(Credit: Central Health District)
Central Health has started contacting a select group of high health-need patients who receive care through its Medical Access Program (MAP) or on a sliding fee scale to offer them the opportunity to enroll in private health insurance, which offers more comprehensive health coverage compared to what they have now.
For a limited number of patients, Central Health’s nonprofit health insurance company – Sendero – is offering an expanded version of its current IdealCare health plan. Central Health will cover the costs of insurance premiums for select MAP and Sliding Fee Scale (SFS) program patients who choose to move to the new plan, called CHAP (aka Central Health Premium Assistance Program) IdealCare by Sendero. By moving patients from MAP and SFS to Sendero, Central Health will leverage local tax dollars for patient care available through the Affordable Care Act (ACA).
“A limited group of patients with very specific health situations will have access to more comprehensive health coverage through private insurance than what they have now,” said Mike Geeslin, President and CEO of Central Health. “One of the most important benefits of moving to private insurance is access to a larger network of doctors. However, no one is required to leave the MAP or the Sliding Fee Scale program and enroll with Sendero – it’s the member’s choice.”
If a certain number of MAP and SFS members choose to move to Sendero, it can draw down more federal funds from the ACA’s Risk Adjustment Program. The program is designed to compensate insurers in the Health Insurance Marketplace whose members are sicker and require more services – and cost more to cover. Insurance plans with healthier members pay into the program since theoretically healthy members have fewer claims and are less expensive to cover.
“Sendero’s members historically have been healthier, which is a good thing,” said Wes Durkalski, President and CEO of Sendero, “But as a result, we’ve had to pay into the Risk Adjustment Program instead of drawing money out of it. Our goal is to flip that – pull money down from the Risk Adjustment Program and use those funds to help some of Travis County’s sicker patients access more comprehensive health coverage through CHAP IdealCare by Sendero.”
Last week, Central Health’s Eligibility Team began calling MAP and Sliding Fee Scale patients with high health needs to schedule in-person meetings to discuss their options. Interested patients will meet in person with a Sendero representative who can answer specific questions about what doctors and benefits are included in the plan.
“We’re emphasizing that there will be no lapse in health coverage for MAP and Sliding Fee Scale members,” said Kit Abney Spelce, Senior Director of Eligibility Services. “If someone is eligible and they choose to move to IdealCare by Sendero, their existing MAP or Sliding Fee Scale coverage will end on Dec. 31, 2018. Their coverage with CHAP IdealCare by Sendero will begin, Jan. 1, 2019 and continue through December 31, 2019.”
Abney Spelce added that funding for this program is available for one year. If funding is no longer available after one year, eligible participants will have the option to return to MAP or the SFS program.
Background
The Central Health Board of Managers voted Sept. 22 to provide additional funding for Sendero – $26 million in FY 2019 – in part to pay for this new strategy in an effort to make Sendero financially stable. Additional funding for Sendero comes with a strict set of conditions from the Central Health Board of Managers. “No money will be spent until our CEO presents a viable strategy that includes outcome measures and objectives reported to the board no less than quarterly,” said Board Chair Dr. Guadalupe Zamora. “If explicit outcomes and measures are not met by June 2019, the board made it clear it will cap future funding for Sendero, which could result in an exit from the insurance market. We want Sendero to survive and we believe this is its best chance.”
