State eyes one family, one card health coverage

Tennessee’s health insurance exchange developers have been considering a new option that aims to streamline health care coverage for poorer families in the state as key health system reforms take effect in 2014.

The proposal, known as the “One Family, One Card Across Time” or “Bridge” option, arose from concerns that the Affordable Care Act’s 2014 coverage expansions would result in a fragmented, uncoordinated eligibility system, said Brian Haile, director of the state’s insurance exchange planning initiative.

Situations may arise in which a family has four insurance cards at any one moment, Haile said. A child younger than 5 may be eligible for Medicaid, while another who is 6 to 18 years old might qualify for the Children’s Health Insurance Program. If the mother is pregnant, she would be eligible for Medicaid, he said. The father, depending on his income level, might be eligible for premium-assisted tax credits for private coverage under the insurance exchange.

Shifts in household composition or income level could change a person’s eligibility status, resulting in displacement of coverage. A family that adds a new member, for example, might trigger a special enrollment or eligibility redetermination, Haile said. As a result, “this poor family can go through nine different insurance cards in just 90 days.”

The state wanted to come up with an option to help stabilize insurance situations for these types of families so they could have one card that allows the use of a single network of health professionals, Haile said. No special application would be required for these families, and the “Bridge” would be just one product of many that would be offered on the state’s health insurance exchange, he said.

Yarnell Beatty, director of the legal and government affairs division with the Tennessee Medical Assn., said the association was carefully studying the proposal. “However, at this time, the TMA has no position on the Bridge option,” he said.

One Tennessee physician, Reid Blackwelder, MD, said the program appeared to be a “creative approach to addressing the unique needs of families who may well have several different coverages in place, creating confusion and a risk of interrupted care.” Any process that seeks to reduce administrative hassles “is a step in the right direction,” said Dr. Blackwelder, president-elect of the American Academy of Family Physicians.

At this point, there is no income eligibility cap for the program, Haile emphasized. The state is trying to stay away from artificial income limits because “we want to meet families where they are. If their income changes and they shift eligibility status, they can go from one category to the next, but they can maintain that one family, one card motif.”

The Medicaid managed care plan in which the family is enrolled will determine which network the family uses. “We’re 100% Medicaid managed care, and with very few exceptions, all families are enrolled in the same Medicaid managed care organization,” Haile said.

The state has three Medicaid managed care organizations: BlueCross BlueShield of Tennessee, UnitedHealthcare and Amerigroup. If the family members are in Amerigroup, for example, they would have the option of enrolling in the Bridge plan or another qualified health plan that Amerigroup offers, he said.

Mary Danielson, director of corporate communications for the Tennessee Blues plan, said the insurer understood and supported the need “to increase access to affordable coverage and for the state exchange to be as simple as possible for the consumer to use.” BCBS of Tennessee is working to respond to a state request for information to “help address how the Bridge card could support these goals,” she said.

The benefit design, which will be issued by a designated managed care plan, will be different for each relative to reflect eligibility status. “Some family members are going to have a Medicaid benefit design, some family members are going to a benefit design related to their premium tax credit,” Haile said. The point of the proposal is that families should at least have the option to use the same underlying network and insurance card regardless of their eligibility category.

The program is one of several options that the state may consider if it were to move forward with a state-based insurance exchange, Haile said. States have until Nov. 16 to announce their intentions to launch a state exchange to the Dept. of Health and Human Services. They have until Dec. 14 to submit blueprints for those insurance marketplaces. “If the governor directs us to move forward [on a state-based exchange], we would strongly consider doing something like the Bridge,” he said. The state also is awaiting final legal approval from the federal government to go ahead with this option.