HJBR Jul/Aug 2023

HEALTHCARE JOURNAL OF BATON ROUGE  I  JUL / AUG 2023 49 Michael P. Smith, MS Senior Vice President, Plan Product Louisiana Healthcare Connections reduces an enrollee’s monthly payments for insurance coverage, and the cost shar- ing reduction is designed to minimize out-of-pocket costs for a doctor’s visit or hospital stay. To receive either type of fi- nancial assistance, qualifying individuals and families must enroll in a Health Insur- ance Marketplace plan. In Louisiana, that is offered through Healthcare.gov. Any in- dividual who meets the financial eligibility criteria can receive premium tax credits. But to receive cost sharing reductions, a Silver tier plan must be selected. The marketplace’s enrollment assis- tance framework can also ease coverage transitions for Medicaid disenrollees. The marketplace websites, exchange call centers, navigators, certified application counselors, and community partners are all resources designed to help guide indi- viduals through the marketplace enroll- ment process as well as understand their eligibility requirements and coverage op- tions. Marketplace Tiers The minimum health benefits that all individual plans must cover are required, and, because the plans are divided into four tiers, it’s easier to compare “apples to apples.” Named after metals — Bronze, Silver, Gold, Platinum — the four tiers differ based on how the cost of healthcare services are split between the insured and the insurer. Bronze plans have the lowest premiums and higher cost sharing amounts. Gold and Platinum plans have progressively higher monthly premiums and lower cost sharing amounts. Many individuals though, espe- cially those with low incomes, will qualify for financial assistance in the form of pre- mium credits and cost share reductions. Those eligible for cost sharing reduction assistance must be enrolled in a Silver plan to receive those benefits. Those with low- er incomes will receive the most financial support. Continuity of Coverage Healthcare coverage — whether Medic- aid, other government coverage, employer based, or in the Marketplace — is import- ant. Individuals without coverage are less likely to have an established primary care provider, access to preventive services, and tend to have chronic needs. Addi- tionally, these factors contribute to higher healthcare costs for everyone. Awareness and education of health in- surance coverage options is important for everyone but especially for those individ- uals impacted by the Medicaid redetermi- nation process. The benefits of remaining covered under health insurance coverage benefit us all. n REFERENCES Wiker, S. and Wagner, J. “Unwinding the Medicaid Continuous Coverage Requirement: Frequently Asked Questions.” Center on Budget and Policy Priorities, The Center for Law and Social Policy, updated April 28, 2023. https://www.cbpp.org/ research/health/unwinding-the-medicaid-con- tinuous-coverage-requirement Murphy, N. and Millender, S. “How States Can Build Bridges by Smoothing Medicaid-to-Mar- ketplace Coverage Transitions.” Center for American Progress, Feb. 14, 2023. https://www. americanprogress.org/article/how-states-can- build-bridges-by-smoothing-medicaid-to- marketplace-coverage-transitions/ U.S. Department of Health and Human Services. “Fact Sheet: COVID-19 Public Health Emergen- cy Transition Roadmap.” Press release, Feb. 9, 2023. www.hhs.gov/about/news/2023/02/09/ fact-sheet-covid-19-public-health-emergency- transition-roadmap.html#:~:text=Based%20 on%20current%20COVID%2D19,day%20on%20 May%2011%2C%202023 Centers for Medicare and Medicaid Services. www.medicaid.gov Corallo, B.; Burns, A.; Tolbert, J.; Claxton, G. “What Happens After People Lose Medicaid Coverage?” Kaiser Family Foundation, Jan. 25, 2023. www. kff.org/medicaid/issue-brief/what-happens- after-people-lose-medicaid-coverage/#:~:text =KFF%20estimates%20that%20between%20 5,first%20time%20since%20March%202020. Centers for Medicare and Medicaid Services. “Temporary Special Enrollment Period (SEP) for Consumers Losing Medicaid or the Children’s Health Insurance Program (CHIP) Coverage Due to Unwinding of the Medicaid Continuous Enrollment Condition– Frequently Asked Ques- tions (FAQ).” Press release, Jan. 7, 2023. https:// www.cms.gov/technical-assistance-resources/ temp-sep-unwinding-faq.pdf Kaiser Family Foundation. “Explaining Health Care Reform: Questions About Health Insurance Subsidies.” Oct. 27, 2022. www.kff.org/health- reform/issue-brief/explaining-health-care- reform-questions-about-health-insurance- subsidies/ Responsible for the oversight of products and pro- grams designed to support the growth of Louisiana Healthcare Connections, Mike Smith cultivates re- lationships with key stakeholders, both internally and externally. With over 25 years of experience in managed care and healthcare, Smith holds a mas- ter’s degree in management with a concentration in healthcare from Troy University, and a BBA in fi- nance fromLoyola University of NewOrleans.Prior to joining Louisiana Healthcare Connections,he served as executive director of the NewOrleans market for Peoples Health and prior to that held senior leader- ship positions with Sacred Heart Health System in Pensacola, Florida.