Nevada Health Link

June 12, 2013

Implementation Challenges

AHIP’s Exchange Conference

Operated by the Silver State Health Insurance Exchange

Agenda

1. Goals of the Exchange

2. Status of Implementation

3. Finance and Sustainability Plan

4. Outreach and Education

Can we do what we

say we will do?

Goals of the Exchange

• Increase the number of insured persons in Nevada

• Measures: Enrollment; uninsured rates

• Facilitate the purchase and sale of health insurance

• Measures: Satisfaction surveys; appeals rates; unsubsidized

enrollment; percent of customers that stay with their plans in

subsequent years; budget; PMPM costs

3

Strategic Plan

Goals of the Exchange

• Assist qualified employers in the enrollment and purchase of

health coverage and the application for subsidies for enrollees

• Measures: Employer enrollment; satisfaction surveys

• Provide consumer education on matters relating to enrollment in

and effective use of health insurance

• Measures: Awareness; seminar attendance; satisfaction

surveys

4

Strategic Plan

Goals of the Exchange

• Assist residents of Nevada with access to programs, premium

assistance tax credits and cost-sharing reductions

• Measures: Testing; secret shoppers; unscheduled web portal

down time; enrollment within one session; enrollment within 7

days

5

Strategic Plan

Can we meet these measures?

• Nevada has received Conditional Certification from the Secretary of U.S.

HHS to operate a State-Based Exchange

• The Exchange Board has approved 35 substantial recommendations of

the Advisory Committees

6

Status of the Development and

Implementation of Nevada Health Link

Are policies appropriate to

ensure geographic coverage?

Do Nevada policies add cost?

New regulations?

• IT Implementation is on-time: Eligibility Engine (DWSS/Deloitte) and

Business Operations Solution (Exchange/Xerox) will meet the October 1,

2013 deadline for operability

7

Status of the Development and

Implementation of Nevada Health Link

Will the Federal Hub be ready?

Will testing go smoothly?

Will certification go smoothly?

• Eleven group carrier onboarding meetings complete (January-May)

• Ongoing one on one meetings in tech, ops and fulfillment tracks

8

Status of the Development and

Implementation of Nevada Health Link

Will QHP rates and plan designs

be correct in system?

Will enrollment be effectively

communicated?

Will billing be correct?

• ACA Federal Establishment Grants

• Fees Charged to Carriers for

Exchange Enrollment

• Advertising

9

Finance and Sustainability Plan

Will fees disadvantage QHPs?

Are reserves and fees sufficient?

Staffing Plan Staff for policy and

contract support only

10

Executive Director

Executive Assistant

Chief Operating Officer

Grants and Project Analyst

Finance & Research Officer Information Technology

Officer Communications Officer

Administrative Assistant

Information Technology

Analyst

Training Officer

Quality Assurance Officer

Benefits Manager

Administrative Assistant

New Positions (4)

Effective 7/1/13 and 10/1/13

Current Positions (9) Board

Are staffing levels appropriate?

Outreach and Education • Plan for Navigators, Enrollment Assisters and Producers

- 44% of enrollees will use Exchange Enrollment Facilitators (EEFs)

• Certified by the DOI – AB425

• Navigators - $370,000, ~34 individuals in FY 2014

• Enrollment Assisters - $1,826,000, ~169 individuals, FY

2014

• Certified Application Counselors – not paid by Exchange

11

Are EEFs sufficiently trained?

Do we have enough EEFs?

Outreach and Education • Plan for Navigators, Enrollment Assisters and Producers

- 22% of enrollees will use Brokers and Agents

• Paid by carriers

- 30% of enrollees will use Web Portal with the help of a Call Center

• 50 plus individuals in Las Vegas (staff size flexes with

demand)

- 4% of enrollees will use Web Portal alone

12

Can the call center meet demand

(staff size; training)?

Will Brokers step up?

Marketing/Branding/Outreach

• $5,419,900 budget for 15 months

• Contract began January 2013

• Goal: Enroll 118,000 persons, mainly in 138% to

400% of FPL

• Reach hundreds of thousands of Nevadans

directly with outreach

13

Overview of Marketing/Outreach

14

Outreach

• Partnering with numerous

non profits serving this

population

• Presence at events, festivals,

neighborhood venues

• Presentations; Door to door campaign

• Grassroots, person to person approach

15

Will outreach be sufficient?

Nevada Health Link Operated by the Silver State Health Insurance Exchange

2310 South Carson Street, Suite 2

Carson City, NV 89701

(775) 687-9939

contact@exchange.nv.gov

www.exchange.nv.gov

We will be ready