SustiNet Board considers governance and structure recommendations

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At today’s meeting the SustiNet Board considered three different structural options for the new SustiNet Plan. Options varied in whether the new SustiNet governing body will oversee or directly administer the plan, whether the SustiNet option will be a licensed state insurance product offered in the new state health insurance exchange, the relative roles of SustiNet and existing state agencies, liability and responsibility for complying with federal Medicaid laws, and layers of administration. Pros and cons of offering SustiNet inside and/or outside the new exchange were discussed – federal premium subsidies are only available inside the exchange, but undocumented immigrants may not purchase coverage in the exchange. Concerns were raised about levels of authority, raising capital reserves necessary for state licensure under current state law, and ensuring SustiNet is compatible with efforts to coordinate delivery system and payment reform across all payers. Next month we get the cost and financing numbers.
Ellen Andrews