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KH to assist residents with healthcare exchange

Posted: October 17, 2013 4:43 p.m.
Updated: October 18, 2013 5:00 a.m.

Three KershawHealth employees will become certified application counselors, or CACs, and assist patients and others interested in learning more about the healthcare insurance marketplace created by the Affordable Care Act. During Monday’s KershawHealth Board of Trustees meeting, KershawHealth Executive Vice President and COO/CFO Mike Bunch said the healthcare organization is waiting for an email giving it the go-ahead to have the employees trained.

Bunch began his presentation by mentioning media reports of how the federal government’s health insurance website (www.healthcare.gov) had been overwhelmed during its first days by those seeking information about and register for insurance under the new exchanges.

“It is my understanding that most of the applications are now being taken on paper in light of the online problems,” Bunch said, who noted that an article in Modern Healthcare magazine reported that more than 4.7 million unique visitors went to HealthCare.gov on its first day; that figure jumped to 7 million by the second day.

Still quoting from the article, Bunch said the open enrollment period runs through March 31, 2014, but that consumers have until Dec. 15 if they want their coverage to begin on Jan. 1. However, he also noted that the article stated that 140 different insurance “issuers” are offering more than 1,700 different plans.

In conjunction with another Modern Healthcare article in the same edition, Bunch began talking about CACs -- employees of organizations granted permission to designate staff members “to help guide people through the online insurance marketplaces” established by the Affordable Care Act. They are required to undergo five hours of online training and take a test to become certified.

Bunch said there are already two entities in Kershaw County that have CACs to accept healthcare exchange applications: Sandhills Medical Foundation and AccessKershaw. He said Sandhills has two phone numbers, a general one and one at its Lugoff location, Kershaw County residents can use to ask questions.

KershawHealth will become the third such organization.

“We were told last week, preliminarily, (that) we are a certified site,” Bunch said. “We actually filed our application in early September and have been waiting well over 30 days and were notified last week that we will be a certified site. At this time, we are awaiting an email from CMS (the Centers for Medicare and Medicaid Services) and then we’ll have individuals in our departments (undergo) the five hours of training and take the test to be certified.”

Bunch said there will be three such employees at first, but that KershawHealth hopes to expand the number of CACs within the organization. The CACs, who will be unpaid volunteers in terms of this work, will initially be housed on the main campus but Bunch said KershawHealth hopes it will have CACs at most if not all of its main sites.

He said the wait to receive certification has been hampered by the federal shutdown.

Later in the presentation, Bunch explained that in addition to CACs, there are also three companies in South Carolina designated as “Navigators:” DECO Recovery Management LLC, The Cooperative Ministry and the Beaufort County Black Chamber of Commerce. These groups received federal grant money to conduct public education activities, distribute information about enrollment and the premium tax credits, facilitate enrollment, and provide referrals for any enrollee with grievances or questions about their health plan.

Bunch said DECO and The Cooperative Ministry are state-wide in scope whereas the Beaufort group is more regional in nature. He said both DECO and The Cooperative Ministry have contacted KershawHealth about having resources in Kershaw County.

“Some of those may even end up in some of our facilities, such as emergency rooms,” he said.

Bunch also spent time discussing what the health insurance exchange program does, what it offers and the possible benefits for consumers in Kershaw County. The information he provided originated with the S.C. Hospital Association (SCHA), based on what was known as of Oct. 2.

The exchange is being touted as an easier way to shop for health insurance because all the options are gathered in one place.

“Most people will be able to get a break on costs,” Bunch said. “The key statistic there is that 90 percent of people who are currently uninsured will qualify for discounted or free health insurance.”

He also said that the healthcare exchange offers an “apples to apples comparison” as consumers look at the various levels of plans.

Since South Carolina did not choose to create an exchange of its own, state residents must go through the marketplace established and operated by the federal government.

“Some of the states that created their own marketplace are having more success with their websites than the federal website. South Carolina made a decision to use the federal website and marketplace and that’s the website that’s clogging up,” Bunch said.

He noted that there are four qualified health plans available to South Carolina residents: Blue Choice Health Plan, Consumers’ Choice Health Plan, Coventry Health Care of the Carolinas and Blue Cross Blue Shield of South Carolina.

“(KershawHealth) is a participant -- we have contracts -- with all but Consumers’ Choice Health Plan,” Bunch said.

CEO Donnie Weeks said KershawHealth is negotiating with Consumers’ Choice, but said “it may or may not happen.”

Responding to a question from Vice Chair Dr. Tallulah Holmstrom, Bunch said hospital-employed physicians should be covered by those plans.

“We’re going to need to look at the various disciplines, like radiology … we’ll have to assess all those and that’s on the radar in addition to the Consumers’ Choice negotiations,” Bunch said.

Each of the qualified health plans are in one of four tiers of coverage: bronze, silver, gold and platinum.

“Bronze covers 60 percent of the actuarial value of the benefits. Silver, 70 percent; gold, 80 percent; and platinum 90 percent,” Bunch said. “The less you pay up front in premiums, the more risk an individual will have when you use the service. Less premiums up front means when they go to use the service, they’ll have to pay more through deductibles or co-pays, and the higher the coverage -- like platinum -- means an individual will pay more up front and less out-of-pocket when they get the services.”

Next, Bunch went through the essential health benefits offered by the qualified health plans, which must at least include the following 10 categories:

• ambulatory patient services;

• hospitalization;

• maternity and newborn care;

• mental health and substance abuse programs, including behavioral health treatment;

• prescription drugs;

• rehabilitative and habilitative services and devices;

• laboratory services;

• preventative and wellness services and chronic disease management;

• pediatric services, including oral and vision care.

“What the aim is -- back to that apples to apples comparison -- the exchange program is, essentially, going to guarantee that any of the plans cover these basic services. However, back to the bronze, silver, gold and platinum, the out-of-pocket varies based on which level an individual would pick for these various services,” Bunch said.

He also said the plans cannot charge more or deny coverage based on pre-existing conditions or gender; there are limits on premium variation based on age; there is a ban on annual and lifetime limits; and all plans include an out-of-pocket maximum of $6,350 for an individual and $12,700 for a family.

According to the SCHA information Bunch used in his presentation, there are various economic benefits for consumers signing up through the exchange. They include premium tax credits and cost-sharing reductions related to the federal poverty level. There are also penalties for either not having private insurance or signing up for coverage through the exchange. However, there are also exemptions from being required to purchase health insurance. These include certain financial hardships; being uninsured for less than three months; religious objections; being a Native American, prison inmate or an undocumented immigrant.

Although the rules have so far been delayed for one year, businesses with 50 or fewer employees will not be required to provide health insurance to their employees. Businesses with 50 or fewer full-time equivalent employees can use the Small Business Health Options Program to offer coverage to their employees.

Bunch said the federal marketplace could extend coverage to many people, but that many of the state’s most vulnerable residents could be left out of coverage. He also said political challenges still exist against full implementation of the Affordable Care Act.

Finally, Bunch also noted that while South Carolina declined to expand its Medicaid services, the state Medicaid agency is spending additional money to deal with a possible additional influx of applicants.

Why?

“As residents start going into these (exchange) websites and start filling out all their information, all their financial details, and they start to look and pick plans, some individuals are going to determine that they’re already eligible for Medicaid,” Bunch explained. “It may be in the form of they’re not eligible, but their children are eligible. So, it could be a variety of ways that individuals will discover that they are, in fact, eligible for Medicaid.”

Bunch said it is estimated that some 240,000 South Carolinians who are eligible for Medicaid are not enrolled in the program.

In response to a question from the board, Bunch said KershawHealth’s CAC efforts with patients will be passive. Instead of seeking out patients to educate, they will respond to requests for assistance. One trustee suggested KershawHealth could easily identify patients who are frequently using services who might need assistance with the healthcare exchange.

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