Delawareans have 3 months to sign up for 2016 coverage to avoid penalty

WILMINGTON – Delaware will launch the third open enrollment period of its Health Insurance Marketplace on Sunday, ready to build on the success of the first two seasons in which more than 23,000 Delawareans enrolled in private health plans and activated their coverage.

Department of Health and Social Services Secretary Rita Landgraf joined County Executive Tom Gordon and Paul Reynolds from the Department of Insurance to preview the launch during an event Thursday at Absalom Jones Community Center.

Open enrollment for health coverage in 2016 runs from Nov. 1 through Jan. 31 on HealthCare.gov. Individuals must sign up by Dec. 15 for coverage to be effective Jan. 1. Policies for all current enrollees expire Dec. 31.

Individuals enrolled this year can renew their current plan or enroll in a different plan for 2016. While insurance companies will automatically renew many consumers’ coverage, individuals who bought a marketplace plan are encouraged to go to HealthCare.gov to update their household income and other personal information, review their current coverage, and check out the new plans among the 29 individual plans offered for 2016.

Secretary Landgraf said she is eagerly anticipating the start of the third enrollment season. “Beginning Nov. 1, more Delawareans who previously were denied coverage because of a disability or other pre-existing condition, or who thought health insurance was beyond their monthly budgets, will have the chance to join thousands of their neighbors who are enjoying the peace of mind and possibility of improved health that come with being covered.” She said one common misconception that people have is that tax credits won’t apply to them. Tax credits, which help to lower the monthly premium, are available for individuals making up to about $46,000 a year and for families of four with an annual household income of up to about $95,000.

Giving Delawareans access to health care is just a first step, Landgraf said. “Delivering quality care, producing better health outcomes, and reducing health care costs have always been at the heart of the Affordable Care Act. With the start of open enrollment we will take the next step toward a healthier Delaware.”

The Health Insurance Marketplace in Delaware for 2016 will include:

• More choice: Individuals who are enrolling for the first time or re-enrolling will have more plans to choose from: 29 plans vs. 25 in 2015. Highmark Blue Cross Blue Shield, Aetna Health, and Aetna Life Insurance administer the plans. A dozen dental plans will also be available.
• Health benefits that include coverage of pre-existing conditions, outpatient care, emergency services, hospitalization, prescription drugs, mental health and substance use disorder services, lab services, and pediatric services.
• Rate changes: Individual-plan premiums will increase an average 22.4 percent for Highmark plans and less than 17 percent for Aetna.
• Small business employers: Owners will have 15 SHOP (Small Business Health Options Program) plans to choose from for 2016 vs. 16 in 2015. Premiums will decrease 0.5 percent to 1 percent for Aetna plans and increase 12.7 percent for Highmark plans. Small business owners can enroll in SHOP at any time.
• Federal tax credits that in 2015 helped to lower the cost of coverage for 84 percent of Delawareans who enrolled. Their average monthly tax credit was $260.
• A new and improved ChooseHealthDE.com, Delaware’s official source of information about the Health Insurance Marketplace and connection to HealthCare.gov, the federal enrollment site. The new site, launched today, has a cleaner look and improved navigation. A penalty calculator will again allow visitors to see how much they could pay for going uninsured.
• A higher penalty for going uninsured. Those who are not exempt and do not buy insurance for 2016 will pay $695 per adult (plus $347.50 for each child younger than 18 not covered) or 2.5 percent of their household income, whichever is higher.
• Free in-person enrollment assistance from federally funded and trained specialists at several Delaware organizations, including Westside Family Healthcare, Chatman LLC, Henrietta Johnson Medical Center and La Red Health Center. State-licensed insurance agents and brokers also are available to assist individuals and employers with their enrollments. Go to www.ChooseHealthDE.com for details.
• A faster, smoother and safer enrollment process on Healthcare.gov that includes new features such as a calculator that estimates total costs – deductible, co-pays, cost-sharing — based on the plan and a consumer’s expected medical needs; a simplified re-enrollment process; and a “privacy manager” that gives users more control over the information they choose to share.

About eight out of 10 current enrollees will be able to buy a 2016 plan with premiums less than $100 dollars a month after tax credits, and about seven out of 10 will have a plan available for less than $75 a month, according to the U.S. Department of Health and Human Services.

Those attending Thursday’s kickoff heard from Nancy Lemus, a 35-year-old woman from New Castle who has struggled to get health care for her and her son, Christopher, 10, who has cerebral palsy and dystonia, a movement disorder that causes debilitating spasms. Lemus, who works part-time jobs as a waitress and a nursing aide, said she is eager to explore her health insurance options through the marketplace.

Delaware’s senators and congressman urged uninsured Delawareans to find out what’s available for them on the marketplace.

“Over the last several years, I’ve had a chance to meet with Delawareans who found affordable health care and peace of mind through the health insurance marketplace,” Sen. Tom Carper said in a statement. “With open enrollment now underway, I strongly urge all uninsured individuals to go to ChooseHealthDE.com to get information about the various health insurance plans available and potential financial assistance they may qualify for to reduce their insurance costs. And because enrolling in health insurance can be overwhelming, there is free, in-person assistance available to help individuals and families. Every Delaware family deserves access to the quality health care they need, and the marketplace is making that a reality for thousands of Delawareans for the first time.”

Sen. Chris Coons reminded Delawareans to enroll as soon as possible. “It’s an important process and a right that all Americans have access to comprehensive health insurance that fits their needs, regardless of age, background, or pre-existing conditions.”

Added Congressman John Carney: “Next week begins another opportunity for Delawareans to get quality health care coverage that works for themselves and their families. While we still have a lot to do to improve on the quality and cost of health care, the marketplace is an important step that provides thousands with access to care. I encourage Delawareans to look at their options.”

Insurance Commissioner Karen Weldin Stewart said she is excited about the start of another open enrollment period. “I intend to keep working with my partners to make sure comprehensive health care is affordable for all Delawareans.”

In addition to the Health Insurance Marketplace, some residents might be eligible for coverage though Delaware’s expanded Medicaid program, which is open year-round. More than 9,000 individuals have received coverage under the Medicaid expansion. To be screened for or to apply for Medicaid benefits, go to Delaware ASSIST.

For more information, go to www.ChooseHealthDE.com or call 1 (800) 318-2596, TTY: 1 (855) 889-4325. You can enroll in marketplace coverage directly at www.HealthCare.gov or through an agent or broker, always with no charge to the individual.

NOTE TO MEDIA: Photos from Thursday’s Delaware Health Insurance Marketplace Kickoff Event will be available for download beginning Thursday afternoon at DHSS’ flickr page.

For more information, contact Jill Fredel, Director of Communications, (302) 255-9047 (office) or (302) 357-7498 (cell).

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Delaware Health and Social Services is committed to improving the quality of the lives of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations.

Two Organizations Receive Federal Grants to Help Delawareans Get Covered Through the Health Insurance Marketplace

NEW CASTLE – Chatman LLC and Westside Family Healthcare were awarded federal grants today to help Delawareans learn about their options and sign up for coverage through the Health Insurance Marketplace. Open enrollment for coverage beginning Jan. 1, 2016, starts Nov. 1 and ends Jan. 31, 2016.

The Centers for Medicare & Medicaid Services (CMS) announced the following grants to fund the work of certified enrollment assisters known as navigators:

• Chatman LLC, $339,096
• Westside Family Healthcare, $260,904

The awards announced today cover the first year of a three-year grant that runs until Sept. 1, 2018. The funds will support outreach efforts designed to help Delawareans understand the coverage options and financial assistance available at HealthCare.gov.

Chatman, whose Delaware office is at Widener University Law School on U.S. 202 near Wilmington, has employed navigators in Delaware during each of the first two open enrollment periods. Chatman will serve underserved populations statewide, with particular outreach to minorities, special needs individuals, Latinos, African Americans, young adults, immigrants, those with limited English proficiency, and rural residents.

Westside, a federally qualified health center with several locations in New Castle and Kent counties, will primarily serve individuals and families in those counties and will expand its current outreach and education program, which works with existing Westside patients and conducts outreach in the community.

Westside also employed federal navigators last year and was one of four organizations that employed Marketplace guides, who performed similar outreach and education roles during the first two years of Delaware’s Health Insurance Marketplace. Contracts for all four Marketplace guide organizations ended last spring.

Navigators provide free, objective information about health coverage to consumers to help them make the best possible choice. They are knowledgeable about the qualified health plans available in Delaware’s Health Insurance Marketplace and public programs including Medicaid and the Children’s Health Insurance Program (CHIP).

Through the first two years of the marketplace, 25,036 Delawareans enrolled for private health insurance coverage, with enrollment increasing 74 percent from Year 1 to Year 2. As of March 2015, a total of 22,297 Delawareans were paying their monthly premiums and had active coverage.

“The Affordable Care Act is expanding access to health coverage for thousands of hard-working people in Delaware, but picking the right plan and understanding the benefits it offers can be confusing,” said U.S. Senator Tom Carper. “Health care navigators help make that task a little easier. These federal grants will help to spread the word about resources available to consumers who have questions and need assistance enrolling in health plans through Delaware’s marketplace. This crucial federal investment will go a long way toward getting every person in our state the health coverage they deserve.”
Added Congressman John Carney: “More Delawareans are enrolling in health insurance than ever before. They need help to make smart, informed choices for themselves and their families. The navigators supported by this federal grant have already helped thousands of Delawareans. They’ll continue to be an important resource as we get closer to the next enrollment period.”
Federally funded navigators were a key part of Delaware’s enrollment assistance efforts during the first two years of the Health Insurance Marketplace, and they are expected to play an even more critical role now that the state’s contracts with Marketplace guides have ended. Navigators will join agents and brokers, certified application counselors and staff from federally qualified health centers to provide enrollment assistance in Delaware.
“Navigators are in-person, community-based resources for those who need help understanding their health coverage options and how to sign up for a plan,” said Secretary Rita Landgraf of the state Department of Health and Social Services. “We look forward to working with the experienced, trusted partners at Chatman and Westside to help Delaware’s remaining uninsured residents get coverage that fits their needs and that connects them to quality care. We will especially rely on the navigators as we continue to engage traditionally hard-to-reach populations such as Latinos and young adults.”
Delawareans who need health insurance before Jan. 1, 2016, can still get covered if they qualify for a special enrollment period due to a life change like getting married, having a baby, or losing other coverage, or through Medicaid and the Children’s Health Insurance Program, which provide coverage to families and individuals with limited income or other circumstances.
For information about Delaware’s Health Insurance Marketplace and how to contact navigators for assistance, go to www.ChooseHealthDE.com or call the federal Marketplace help center at (800) 318-2596.

For more information, contact Jill Fredel, Director of Communications, (302) 255-9047 (office) or (302) 357-7498 (cell).

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Delaware Health and Social Services is committed to improving the quality of the lives of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations.

NOTE TO MEDIA: DHSS Secretary Rita Landgraf will do a media-only call at noon today (12:00) to discuss the Supreme Court decision and what it means for Delaware. Call-in info: 302-255-2725/123147

Delaware Officials Gratified by Supreme Court Decision on Health Insurance Subsidies
Federal Tax Credits for More Than 19,000 Delawareans Will Not Change

NEW CASTLE (June 25, 2015) – Delaware officials are gratified by today’s U.S. Supreme Court decision to uphold federal tax subsidies for enrollees of Health Insurance Marketplaces in every state who are eligible for them, including the more than 19,000 Delawareans who receive tax credits to help pay for their coverage.

While the provision of tax credits will not change, Delaware officials said they would continue to do their due diligence in evaluating Delaware’s marketplace.

“I support today’s decision by the Supreme Court that tax subsidies on the Health Insurance Marketplaces are legal in every state, including Delaware,” Gov. Jack Markell said in response to the 6-3 decision in King v. Burwell. “For the more than 19,000 Delawareans who qualify, the federal subsidies are critical in helping to make health insurance more affordable. And we know that coverage is an important component in connecting Delawareans to care.”

Department of Health and Social Services Secretary Rita Landgraf said she is grateful that the 19,128 Delawareans who qualify for subsidies on Delaware’s marketplace will continue to receive monthly tax credits that average $265.

“For too many people, the federal subsidies are the difference between being able to afford access to care and not being able to afford that access. Or simply, the subsidies can be the difference between being insured or uninsured,” Secretary Landgraf said. “Protecting those subsidies has been and will continue to be one of our highest priorities.”

Delaware is a state-federal partnership state, which means that it is responsible for management and certification of the private insurance plans sold on the marketplace, along with assisting Delawareans in understanding their options during enrollment. To provide year-round information about the marketplace, Delaware officials created www.ChooseHealthDE.com. Under the state-federal partnership model, Delaware outsourced the information technology to the federal government through www.HealthCare.gov.

Because federal start-up funds ended after this year’s second year of enrollment, Delaware officials also are evaluating the long-term operations of the state’s marketplace. One option that officials are exploring is the Supported State-Based Marketplace (SSBM). Under this model provided by the U.S. Department of Health and Human Services (HHS), Delaware would be responsible for operating the marketplace, but would assess insurers a fee to sell plans on the marketplace and the state must pay a fee to the federal government to use HealthCare.gov and the Federal Call Center to facilitate enrollment each year. On June 1, Delaware applied for non-binding, conditional approval of a Supported State-Based Marketplace. HHS Secretary Sylvia Burwell granted conditional approval on June 15.

A final decision on any changes to Delaware’s marketplace will be made later this summer.

Nationwide, Delaware had one of the highest increases in enrollment between 2014 and 2015, with 25,036 Delawareans enrolling in 2015, up 74 percent over the 2014 enrollment of 14,397.

Enrollment for 2016 will begin Nov. 1 and run through Jan. 31, 2016. The penalties for not having insurance in 2016 will increase to $695 per adult ($347.50 for each child under 18), or 2.5 percent of your annual household income, whichever is higher.

NEWS FROM THE DELAWARE DEPARTMENT OF HEALTH AND SOCIAL SERVICES

For more information, contact Jill Fredel, Director of Communications, (302) 255-9047 (office)
or (302) 357-7498 (cell).

Delaware Health and Social Services is committed to improving the quality of the lives of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations.

Delaware is featured participant at launch of national initiative to achieve better care and smarter spending in health care system

Wilmington, DE – Joined by President Obama, U.S. Health and Human Services Secretary Sylvia Burwell, as well as representatives from health care providers, insurers, consumer groups, and the business community at the White House today, Governor Markell addressed Delaware’s commitment to transform delivery of health care and to provide a model for the country to pay for quality, rather than quantity, of services.

The Governor spoke at a kick off for the U.S. Department of Health and Human Services’ (HHS) Health Care Payment Learning and Action Network, which aims to accelerate the transformation of the nation’s health care delivery system to one that achieves better care, smarter spending, and healthier people by supporting the adoption of alternative payments models. According to HHS, more than 2,800 individual payers, providers, employers, patients, states, consumer groups, consumers and other partners have registered to participate in the Network.

“Current payment models incentivize hospitalizations and quality of treatment, not initiatives like care management programs designed to keep people out of the hospital,” said Markell. “I believe that is the crux of what we are all trying to change. In Delaware, we have brought together all parts of our health care community to develop a plan to become one of the healthiest states while reducing the growth of health care spending.”

At today’s event, HHS highlighted Delaware’s commitment to shift at least 80 percent of health care spending to payment models that reward quality and efficient care. In addition, as part of the Delaware’s Health Care Innovation Plan, the state is working to ensure every Delawarean has a primary care provider, and give providers the tools and training to thrive under new payment models. The state aims to reduce the growth of healthcare spending by 1-2 percentage points, bringing it more closely in line with growth of the state’s economy.

“Thousands of Delawareans are already benefiting from increased access to quality, affordable health care through the Health Insurance Marketplace and our state’s expanded Medicaid program,” said Secretary Rita Landgraf of the Delaware Department of Health and Social Services. “But access to care is just one step on the path to healthier communities. Better care and lower costs are other critical components, which is why we’ve embarked on an effort to transform our health care system through the Delaware Health Care Innovation Plan — and why we are excited to participate in the Health Care Payment Learning and Action Network.”

— Key elements of the Health Care Learning and Action Network:

The Health Care Payment Learning and Action Network (“Network”) is being established to provide a forum for public-private partnerships to help the U.S. health care payment system (both private and public) meet or exceed recently established Medicare goals for value-based payments and alternative payment models.

To help drive the health care system towards greater value-based purchasing — rather than continuing to reward volume regardless of quality of care delivered, HHS has set a goal of moving 30 percent of Medicare payments into alternative payment models by the end of 2016 and 50 percent into alternative payment models by the end of 2018. Alternative payment models include models such as Accountable Care Organizations (ACOs), bundled payments, and advanced primary care medical homes. Overall, HHS seeks to have 85 percent of Medicare payments tied to quality or value by 2016 and 90 percent by 2018.

The Network will serve as a forum where payers, providers, employers, purchasers, state partners, consumer groups, individual consumers, and others can discuss how to transition towards alternative payment models that emphasize value.

The Health Care Payment Learning and Action Network will perform the following functions:

• Serve as a convening body to facilitate joint implementation of new models of payment and care delivery;
• Identify areas of agreement around movement toward alternative payment models and define how best to report on these new payment models;
• Collaborate to generate evidence, share approaches, and remove barriers;
• Develop common approaches to core issues such as beneficiary attribution, financial models, benchmarking, quality and performance measurement, risk adjustment, and other topics raised for discussion; and
• Create implementation guides for payers, purchasers, providers, and consumers.

Participants will be expected to actively engage in the Network by contributing to workgroups, sharing best practices, and learning from peers. They will also:

• Support national alternative payment model goals for the U.S. health system that match or exceed the Medicare fee-for-service goals (30% alternative payment model penetration by 2016 and 50% by 2018);
• Agree that progress towards national goals should be measured; and
• Work with Network participants to establish standard definitions for alternative payment models

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WILMNGTON – If you are the parent of a child in Delaware who receives health coverage through UnitedHealthcare, you recently received a letter stating that the current contract relationship between UnitedHealthcare and the Nemours Foundation (including A.I. duPont Children’s Hospital) is scheduled to expire on April 1, 2014.

I remain hopeful that UnitedHealthcare and Nemours will resolve their business differences so that UnitedHealthcare policyholders can continue to have A.I. duPont Children’s Hospital and Nemours pediatricians as in-network providers.  It is in the best interests of both parties and of the children they serve to resolve this issue quickly so that the care for these children is not interrupted or terminated.    Along with the Delaware Department of Health and Social Services, I stand ready to work with both parties on resolving this in the next few weeks.

However, because neither UnitedHealthcare nor Nemours appears to be making serious efforts to resolve their differences – despite the best efforts of the state – it is also important that parents make plans to ensure that their children receive appropriate medical care after April 1, 2014.  There is no “grace” period. Unless you take active steps in advance, services provided by Nemours will not be covered.  We suggest the following to make sure you are prepared:

• Children receiving Medicaid or CHIP benefits administered by United Healthcare.  Parents of children receiving Medicaid or CHIP benefits administered by UnitedHealthcare can ensure that their children continue to have access to Nemours pediatricians and A.I. duPont Hospital by calling the Delaware Medicaid Health Benefit Manager at 1-800-996-9969 and asking to switch their Managed Care Organization to DPCI.  The deadline for transfers is March 15, 2014. Parents who wish to remain with United Healthcare will need to select a new pediatric provider if they currently receive services from Nemours.

• Children whose parents receive self-insured health insurance benefits administered by UnitedHealthcare through a private employer.  There are two different ways that Delawareans receive health benefits overseen by UnitedHealthcare through their jobs.  Some Delawareans work for companies that are self-insured and hire UnitedHealthcare to administer their self-funded health benefit plans.  You can find out if your company is self-insured by asking your HR or personnel department.  Some of these self-insured companies use more than one insurance carrier to administer their benefits.  If your company uses more than one carrier, you should ask your HR department if the company is willing to allow you to switch to another carrier that has Nemours in-network outside the normal open enrollment period.  If your company does not use more than one carrier, you should talk to your HR department about any medical conditions your child has that make it important that s/he be seen at A.I. duPont Children’s Hospital, so your employer can make an informed decision about how to address the situation with UnitedHealthcare.

• Children whose parents receive health insurance from UnitedHealthcare through employer group health insurance or individually purchased health insurance.  If you are a UnitedHealthcare policyholder, through your employer or through a policy that you purchased directly from UnitedHealthcare, you have legal rights that are part of the insurance contract.  These rights include a minimal level of medical care that your child is entitled to receive.  If you have a child who is seen at A.I. duPont Children’s Hospital, you should immediately find out what UnitedHealthcare’s plan is for your child’s future medical care.  If you do not receive a prompt response or are unsatisfied with the response, you should contact the Delaware Insurance Department at 1-800-282-8611 or 302-674-7310 to receive help in enforcing your legal rights.