PS: Subsequent to the passage of the legislation, we did a request for proposals inviting interested insurance companies to bid on the program. There were four companies that did, which happened to be all four of the Blues. In the western part of the state it is Highmark; in the central part of the state the insurance coverage is being provided by Keystone Health Plan Central of Capital Blue Cross; in the northeastern part of the state it is First Priority, which is a subsidiary of Blue Cross of Northeastern Pennsylvania; and in Philadelphia and suburban counties it is Independence Blue Cross’ Keystone Health Plan East. The carriers are contracted with us to do a number of things in addition to actually providing the health care coverage. They do outreach for the program. They are responsible for all enrollment activities. An individual who is interested in applying for adultBasic applies directly through the company, uses their application document or submits an online application which is submitted to the company of their choice. If the applicant is eligible, they are instructed to remit their $30 payment and enrollment would begin the first of the following month. They’re issued a medical card which looks just like a normal First Priority card or a Keystone Health Plan Central card—the companies are prohibited from identifying individuals as being low-income or a part of adultBasic. The statute, and we, are concerned about any kind of stigmatization that might be associated with the program, much in the same way that we have been with the Children’s Health Insurance Program (CHIP). The program uses an HMO model and the contract calls for a per-member-per-month payment. We’ve negotiated a rate with each of the contractors as to how much we’re going to pay them based on actuarial data for each company.

PS: There were some tough choices that needed to be made, given the amount of money there was available to the program. The program is not an entitlement and enrollment is limited to the amount of money that we have available. In the end, I believe the legislature opted to serve more people, as opposed to providing a richer benefit package, and that’s one of the reasons why pharmaceuticals are not included. Because Highmark and Independence Blue Cross offer a pharmaceutical discount to members of their commercial HMO products, they are offering it to the adultBasic members as well. Other than that, the benefits are uniform across all four carriers.

PS: They are paid through the insurance companies. It’s my understanding that the companies are negotiating general rates with the providers for all bodies of their HMO business, irrespective of whether it was adultBasic or private insurance coverage. It’s not a requirement, but that is a practice that has been adopted by all of the companies that have been working with us in the CHIP and in adultBasic.

PS: We are using the requirements established by Act 68, which govern quality assurance activities for all HMOs throughout the commonwealth. The companies are compelled to have certain reviews conducted by both the Department of Health and the Insurance Department. We elected to use the national standards in the form of HEDIS, established by the National Committee on Quality Assurance. Essentially we’re using those same quality assurance standards for this program as HMOs are subject to for regular lines of business. We will be doing analysis of data related to utilization down the road. We’re probably going to have to have at least two years of experience with the program under our belt, so we’ll not have a true picture of what services individuals are using and whether they’re meeting quality standards for at least a year or two years down the road.

PS: The funding for the program for this particular year is around $93 million dollars and we also have an additional $3 million and change for administration. It’s my understanding that what we receive in the future will depend upon the revenue that is received through the tobacco settlement, which may vary from year to year. Between the Department of Public Welfare and the Insurance Department we are slated to receive a full 30 percent of the annual revenue received from the tobacco settlement. The Department of Public Welfare is receiving 25 percent of that 30 percent for the purposes of a program that allows disabled working adults to purchase Medicaid who otherwise might have been at risk of losing their Medicaid because they go back to work. The balance of the funding comes to the Insurance Department to operate the adultBasic program.

PS: Based on the current structure of the statute, our proportion would be reduced accordingly. I couldn’t speculate on what the legislature might do in reaction to that. With the CHIP program, we started out with a similar situation almost 10 years ago and now we have both general fund revenue and federal revenue to support that program. So, anything is possible in the future.

PS: I think part of it is stigmatization—people don’t necessarily want to attach themselves to a public program. Some people don’t see the need for insurance until they actually have some sort of family crisis where there’s a health care issue. We’ve done focus groups with families who have participated in the CHIP program and have left for some reason and what we know from national studies is that about 60 percent of those people actually go away because their circumstances have changed—they’ve gotten private insurance, or what have you. I think it really has to do with personal preference more than lack of earnestness on our part in trying to get the word out. We have been doing mass marketing of the CHIP program and have more than doubled its enrollment over the last four years. We began distributing adultBasic applications in April in anticipation of the first coverage month being July. Up to this point we have distributed over 50,000 applications and half or so of those have been returned. We’re now doing radio advertising with a focus on minority radio stations. We are concerned that there are some populations of people that have a greater percentage of uninsured than others, the Hispanic population being one of those.

PS: I have been in communication with some folks but we have not done any direct marketing with the medical community yet. I’m slated to work with the hospital association later this month—we’re doing three special meetings targeting hospital personnel.

PS: We estimated that, given the amount of money that we have, there may be as many as 40,000 people that can be served each and every month over a full year period. In the first month of the program we’ve enrolled 6,000 people. It’s estimated that the number of uninsured in the commonwealth within the program’s income range is about 325,000. With census data on the uninsured in some states, however, there are margins of error as high as 40 percent because of sample size. So, we are shortly going to be embarking on a state-specific study of the uninsured in Pennsylvania, simply because of our frustration with the census data. Keep in mind also that adultBasic may be a transition program for some people, so over the span of a year there may be many more than 40,000 individuals that we would service.

PS: Individuals have the option to purchase the product at the cost of it—on average statewide it would be about $200 a month. They can also elect to be part of a waiting list. We’re going to be operating that waiting list when we come to that point on a first-come-first-serve-basis. But I don’t think that’s going to be an issue for us for a couple of months.