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The Three-Share Approach
Eileen Ellis
Health Management Associates
April 21, 2006
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=
Covering the working uninsured
lMore than 45 million people uninsured
–More than 60 million at some time during a year
lMore than 2/3 of the uninsured are employed
–o= r a dependent of an employed person, and
–= Many work for firms that do not provide insurance, or
–The cost of insurance is prohibitive for lower wage workers. <= /span>
–About 20% of working uninsured work for smaller employers
–
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=
Local solutions
lBecause there is no appa= rent national solution
lA numbe= r of local communities have undertaken the development of county-based initiatives to subsidize premiums for workers in fi= rms not able to provide coverage on their own.
lCurrent= ly 6 plans in Michigan, 3 plans in Illinois, under discussion in Ohio, Oklahoma and Texas.
lSeveral have bee= n in operation for several years.
l
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=
What does “Three-Share” mean?
lThree-Share means cost is split between:
lEmployer
lEmployee
lPublic or Community Subsidy
lEmployer is smal= l (usually <50 workers) & uninsured,= 3;
l with relatively low median w= age (usually <$15/ hour)
lPublic subsidy does not mean an increase in cost of caring for indigents.<= span style=3D'font-size:71%;display:none'>
l
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=
How does “Three-Share” work?
lThe community decides:
lWho is eligible
–= Size of firm, wage levels
–= History of insurance coverage
–= Length of employment, part time / full time
lWhat benefits are covered
–= Copays
–= Deductibles (generally zero or very small)
lChoice of insurer and provider
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=
Why does “Three-Share” work?
lBy splitting the financial responsibility, Three-Share ensures that each party has a vested interest in the program’s success.
– Even more important
lThe subsidy, by making the program less expensive, ensures the retention of workers with lower health care costs, thus stabilizing the program for all workers and firms.
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=
How does the subsidy work?
l= Many counties already subsidize indigent care
lWith cooperation from the State’s Medicaid agency, these funds can be increased by the Medicaid match by using a = CPE or IGT.
lThe increased funds can then be used to provide the subsidy for the new program.
lPlan costs between $150 and $250 PMPM, <= /div>
lSubsidy between $50 and $80 PMPM.
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=
How about financing? Illinois
lLocal Departments of Health (DoH) are = currently paid less than cost for Medicaid services
lCounty/City certifies Medicaid loss to State Agency under an intergovernmental agreement
lState Agency increases federal payments to <= span style=3D'position:absolute;top:71.0%;left:13.1%;width:82.77%;height:6.0%'>= DoH
lDoH uses extra funds to finance coverage for = uninsured using a Three Share arrangement
–
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=
How about financing? Options
lBeyond the methods used by IL:
–States with room in DSH cap should look to MI =
–States with Constitutional requirement to provide for the indigent could use existing County funding as “seed money” = to expand federal funds by providing coverage of indigents or increased funding for under-paid providers who cover the indigent
–States could use waiver authority to provide coverage for limited benef= its for those who could spend down to Medicaid.
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=
Michigan Models – Not Insuran= ce
lWayne County Health Choice – begun in 1994&#= 13;
lServices provided & paid for by 3 competing managed care plans
–Unlicens= ed subsidiaries of licensed HMOs
lCurrent enrollment more than 4,000 members
lMuskegon County Access Health– begun in 1999=
lServices provided and paid for by Access Health (not an insured product)
lCurrent enrollment over 1,000 members
lClaims administered by a third party administrator, but risk retained by Access Health
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=
Michigan Models – Insurance
<= span style=3D'font-size:86%'>lUnderwritten by a licensed insurer
<= span style=3D'font-size:86%'>lFirst dollar covera= ge
<= span style=3D'font-size:86%'>lNominal copayments&= #13;
<= span style=3D'font-size:86%'>lAnnual and lifetime limits on benefits
lIngham, Kent & Washtenaw Counties
<= span style=3D'font-size:86%'>lBegun in 2004 & 2005
lFour Star Plan = 211; Wayne County MI (Fall 2005)
lSponsored by Wayne = County and 4 Health Systems
<= span style=3D'font-size:86%'>lHealth Systems comp= rise provider network
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April 21, 2006
Health Management Associates
12
=
Winnebago County, Illinois
lHealth Access Plan
<= span class=3DBB style=3D'position:absolute;left:-4.57%;top:.3em'>lBegun = in July of 2003
<= span class=3DBB style=3D'position:absolute;left:-3.97%;top:.3em'>lUnderw= ritten by Pan American Life Insurance
lEnroll= ment will be limited to 3,000 once funding is secured.
<= span class=3DBB style=3D'position:absolute;left:-4.57%;top:.3em'>lCurren= tly covering 50 members.
------=_NextPart_01C66E98.2CE705E0 Content-Location: file:///C:/2087BD93/EileenEllis_files/slide0032.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The Three-Share Approach
April 21, 2006