Senate President Andy Gardiner sent out today a press release on an amended Florida Health Insurance Affordability Exchange – a key component of the Senate’s plan to cover uninsured, low-income families.
“These adjustments are the product of feedback from Senators, constituents and other stakeholders and together represent a continued effort by the Senate to advance solutions and build consensus around a fiscally responsible expansion of health care coverage,” said Gardiner in a memo. “This Florida solution will improve access to health care for low income Floridians and mitigate the impact to our economy as we transition from LIP to a more sustainable solution to the health care challenges facing our state.”
The amendment removes the Phase 1 enrollment in Medicaid Managed Care. Thereby, streamlining a smoother transition for enrollees.
It strengthens the work requirements by leveraging existing state resources for the unemployed, clarifying that job-seeking activities that qualify for FHIX coverage must involve registration with Career Source.
Florida Healthy Works issued this statement:
“Demonstrating a continued commitment to finding a solution to Florida’s health care crisis, the Florida Senate today offered a new version of its Florida Health Insurance Affordability Exchange (FHIX) plan that preserves conservative guardrails and strengthens personal responsibility measures while extending health care coverage to more than 800,000 low-income, working Floridians.
With more consumer choice, stronger work requirements and greater state control, this is a Florida solution – and compromise – that we trust the Florida House of Representatives and Governor Rick Scott will consider.
A Healthy Florida Works fully supports the Senate’s FHIX compromise. A fiscally-responsible approach that covers more people is the right thing to do for Florida businesses and families.â€
Summary of Proposed Amendment to FHIX
1. Eliminate Phase 1 Medicaid Enrollment
Background: SB 7044, considered in the 2015 Regular Session, expanded coverage through a three phase process. The first phase enrolled people in the Managed Medical Assistance (MMA) plans for immediate coverage as of July 1 while AHCA sought a waiver to implement the Florida Health Insurance Affordability Exchange (FHIX) as a consumer-driven, market-based alternative to traditional Medicaid. The bill called for a transition to FHIX by January 1, 2016.
Amendment:
Phase 1 is eliminated.
MMA plans are no longer included as products offered on the exchange.
2. Strengthen Work Requirements
Background: SB 7044 established specific work requirements for participants. Enrollees must provide proof of employment, or on-the-job training or job placement activities, or pursuit of education opportunities. Parents are required to meet a minimum requirement of 20 hours per week and childless adults are required to meet a minimum of 30 hours per week. The bill allows an exception to the work requirement for individuals who are disabled or caregivers of a person with disabilities.
Amendment:
Clarifies that job-seeking activities must involve registration with Career Source.
Clarifies that the definition of disability does not require SSI determination, but is a broader category that can be verified by the eligibility caseworker.
3. Expand Consumer Choice Options
Background: SB 7044 created a state exchange to offer a variety of coverage plans and other ways to purchase health care including prepaid contracts and bundled health services purchased directly from providers. The bill required at least two ACA-compliant plans to be offered in every region of the state, but did not arrange any mechanism for enrollees to access the full range of plans on the federal exchange.
Amendment:
Provides for FHIX participants to be offered plans available on the federal exchange either through availability on FHIX or through a premium credit that the enrollee can take to the federal exchange to use in purchasing coverage.
4. Preserve State Control
Background: SB 7044 authorized the Agency for Health Care Administration to seek a federal waiver to implement FHIX, but was silent on what happens if the terms and conditions of that waiver vary significantly from the legislation.
Amendment:
AHCA is prohibited from implementing any waiver that varies substantially from the provisions of the statute.In the event significant changes are made, additional legislative approval is required before implementation.
Summary of FHIX Incorporating Above Amendment
Coverage Population & Eligibility Requirements:
The FHIX program will extend coverage to an estimated 800,000 low-income Floridians.
The expanded population will include individuals earning less than 138% of the Federal Poverty Level (FPL), who are not currently eligible under s. 409.902, F. S. Individuals who earn an annual income of up to approximately $16,000 or parents who earn up to approximately $33,000 for a family of 4 will now be eligible.
Must be a Florida resident.
Products and Services:
All Florida Health Choices Program products and services.
All plans available on the federal exchange either through availability on FHIX or through a premium credit that the enrollee can take to the federal exchange to use in purchasing coverage.
All products offered by Florida Healthy Kids Corporation.
Employer sponsored plans.
Cost-Sharing Principles:
Participants may be charged for inappropriate use of emergency room visits, $8 for the first visit and up to $25 for subsequent visits.
Participants will be assessed mandatory monthly premiums based on their modified adjusted gross income as follows:
Less than 22% of the FPL: $3
Between 22.01%-50% of the FPL: $8
Between 50.01%-75% of the FPL: $15
Between 75.01%-100% of the FPL: $20
Between 100.01%-138% of the FPL: $25
If a full premium payment is not received after a 30-day grace period, the premium assistance will be suspended and the participant may not re-activate coverage for a minimum of 6 months.
Employment Requirements:
Participants are required to complete an initial application for coverage which includes proof of employment, on-the-job training or placement activities, or pursuit of educational opportunities at a minimum hourly level as follows:
Parents with children under the age of 18: Minimum requirement of 20 hours per week.
Childless adults (disabled adults or caregivers of disabled children or adults may submit exceptions): Minimum requirement of 30 hours per week.
Participants must maintain the above work or educational requirements and will submit a renewal annually.
To qualify, job-seeking activities must involve registration with Career Source.
The definition of disability does not require SSI determination, but is a broader category that can be verified by the eligibility caseworker.
Implementation:
There will be a 2-phased approach to eligibility and enrollment that uses existing resources:
Phase One – Transition participants to the Florida Health Choices marketplace to select plans, services, and products using premium credits based on a risk adjusted rate beginning January 1, 2016; and
Phase Two – Fold Florida Healthy Kids enrollees into the marketplace starting July 1, 2016.
A Transition Workgroup will oversee the process and make recommendations to the Agency for Health Care Administration (AHCA).
Administration:
The Department of Children and Families will continue to determine eligibility.
The Agency for Health Care Administration is the recipient and distributor of federal funds, chairs the FHIX Workgroup and has overall responsibility for the program.
The Florida Healthy Kids Corporation will provide customer support, financial services, and retain its other responsibilities until Phase Two.
Florida Health Choices, Inc., will implement and operate the FHIX marketplace.
Participant Responsibilities:
Apply for coverage.
Execute participant contract to acknowledge program limitations, including possible non-funding, participant responsibilities for payments and work or education, and disenrollment consequences.
Make monthly premium payments based on income and work or educational requirements that begin in Phase Two.
Assume cost sharing for services based on products selected in the marketplace.
Renew eligibility annually.
Participant Rights:
Access the FHIX marketplace to shop and select coverage, services, and products.
Avoid disruption of coverage through portability and continuity of coverage when eligibility changes.
Retain premium credits earned despite changes in circumstances in a health reimbursement or health savings account.
Select more than one plan or product on the FHIX marketplace.
Choose from at least two plans on the FHIX marketplace that are compliant with the Patient Protection and Affordable Care Act.