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HomeMy WebLinkAboutAgenda 11-14-23; 7-a - Implementation of Medicaid Expansion in Orange County 1 ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: November 14, 2023 Action Agenda Item No. 7-a SUBJECT: Implementation of Medicaid Expansion in Orange County DEPARTMENT: Social Services ATTACHMENT(S): INFORMATION CONTACT: Medicaid Expansion Presentation Nancy Coston, 919-245-2800 Lindsey Shewmaker, 919-245-2800 PURPOSE: To receive an update regarding the expanded Medicaid availability in Orange County beginning on December 1, 2023. BACKGROUND: The North Carolina General Assembly approved legislation in early 2023 that authorized Medicaid expansion in North Carolina, and Governor Roy Cooper signed it into law in March 2023. However, the expansion legislation did not include a specific date that eligibility rules would change, and it also made Medicaid expansion contingent on the passage of a State budget for the 2023-25 fiscal years. The budget was ultimately approved in September, and December 1, 2023 was announced as the start date of Medicaid Expansion in North Carolina. Starting December 1, 2023, North Carolina is providing health care coverage to more people through Medicaid. Medicaid will cover people ages 19 through 64 years with incomes up to 138% of the Federal Poverty Level. This is about $20,000 for an individual and about $34,000 for a family of three. Medicaid provides comprehensive medical coverage including services like primary care, maternity care, hospitalizations, prescription drugs, and hearing and vision. Current Medicaid recipients with full coverage will not see any changes and will continue receiving services. An additional 600,000 North Carolinians are expected to receive coverage through the expanded Medicaid program. In Orange County, an additional 6,800 people are expected to receive coverage once the program is fully implemented. In anticipation of Medicaid Expansion, the Orange County Board of County Commissioners, based on the recommendation of the County Manager, approved the creation of nine (9) new positions to assist with enrollment. Social Services staff have been working to fill those positions and get new staff trained to be ready to take applications in December. 2 FINANCIAL IMPACT: There are no additional County costs for Medicaid expansion at this time. SOCIAL JUSTICE IMPACT: The following Orange County Social Justice Goals are applicable to this item: • GOAL: FOSTER A COMMUNITY CULTURE THAT REJECTS OPPRESSION AND INEQUITY The fair treatment and meaningful involvement of all people regardless of race or color; religious or philosophical beliefs; sex, gender or sexual orientation; national origin or ethnic background; age; military service; disability; and familial, residential or economic status. • GOAL: ENSURE ECONOMIC SELF-SUFFICIENCY The creation and preservation of infrastructure, policies, programs and funding necessary for residents to provide shelter, food, clothing and medical care for themselves and their dependents. • GOAL: CREATE A SAFE COMMUNITY The reduction of risks from vehicle/traffic accidents, childhood and senior injuries, gang activity, substance abuse and domestic violence. ENVIRONMENTAL IMPACT: There is no Orange County Environmental Responsibility Goal impact expected from Medicaid expansion. RECOMMENDATION(S): The Manager recommends that the Board receive the report on implementation of Medicaid expansion in Orange County and provide any comments or questions. - - 3 OR- -A-NGE COUNTY NORTH CAR(3LINA Medicaid Expansion and Orange County: Expected Changes in 2023-2024 November 14 , 2023 4 What is Medicaid Expansion ? 0 Starting December 1 , 2023, North Carolina is providing health care coverage to more people through Medicaid Medicaid will cover people ages 19 through 64 years with higher incomes • People who have never previously been eligible in North Carolina may be able to get Medicaid Medicaid pays for doctor visits, yearly check-ups, emergency care, mental health and more — at little or no cost to recipients ORANGE COUNTY 2 NORTH CAROLINA 5 What types of services are covered under Medicaid ? 0 primary care for check-ups or • vision and hearing services illness • prescription drug benefits to hospital services to stay pay for medicines overnight (inpatient) or • behavioral health procedures when you can go 0 preventative and wellness home the same day out atient services (outpatient)p ) 0 devices and other therapies • maternity and postpartum care for women who are dental services pregnant and after giving birth ORANGE COUNTY 3 NORTH CAROLINA 6 How will this impact Orange County residents? • As of September 2023 there were 20,724 Orange County residents receiving Medicaid • New enrollment in year one of Medicaid expansion in Orange County is estimated to be 5,344 • Total new enrollment due to Medicaid expansion after the ramp-up is expected to be 6,869 Orange County Medicaid Recipients 30,000 26,068 27,593 25,000 20,724 20,000 15,000 10,000 5,000 0 +- 2023 2024 2025 ORANGE COUNTY 4 ■Medicaid Recipients NORTH CAROLINA 7 More North Carolinians will be eligible • People are eligible if they are And if someone was already 19 through 64 years old AND eligible, nothing changes. have income below 138% of the Federal Poverty Level. Group Annual Income in 2023 . . 211% of Federal Poverty Level 1 - $30,800 Household Size Annual IncomeChildren 2 - $41,600 3 - $52,500 Single Adults <_ $20,120 196% of Federal Poverty Level 1 - $28,700 Family of 2 <_ $27,214 Pregnant Women 2 - $38,700 3 - $48,700 Family of 3 <_ $34,307 -Older Adults > 65 100% of Federal Poverty Level -People with blindness Family of 4 <_ $41,400 -People with disabilities 1 - $14,6002 - $19,700$14,600 2 - $19,700 *Asset limits also apply Family of 5 _< $48,493 Family of 6 _< $55,586 ORANGE COUNTY 5 NORTH CAROLINA 8 Are there any other eligibility criteria? 0 In addition to the age and financial criteria, expanded Medicaid will not include people who are: — Pregnant (they can be covered under another Medicaid program) — Entitled to or enrolled in Medicare benefits under Part A or B — Otherwise eligible for and enrolled in another full Medicaid program • If the applicant is a parent/caretaker of a child living in the home under age 21 : — The child must be currently receiving Medicaid and/or have Minimum Essential Medical Coverage (MEC), which is any insurance plan that meets the Affordable Care Act requirement for having health coverage or comprehensive medical insurance, which provides basic medical care and hospitalization. ORANGE COUNTY 6 NORTH CAROLINA 9 Are immigrants now eligible for Medicaid ? 0 Some non-US citizens can get health coverage through Medicaid. To be eligible they must be: — A person living in North Carolina — A non-citizen with qualified immigration status. Most people must wait five years. • Non-citizens without documents who do not qualify for full health coverage under Medicaid may be able to get temporary coverage for emergency conditions that need to be treated in an emergency room. ORANGE COUNTY 7 NORTH CAROLINA 10 How much will Medicaid cost for a recipient? 0 There are no monthly premiums Medicaid pays the cost for most health care services The highest copay is $4 and that is only required on some services Service . . . WP Chiropractic visits Doctor visits Non-emergency and emergency department visits Optometrist and optical visits Outpatient visits Podiatrist visits Generic and brand $4 per prescription prescriptions ORANGE COUNTY 8 NORTH CAROLINA 11 What information do people need to apply? It takes time to complete the application. Here is some of the information applicants will be asked to provide for each person applying: — Full legal name — Date of Birth — Social Security number (or immigration documents) — North Carolina residency — Income information (from paystubs, W-2 forms, tax returns or business records) — North Carolina uses external resources to verify the information you provide. If more information is needed, you will receive a letter in the mail from your local DSS. ORANGE COUNTY 9 NORTH CAROLINA 12 What documents can be used if DSS asks for more information ? North A photo ID with your NC address listed, or Carolina A utility bill, or Residency A lease or mortgage agreement, or • Vehicle registration, or • Documentation of employment, or If they do not have any documentation, they can check a box in ePASS labeled "NC Residency Declaration." Income If they're Employed - pay stubs, employer verification or their most recent tax return to show proof of their income. • If they're Self-Employed -their most recent tax return or copies of business records. If they don't have that, they can fill out a Verification Form for Self-Employment Income and Expenses form. Date of Birth A photo ID with their date of birth listed, or • Birth certificate Social Security A copy of their Social Security card, or Number Another official document containing their name and SSN, or • Amilitary ID card Citizenship Birth Certificate, or • Passport Immigration Status A copy of their VISA/immigration card. ORANGE COUNTY 10 NORTH CAROLINA 13 What if someone currently has limited benefits through Family Planning Medicaid ? If someone meets the new eligibility rules they will automatically receive full Medicaid coverage as of December 1 , 2023 and they will: — Get a letter from the NC Department of Health and Human Services letting them know that they will start getting full Medicaid coverage. — Be assigned a health plan. If they want to change it, they will have 90 days to pick a new one. — Get a packet from their health plan with a new Medicaid ID card. Their ID card also has the name of their primary care doctor. They can change the doctor that was assigned by contacting their health plan. — If they have health coverage through HealthCare.gov they will need to cancel that plan. Clients need to understand that they should not cancel a plan until they receive information from their new health plan through Medicaid. ORANGE COUNTY 11 NORTH CAROLINA 14 How to apply for Medicaid People can apply in 4 ways: Lis . . . ePASS Paper application In person at your Call DSS office local DSS office Muni 12 ORANGE COUNTY NORTH CAROLINA 15 After someone applies , how long does it take to find out if they qualify for Medicaid ? • It may take up to 45 days after they apply. Incomplete applications may take longer. • Applicants can help the process go faster by: — Applying online at ePASS and providing all information requested. If the application is incomplete, it may take longer to process. DSS will reach out to applicants if they do not have what is needed to complete an application, so be sure to respond to mail or phone calls. — Keeping their contact information up-to-date in ePASS, so they don't miss important information about their Medicaid benefits — Sign up for an enhanced ePASS account. An enhanced ePASS account allows people to keep their information updated without having to contact the local DSS office ORANGE COUNTY 13 NORTH CAROLINA 16 What happens once someone is approved ? • Most people who get health coverage through Medicaid are part of NC Medicaid Managed Care. This means they can choose the health plan that is best for them. • All health plans offer the same base services. Some have extra services. Each has its own network of doctors and professionals. • Recipients can choose their health plan and their primary care doctor - family doctor, clinic or health care provider - when they apply. • They will receive a health care plan ID card in the mail. It will come from the health plan that they selected. If they did not select a health plan, one will be assigned. Recipients have 90 days to pick a new one. They will receive a packet from the NC Medicaid Enrollment Broker that tells them how to change plans. ORANGE COUNTY 14 NORTH CAROLINA 17 Medicaid Managed Care Health Plans Medicaid recipients in Orange County currently have access to the following Standard Medicaid Managed Care Plans AmeriHealth Carolina Healthy Blue Caritas Complete Health United Healthcare Community . ORANGE COUNTY 15 NORTH CAROLINA 18 What can impact ongoing eligibility? Recipients of expanded Medicaid (MXP) will be re-evaluated for eligibility every twelve months to ensure they remain eligible Changes in circumstance should be reported during the enrollment period and could result in a re-evaluation of eligibility. These could include: — Any change in income or household composition — Pregnancy — Medicare eligibility — 3rd party insurance coverage ORANGE COUNTY 16 NORTH CAROLINA 19 What if someone is not eligible under expansion ? • If someone is still not eligible for health coverage through Medicaid, they may be able to get health coverage through the ACA Marketplace at HealthCare.gov • Open enrollment for 2024 began November 1 , 2023, and ends January 15, 2024. People can apply at other times of the year if they qualify for special enrollment such as loss of a job, change in family circumstance, or loss of Medicaid coverage. • Households with incomes up to 400% of the federal poverty level may be eligible for help to pay for health coverage • If someone doesn't have health insurance, they can also get basic health care services at federally qualified health centers, rural health clinics, and free and charitable clinics. Costs vary based on income. Learn more at https://www.ncdhhs.gov/divisions/office-rural- health/safety-net-resources f ORANGE COUNTY 17 NORTH CAROLINA 20 Medicaid Expansion and the Health Insurance Marketplace Household Income % contribution of % contribution of Range (as % of FPL) household income at household income at start of range top of the range Medicaid Less than 138% 0% 0% Marketplace 138%-150% 0% 0% 150% - Less than 200% 0% 2% 200% - Less than 250% 2% 4% 250% - Less than 300% 4% 6% 300% - Less than 400% 6% 8.5% 400% and higher 8.5% 8.5% ORANGE COUNTY 18 NORTH CAROLINA 21 How are we sharing information on Medicaid Expansion ? • Community Presentations — Northern Orange NAACP — Board of County Commissioners — Board of Health • Partnering with Municipalities • Social Media • Flyers and Informational Materials Sent to Community Groups ORANGE COUNTY 19 NORTH CAROLINA 22 Will Orange County be ready? • Orange County DSS staff have been working on plans for most of the year on how to manage Medicaid Expansion • The Board of County Commissioners approved 9 new positions related to Medicaid Expansion in the FY2023-24 budget • Staff have been working to hire and train new staff in anticipation of expansion ORANGE COUNTY 20 NORTH CAROLINA 23 Questions? 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