COVER OREGON UPDATE ROCKY KING, EXECUTIVE DIRECTOR NOVEMBER 20, 2013 PAGE 1

COVER OREGON UPDATE ROCKY KING, EXECUTIVE DIRECTOR NOVEMBER 20, 2013 PAGE 1

OREGON S STRATEGY Provide access to affordable, quality health care for Oregonians, including 560,000 uninsured Create a single portal for OHP, Healthy Kids, tax credits, commercial plans (individual and small employer markets) Feature apples-to-apples comparisons of plans, including searching for your doctor Help small employers provide full range of options to employees (all plans, all carriers) PAGE 2

OREGON S STRATEGY Encourage competition and transparency 11 medical carriers in the individual market program 8 medical carriers in small employer program Portland has the lowest premium rates of 18 major cities Reach Oregonians where they live, work and play Through community partners and agents around the state Strategic education, outreach and marketing campaigns PAGE 3

OREGON S CHALLENGE Comprehensive program goals leads to complexity Scope Other states Washington California PAGE 4

OVERALL TIMELINE Oct. 1, 2013: Dec. 4, 2013: Dec. 15, 2013: Jan. 1, 2014: Open enrollment begins Deadline to submit paper application Deadline to enroll for coverage starting Jan. 1, 2014 Coverage for commercial plans begins March 31, 2014: Open enrollment ends for individual market commercial plans PAGE 5

COVEROREGON.COM PAGE 6

HOME PAGE PAGE 7

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FINDING AGENTS/COMMUNITY PARTNERS PAGE 9

BROWSE PLANS PAGE 10

IT UPDATE PAGE 11

STATUS UPDATE May 2013: Cover Oregon took over management of IT project from OHA Aug. 2013: Decision made to launch with agents and community partners Sept. 2013: Delayed launch of public and CPA portal for further development and testing Oct. 2013: Contingency plans for paper applications implemented Stepped up hiring of temporary staff Enlisted assistance from OHA PAGE 12

STATUS UPDATE IT system is complex, but it is not broken Systems and processes are secure met federal requirements Needed more time to adequately test systems System Integration User Acceptance Regression Performance Security PAGE 13

Individual Working About Cover Oregon Quick browse Get started In Progress Eligibility Determination Plan Selection Enroll PDF Application Portal Application Portal Data Verification PAGE 14

Tribal Complete About Cover Oregon Register Tribe In Progress Set Tribal Sponsorship Member Management Dashboard PAGE 15

Employer Complete About Cover Oregon Anonymous Quote In Progress Group Setup My Account Apply Create Plan Universe PAGE 16

Employee Complete About Cover Oregon Apply In Progress Plan Selection Confirm My account PAGE 17

CPA Complete About Cover Oregon In Progress My account Become CPA Account Set Up Manage clients PAGE 18

Customer Service Complete External Account Create In Progress Backend Application Integrated Voice System Service Request Create Ticketing System Backend Application Application Review Backend Enrollment Manual Medicaid Cont. PAGE 19

Carriers Complete Rate/Benefit Validation Small Group Quote Provider Directory In Progress Carrier Assessment Billing & Reconciliation Enrollment PAGE 20

Interfaces Complete CMS Interfaces SERFF In Progress Medicaid Enrollment Employment Department Medicaid Verification Bank Transactions PAGE 21

Global Functions Complete Internal Billing Account Provisioning In Progress Environments System Integration Medicaid Verification Message Center Document Center PAGE 22

MANAGING THE IT PROJECT Vendor selection Cover Oregon has taken successive and escalating actions Performing code reviews Escalating to senior VPs over summer Requiring VP level onsite management Reorganized development approach, breaking down silos Withholding payment for development services pending discussions with vendor 5% hold back (per contract terms) PAGE 23

ORIGINAL IT DEVELOPMENT TIMELINE System Development & Testing Internal System Use Coverage Begins i15* i16 i17 Nov-Dec 2012 Jan-Feb 2013 Mar-Apr May-Jun Jul-Aug Sep-Oct Nov-Dec Jan-Feb 2014 UAT IV&V System Training Open Enrollment PAGE 24

FUNCTIONAL DELIVERY TIMELINE (OCT-DEC) Oct. 1, 2013 Oct. 15 & 30, 2013 Nov. 18, 2013 Target Nov. 25, 2013 Target Dec. 9, 2013 Target Dec. 16, 2013 Full exchange, including SHOP and Individual DEADLINE MISSED Full exchange, including SHOP and Individual DEADLINE MISSED Eligibility determination provided by CPAs COMPLETED Ability to manually enroll through the system backend PROJECTED COMPLETION Full end-toend functionality through CPAs PROJECTED COMPLETION Full system (minus SHOP and Tribal registration) PROJECTED COMPLETION Ability to start but not finish application DEADLINE MISSED PAGE 25

GETTING ENROLLED IS WHAT MATTERS PAGE 26

HOW TO APPLY (PAPER APPLICATION) Fill out application and send to Cover Oregon Cover Oregon determines eligibility for tax credits, OHP and Healthy Kids Applicant receives letter notifying them what they are eligible for If eligible for a private plan, applicant receives packet to select plan; If eligible for OHP, automatically enrolled! Applicant chooses plan and sends packet back to Cover Oregon Applicant is enrolled in private plan! (pay premium to carrier) PAGE 27

OUTREACH GRANTS 31 Outreach and Enrollment Grants 18 Provider Outreach and Enrollment Grants 14 Public Education and Outreach Grants 10 Small Business Grants 6 Tribal Grants PAGE 28

FAST TRACK ENROLLMENT For families pre-screened as newly eligible for OHP based on SNAP applications or kids enrolled in Healthy Kids More than 260,000 Oregonians received letter from OHP/Healthy Kids letting them know they re eligible If people receive a notice, they just need to fill out and sign the form and send back Once they send back the form, they ll get coverage starting Jan. 1, 2014! More than 70,000 Oregonians have already signed up! More info at: http://ohp.oregon.gov/ PAGE 29

APPLICATION FAIRS Cover Oregon is helping Oregonians around the state to complete the application: Nov. 20: Medford Nov. 21: Eugene Nov. 22: Bend Nov. 23-Nov. 24: Portland Nov. 25: Salem PAGE 30

UPDATING OUR PROJECTIONS PAGE 31

CURRENT STATISTICS COVER OREGON METRICS Reporting Period: 10/1/13 11/18/13 Paper and Electronic Applications 1 24,486 Eligibility Determinations 2 1,371 Electronic Accounts 3 4,223 Calls to Customer Service Center 4 39,465 Total Visits to CoverOregon.com 796,887 Unique Visits to CoverOregon.com 6 470,752 1-Includes applications received by mail, fax, and fillable PDF. To be counted, an application must have the applicant s name and sufficient contact information to reach the applicant. 2-Number of people Cover Oregon has determined eligible for OHP and QHPs. Includes both manual and electronic system determinations. 3-Consumer accounts created on the web portal by agents and community partners. 4-Calls that entered the Service Center s interactive voice response system. 6-Estimate based on unique cookie values in the visitor s browser. PAGE 32

ENROLLMENT PROJECTION REVISIONS Evaluated how current realities and Cover Oregon delays may impact enrollment Still modeling the impacts of grandfathering existing plans Revisions result in: Lower projections of enrollment across the Individual and Small Employer programs Individual enrollment occurs later in the 2014 open enrollment period Small Employer Program enrollment begins later in 2014 due to delayed program launch PAGE 33

ENROLLMENT COMPARISON Prior QHP Projections 500,000 433,400 400,000 377,400 341,400 321,500 107,300 285,400 97,500 300,000 87,800 249,600 87,800 217,800 193,700 78,000 200,000 58,500 128,100 56,600 48,800 326,100 279,900 29,300 233,700 253,600 100,000 207,400 161,200 191,100 144,900 98,800 0 Low Mid High Low Mid High Low Mid High CY 2014 CY 2015 CY 2016 (New) Revised QHP Projections 500,000 399,400 400,000 325,900 93,000 300,000 274,500 256,000 218,400 89,200 85,300 191,200 51,900 200,000 165,700 165,600 45,400 114,200 28,500 46,700 40,900 306,400 100,000 25,700 236,700 189,200 137,200 173,000 204,100 88,500 124,700 144,500 0 Low Mid High Low Mid High Low Mid High CY 2014 CY 2015 CY 2016 *As of December 31st of each year Individual SHOP Reduction 9% 24% 15% 12% 23% 14% 21% 25% 8% PAGE 34

FINANCIAL UPDATE Federal grant funds through 2014 No state funding Starting in 2015 must be self-sufficient, raising revenue through an administrative charge on carriers and state programs Using contract negotiations and remedies to keep expenditures within overall projected amounts Temporary staffing through open enrollment was accounted for in budget paper application process just moved up timing of hires PAGE 35

GRANT SNAPSHOT TO DATE Grant Total Budget Budget Remaining Grant Expiration Date Level 1, Tier 1 $11,164,600 $0 August 13, 2013 Level 1, Tier 2 $6,682,701 $0 May 15, 2014 Level 2 $226,442,074 $147,107,441 December 31, 2014 Total $244,289,375 $147,107,441 PAGE 36

OPERATING STATEMENT JAN-SEPT 2013 Total Actuals Budget Variance Operating Revenues (federal grant) $85,142,163 $88,995,312 ($3,853,149) Operating Expenses $85,628,691 $88,995,312 ($3,366,621) Total Net Income/Loss ($486,527) $0 ($486,527) PAGE 37

FOLLOW-UP TO 2013 SESSION PAGE 38

HOUSE BILL 2118 Quality Metrics Workgroup appointed and now meeting On track to complete work in May PAGE 39

DISCUSSION AND QUESTIONS PAGE 40

CoverOregon.com PAGE 41