Tribal-Sponsorship-

Tribal Premium Sponsorship

KTPSP

The Klallam Premium Sponsorship Program (draft) of our policies and procedures, 'draft 3' , changes are necessary to the plan and your comments welcome.

Fond du Lac Band Planning Guide

See Premiums and Subsidies Chart (for premiums up 300% of federal poverty level (FPL).

Determining Parameters of the Program

Developing a 'Straw Man' Program

Getting Community Input

Getting Council approval

Developing an implementation plan

Refining Proposal

Implementation

Evaluation

Modifications

KTPSP Program Launch Date: July 1, 2013

Application Assistance October 1, 2013

Coverage Begins January 1, 2014.

Next Health Care Reform Informational is at the Strong Family Faire, May 24, 2013. There will be gifts, prizes, and useful sponsorship items (well fridge' magnets and bookmarks).

Timeline:

Fall 2012 Develop Initial Program proposal

Present a draft proposal to council in January 2013.

October 1, 2012 Health Care Reform Staff Meeting so staff can prepare for community input

Februrary 2013 Community Mtg

December 2012 Approve Budget for 2013

January - March 2012 Develop Eligibility Guidelines

June 2013 Approve Program (and budget)

July 1, 2013 Program Launch Date

July 1 to October 1 Community Members can review their eligibility, view options while they help the TSP program estimate costs.

September 2013 Appointments for enrollment

October-December 2013 Application Assistance

January 2013 set aside $240,000 for proposed 2014 Health Insurance Trust Fund ($200,000 to $300,000) to be approved for 2014 budget.

January 2014 Coverage Begins, first monthly payment ($30,000 to $75,000 ) to health insurance exchange.

Monthly reports on Insurance payments to health program

July, 2014 consider changes to eligibility based on revenues from new payors (insurance) and CHS savings. Estimate the cost of insuring any remaining uninsured community members.

Goal of the

Klallam Tribal Premium Sponsorship Program (KTPSP)

Ensure that a Tribally-defined set of community members is 'connected' to the most appropriate coverage for their families.

CHS program enhanced to provide more services for all CHS eligibles and those who may still not have health insurance in 2014.

Added resources used to address Tribal Council's Priority Goal on Prevention

It is likely in 2014 many more will have health insurance coverage, but some may not change anything and still depend on the clinic and CHS program without insurance coverage.

Sign contracts with Exchange health plans so health program can be paid for services provided (using Indian Addendum)

All tribal members and their families will have expert application assistance at their disposal beginning July 1, 2013 we can determine likely eligibles.

Tribal financial support program will have certain conditions of participation (e.g., provide income and insurance information, agree to update, use our health services program).

Enrollment in new health insurance coverage begins October 1, 2013 and actual coverage January 1, 2014.

We need to determine (we do not know) how many will be eligible for financial assistance from the Tribe for the purchase of health insurance but we will examine:

1. How many are uninsured patients of the clinic (100-200)

2. How many community members are uninsured, but not currently patients of the clinic

3. Who is underinsured-some coverage, but not the best value for what they or their employer are paying.

4. Who is paying too much (for example more than 10% of their income) for insurance.

Estimates of the number of the above will be refined, but it is between 120 and 200, not the 200 and 500 persons originally estimated. This is the group who may receive financial assistance to become fully insured.

What are the insurance options for the above....?

ACA Income Categories spreadsheet.

139% Medicaid threshold WA and OR and lower threshold for exchange plans and subsidies

300% upper limit for no-cost sharing for AIANs in exchange health plans

400% upper limit for subsidies and reduced rate insurance (for elders)

Take the Edmonds-Kingston Ferry to visit to the

Port Gamble S'Klallam Tribe.

Nov 2012 Ready for Reform Newsletter Article

Oct 10, 2012 Letter of appreciation to Insurance Commissioner, Office of Insurance.

Port Gamble S'Klallam Health Department for more information about this initiative and others.

February 1, 2012 Ready for Reform Meeting with Washington Tribes (18 tribes, attendance 75)

October 1, 2012 Health Services Department Health Care Reform Meeting Agenda

Tribal Council, November 27, 2012 Sponsorship Update (w corrections)

Special Provisions for Indians in the Affordable Care Act (National Indian Health Board 2010)

Special Provisions for Indians in the Affordable Care Act (CCIIO 2012) Presentation

Who are our uninsured? How do they differ from uninsured in the general population?

Description of General Population (Oliver Wyman)

February 1, 2013 Community and Staff Pizza and Health Care Reform Meeting

See chart for estimated premium cost for single adult

See Milliman Report

Nearly all our patients are AIANs are also enrolled tribal members, but some spouses are not and even some children are non-Indian

Definition of Indian, key element to consider

Sponsorship will cover all uninsured CHS-eligible and Exchange-eligible PGST tribal members (adults) under 300% of poverty because cost sharing exemptions make plan choice easy and very affordable and a great value (Children will be Apple Health/CHIP). A high value plan at the cost of the Bronze Plan.

Working Chart, IHS HQ, for planning purposes

The sponsorship program considers the tribal employee health benefits in planning, but it operates separately from decisions on that program that are develop by Human Resources Dept.

Cost-Benefit Scenarios

1.5 to 2.0 Cost Benefit Ratio will be typical for most Indian health programs if upper limit of sponsorship is set at 300%.

It is very likely that the cost of premiums will be less than the estimated payments for the 'average' medical services for the newly insured for anyone under 300% of poverty.

300% of Poverty Chart

Tribes can sponsor at any income level, this restricts to income range where there is no cost sharing, only premiums (after tax credits).

First estimate was $425,288 in premiums for 195 'lives' in 125 families in 3 income categories and 3 different family sizes

$300,000 in premiums for 120, $500,000 for 180 if spouse of employees who are tribal members are included.

Fond du lac estimates $492,000 in premiums for 180 lives if no children are included-using the TEOC model based on FDL experience.

Range of values under 300% of poverty where subsidies are highest and there is no cost sharing.

For families with both Indian and non-Indian family members CMS will require Qualified Health Plans (QHPs) to offer 2 separate Indian-specific plans for each plan offered in the Exchange.

edfox_phd@yahoo.com 360 710 0728

105 Maple Park Ave SE Olympia,WA 98501

Free and unlimited use granted, citation appreciated

edfox_phd@yahoo.com 360 710 0728

105 Maple Park Ave SE Olympia,WA 98501

Free and unlimited use granted, citation appreciated

This table in a word document

This table in a larger spreadsheet with premiums that vary by income, designated ages, and family size to 4.

When should a tribe buy Exchange Marketplace Insurance? 3 decision rules that do not require cost benefit analysis: 50%, 300% and Hybrid.

KTPSP

Klallam Tribal Premium Sponsorship Program! This page provides updates on one tribe's planning, policy consideration, and implementation of a sponsorship program to buy health insurance for CHS-eligibles.

April 5, 2013 Community and Staff Pizza and Health Care Reform Meeting

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