CHAIN Reaction: Healthy Kids Changes on the Horizon, CHAIN Makes Recommendations to Insurance Regulators

August 27, 2015

Florida Healthy Kids “Full-Pay” Option is Facing Big Changes

Healthy Kids is Florida’s CHIP (Children’s Health Insurance Program) that offers no-cost or subsidized health care coverage to children in lower income families that make too much money to qualify for Medicaid services. Families that earn more than 200 percent of the federal poverty level have the option to purchase coverage for their children by paying a full premium amount. This year, the premiums for the “full-pay” KidCare coverage are increasing substantially.

Families in the full-pay plan should explore all their options for affordable coverage. If this applies to your family or someone you know, contact a Marketplace Navigator to check eligibility for affordability options on the marketplace. Click here to see how Florida CHAIN is working to advocate for children who are affected by this premium increase.

UPDATE: It was announced on August 25, 2015, that the Center for Consumer Information and Insurance Oversight (CCIIO) responded to Florida CHAIN’s inquiry about a Special Enrollment Period in Healthcare.gov for children affected by the Florida Healthy Kids full-pay premium increase. CCIIO’s director assured Florida CHAIN that they have been working directly with Florida Healthy Kids to address the issue. CCIIO is committed to ensuring there will be no gap in coverage for the children affected by this change. They are finalizing the details to place the SEP in effect.

Update on the Florida Statewide Medicaid Managed Care Plan

Florida is completing its first year of full implementation of the statewide Medicaid Managed Care program authorized under a waiver from the U.S. Department of Health and Human Services this month. Early reports indicate the target of five percent cost savings in the first year was an elusive goal. While receiving the state designated plan rates, referred to as “per member, per month rates” from Florida, the participating Medicaid managed care companies reported an aggregate loss of $542.9 million from their Medicaid business. The losses were so severe that two of the managed care companies received warnings from the Office of Insurance Regulation, requiring their parent companies to infuse the Medicaid divisions with additional capital to maintain sufficient cash reserves and continue operations in the state. As a result of the losses, the managed care plans have requested rate increases from the state to continue providing managed care services to Florida’s Medicaid enrollees.

This news is directly related to the requests by Agency for Health Care Administration Secretary Elizabeth Dudek for information about the rates the plans are paying hospitals to provide services to their members. The 2011 statute and corresponding contracts place upper limits on the amount Medicaid managed care companies can pay hospitals and other providers. The state believes that the managed care companies may be over-paying hospitals, thereby contributing to the unexpectedly higher costs. There is no evidence yet that the payments to hospitals exceed statutory and contractual limits, but the investigation will continue along with the overall investigation of Governor Rick Scott’s Commission on Healthcare and Hospital Funding. Florida CHAIN will continue to report on the progress of these and other health care issues.

Florida CHAIN Makes Recommendations to State Insurance Regulators

Florida CHAIN has made several proposals that would benefit consumers to the Florida Office of Insurance Regulation to include in their lawmaking and regulatory priorities for the upcoming 2016 legislative session. The effect of these recommendations would be the protection of consumers from (1) the family glitch that prevents them from receiving tax credit subsidies for a Marketplace plan; (2) insufficient access to physicians and other providers within their insurance provider networks; (3) access issues related to standard of care therapies without discrimination by excessive cost-sharing; and, (4) balance billing from hospital-based providers like emergency room doctors and radiologists.

Consumers will be represented at the Florida Health Insurance Advisory Board meeting on September 9, when these proposals will be discussed by Florida CHAIN’s Policy and Research Director, Laura Brennaman.

Early Bird Registration Rate Ends August 31

Florida’s #CloseTheGap Campaign Gears Up for 2016

Over this past year, the Florida Health Alliance successfully leveraged the strengths of our diverse organizations to execute a formidable Close the Gap campaign. Together, our efforts increased public awareness and conversation, and enjoyed bipartisan support for Medicaid expansion by the Senate, hospitals andtbusiness, media, and communities in Florida. Although the Florida House voted against closing the coverage gap, our campaign received an unprecedented level of attention by the Florida legislature and media. The fight for Medicaid expansion is not over. The next few months are crucial to the campaign.

The fight for Medicaid expansion is not over and the next few months are crucial to the campaign. The Florida Health Alliance is gearing up to renew our calls to lawmakers for Medicaid expansion and we need your support to get it done. If your organization would like to participate and coordinate with members of our broad based, statewide coalition, sign up online today! We will be hosting events and actions across the state, educating the community, and reaching out lawmakers in hopes of extending Medicaid coverage to 800,000 Floridians. Together, we can make this hope a reality.

Florida CHAIN’s Laura Brennaman Appointed to Consumer-Focused Health Advisory Council

Florida CHAIN’s Policy & Research Director, Laura Brennaman, PhD RN, has been appointed by Florida Agency for Health Care Administration Secretary Elizabeth Dudek to its State Consumer Health Information and Policy Advisory Council. Dr. Brennaman’s two-year appointment will expire in September 2017.

The Advisory Council was established to make recommendations to the Florida Center for Health Information and Policy Analysis to accomplish the requirements of section 408.05, Florida Statutes. This statute directs AHCA to make clear communication of essential information consumers need to make choices about their health care, by making available health care quality measures and financial data on pharmaceuticals, physicians, health care facilities, health plans, and managed care entities. This information is made available on www.FloridaHealthFinder.gov.