Galveston County 3 share Proposal Dr Barbara Breier

Galveston County 3 -share Proposal Dr. Barbara Breier, Asst. Vice President for Strategic Initiatives & Director, Center to Eliminate Health Disparities February 9, 2007

What is the 3 -Share Plan? • A collaborative effort – UTMB – Galveston County Chambers of Commerce – Member businesses • A program to provide coverage for the working uninsured, modeled after a successful effort in Muskegon, Michigan.

Galveston 3 -Share Plan • Provide health benefits for working individuals & families – Focus on primary and preventive care needs – Emphasizing the improvement of health status through managing chronic diseases and involving individuals in managing their own care • Costs of the coverage split between – employer – employee – state and local government. • Allow for low monthly health premiums, thus improving accessibility

Key Legislation • Social Security Act, Section 1115 – Modify SCHIP & Medicaid Programs • Health Insurance Flexibility Accountability Waiver (HIFA) – Modify Benefits packages – Public private partnerships – Expand to previously uncovered adults

Development Process Community Activities Outside Validation • Galveston Employers Survey Saurage Marketing Study: Representative Sample of Galveston County Employers n=160 • 21 Focus Groups (CHAT) • Galveston County Chambers of Commerce • Civic Organizations • Cover the Uninsured Week: Letters to the editor, Lecture Series, & Religious Leaders’ Breakfast Media Coverage • Galveston Daily News • Houston’s FOX News • Texas Medicine Magazine • Guidry News Website

Galveston Employer Survey 248 Employers Surveyed 4819 Employees Employee Profile Average of employee: 41 54% Male 46% Female 53% White Non Hispanic 26% Hispanic 22% African American 1% Asian

CHAT Software Program • Choosing Health Plans All Together – created by the U. of Michigan and NIH • Utilizes national averages to compute cost of health care coverage • Players are allotted 50 markers to “purchase” health benefits • 15 benefits are available –full range • 4 Rounds of game played – individual, small group, community, and individual

CHAT Game Board

CHAT Preliminary Results Top Priorities Lowest Priorities 1. 2. 3. 4. 5. 6. 9. Dental 10. Mental Health 11. Uninsured 12. Home Health 13. Vision 14. Infertility (N/A) 15. Alternative Med (N/A) 7. Pharmacy Primary Care Hospitalization Specialty Care Tests Other Medical (ambulance, equipment) Long Term Care/Last Chance (tied)

Actuarial Analysis • Can achieve $180 pmpm with limitations: • • Primary care/Specialty care – 12 v/yr Hospitalization – 30 day annual maximum Pharmacy - $1200/yr Mental Health – 20 v/yr 10% coinsurance w/$1000 annual maximum $50, 000 Annual Maximum Exclusions of high risk, experimental, vision, dental, etc. Care limited to UTMB HMO providers in Galveston County • No ER coverage outside of Galveston County

Eligibility Criteria for Businesses • Has been conducting business operations for at least one year (verified by IRS statements. ) • Has a minimum of 2 employees (including self) that have been employed in the business for one year (does not have to be the same employee). • Has filed appropriate IRS documentation for the reporting of income. • Has filed W-2’s for eligible employees noted above.

Eligibility Criteria for Businesses • Has its principle business location in Galveston County. • Employs 50 percent of its employees in Galveston County if employer has locations outside the county; • Has a median income of $50, 000 per year or less for all employees; • Has not offered group health coverage for the previous 12 months.

Eligibility Criteria for Employees Employee eligibility is determined by their income level and assets. They must be below 200% FPL and meet the State’s SCHIP ASSET TEST POLICY in order to be eligible for the federal match. *Additional funding is being secured to cover employees who do not meet SCHIP asset test criteria.

Where we are now • Waiver document has been reviewed by Texas DHHS • Texas DHHS has given approval and has sent to CMS for review • Met with CMS officials and have responded to their questions and are waiting further review and approval.

Business Plan & Marketing Next Steps • Business plan provides for 3, 000 participants for break-even over 5 -year period • UTMB HMO will administer the plan • Development of this program could not have been possible without support from the Kempner Fund

Market Potential for Statewide Model • Program can serve as a statewide model as an increasing number of businesses seek viable alternatives. • Individuals involved in decisions about their own healthcare create healthier workforces and communities. • Other communities have expressed strong interest including Harris, Travis, Dallas, Bexar and El Paso Counties. www. utmb. edu/cehd

Multi-share Legislation H. B. 882 • Allows for regional health care programs that provide health care services or benefits to the employees (and their dependents )of small employers (< 50 employees) • Flexibility for communities to address their own health needs with eligibility for counties, regional multi-county consortia or other non-profit entities designated by commissioners courts to run the program • Employers and employees are required to pay a share or cost of the program • No funding available in this bill, however encourages governing bodies to seek funds from grants, gifts, & donations

A Proposal for a Statewide Model for Multi-Share Plans for Small Business • Legislation would provide funding ($50 million) for the development of multi-share plans targeted to small businesses with <50 employees. • Flexibility for communities to address their own health needs with eligibility for municipalities, counties, hospital districts or regional multi-county consortia. • Provide planning and infrastructure grants as well as cost-sharing for the 3 rd Share. • Encourage the use of EMR and telemedicine as a tool for improving health outcomes. • Eliminate the need for a HIFA waiver by authorizing on a statewide basis. • Limited to 5 year grants for each entity.