids

• 18.3% working age adults uninsured; 9.3% kids

• 20.7% of women receive initial prenatal care later than the first trimester or not at all

• 28.7% of preschool-age children do not receive all recommended doses of six key vaccines.

• 14.8% of adults reported having poor mental health

Colorado Department of Health Care Policy and Financing

Coverage• Medicaid expansions up to 133% of poverty

• Premium tax credits available up to 400% of poverty

• Cost sharing subsidies up to 250% of poverty (limits out of pocket spending)

• Investments in workforce and clinic capacity

Coverage

Colorado Department of Health Care Policy and Financing

Medicaid Expansion: The Right Choice for Colorado (SB13-200)

Maximizing enhanced federal funding is the best option for Colorado

o Allows provider fee dollars to stretch further with the enhanced federal matching funds

o The Medicaid expansion is expected to have no impact on the state General Fund

Expansion allows Medicaid to cover more than 160,000 additional Coloradans

o Expansion allows us to cover more people with the right services at the right time and drive value in the system

o 58,000 additional parents and adults likely to enroll between 100%-133% of FPL (138% with an automatic 5% income disregard) o In 2013, 133 percent of the FPL was $31,321 for a family of four and

$15,282 for an individualo Supports Colorado’s health and economy by helping people stay healthier

over the long term

Colorado Department of Health Care Policy and Financing

Cost of Expansion

6

Preliminary 10-YEAR ESTIMATE*Caseload and Cumulative Expenditure Projections, 2013-2022

(Representing Net Change, Costs in Millions)

09-1293 ACA **Total

Caseload1 220,300 59,500 271,000

Total Cost $11,709.7 $2,039.2 $13,548.3

State Share: Provider Fee/ Other2

$1,267.3 $128.3 $1,395.6

State Share: GF/Other 2

$0 $0 ($179.5)

Federal $10,382.3 $1,910.9 $12,280

*This is a preliminary estimate of caseload and expenditures and does not include administrative costs or effects of other programs. **The total estimates column above takes into account calculations for eligible but not enrolled individuals and changes to the CHP+ costs and caseload. 1 An estimated more than160,000 Coloradans will be enrolled as a result of the expansion. This is difference between 271,000 (above) and an estimated 110,200 parents and adults without dependent children currently authorized under the provider fee.2 As federal funding tapers, we anticipate savings, provider fees and other public funding will cover the additional caseload.

Colorado Department of Health Care Policy and Financing

UNINSURED AFTER HR

IMPLEMENTATION

INSURED AFTER HR IMPLEMENTATION

UNINSURED WITHOUT HR IMPLEMENTATION

758,000

160,000

220,000

160,000

Health Insurance Status after Implementation

Colorado Department of Health Care Policy and Financing

Insurance reforms

Insurance Accountability

2010 2014Dependent care coverage for adult children to age 26No pre-existing conditions exclusions for childrenNo lifetime limitsNo rescissionsMedical Loss Ratio to 80% ind. market and 85% large group market (2010 reporting, 2011 rebates)Free preventive care (new plans)

No annual limitsGuaranteed issue Guaranteed renewabilityNo gender ratingNo health status ratingAge rating 3:1; Geographic variation/tobacco rating 1.5:1

Colorado Department of Health Care Policy and Financing

Bending the cost curveCoordinated Care Models in Colorado

– Patient-Centered Medical Homes– Accountable Care Collaboratives– Reforming payment systems (HB1281)– Leveraging health information

technologyPreventing and Managing Chronic Disease

Cost Containment

Colorado Department of Health Care Policy and Financing

Improving Value in Medicaid: $280 million in savings over 10

years• Enhancing value-based services• Increasing effectiveness in care delivery• Reforming payment systems to reward value instead of

volume• Leveraging health information technology to improve

quality and efficiency of care• Redesigning administrative infrastructure and reducing

fraud, waste and abuse

10

Colorado Department of Health Care Policy and Financing

Accountable Care CollaborativeUpdate

• The Department reduced Medicaid health costs by $20 million

• Returned nearly $3 million to state and federal taxpayers since its inception

Indicators- ACC Clients• Hospital Readmissions 8.6% reduction• Emergency Room Utilization .23% increase• High-Cost Imaging 3.3% reduction

11

Colorado Department of Health Care Policy and Financing

Payment Reform

Courtesy: Colorado Health Institute

10

Colorado Department of Health Care Policy and Financing

>$92,200 for a family of four;

>400% of FPL

Job-based coverage, or Full-cost coverage in the exchange

$65,150-$92,200; 300-400% of FPL

Job-based coverage, or Subsidized exchange coverage: premiums capped at 9.5% of

income

$46,100-$69,150;200-300% of FPL

Job-based coverage, or Subsidized exchange coverage: premiums and copays to 250%

$30,657-$46,100;133-200/250% of FPL CHP+

Job-based coverage, or Subsidized exchange coverage:

premiums and copays

<$30,657 for a family of four;

< 133% FPLMedicaid Medicaid

Children and pregnant women Adults (non-disabled adults, not eligible for Medicare)F

amil

y In

com

eCoverage Options by IncomeCoverage Options by Income

Citation: The Center for Public Policy Priorities ( www.cppp.org )

Colorado Department of Health Care Policy and Financing

Questions

Lorez MeinholdDeputy Executive Director/ Director of Community Partnership Office 1570 Grant Street Denver, CO 80203 (303) 866-5868lorez.meinhold@state.co.us