Commissioners review CareFirst proposals; HR recommends budgeting for ACA‑eligible hourly employees

Human resources staff walked commissioners through three CareFirst renewal scenarios and three options the county can use to meet Affordable Care Act (ACA) large‑employer obligations.

HR reported CareFirst initially proposed an 18.3% rate increase for FY17, returned with a 16.6% option after benefit changes, and then proposed a 12% option after additional plan design changes. HR explained the 12% proposal included moving the PPO to a Blue Choice Advantage (an HMO‑style network) and changes to prescription coverage and copay structure designed to steer members to lower‑cost care sites.

Catherine Preps, the county’s Human Resources director, summarized member impacts and policy mechanics: “The change to the PPO plan … to become a Blue Choice Advantage Plan has limited or minimal changes to our employees and to the people who are on the plan. It is designed more like an HMO where we would be using CareFirst Physicians and Facilities. And currently, 99.1% of our claims use those facilities and those doctors.” She also described the proposed prescription formulary change and an appeal process for medically necessary brand drugs.

HR explained the behavioral changes intended by the plan design: for example, treating urgent‑care visits as office visits and adding an emergency‑room copay to discourage non‑emergency ER use. HR supplied claim‑use data: 273 urgent‑care visits in 2015 (avg. cost about $100) versus 800 ER visits (avg. cost about $760).

On ACA exposure, HR told the board the county has a set of hourly employees who, because of hours worked, will become eligible for employer coverage under the ACA. HR presented four compliance approaches: convert eligible hourly roles to regular part‑time (RPT) employees (higher cost because of retirement/leave), offer the county’s HMO plan to eligible hourly staff (estimated annual employer cost of about $177,162), adopt a minimum‑value high‑deductible plan (estimated ~$19,000), or accept penalties (estimated, per memo, up to $1.5 million but not recommended). HR recommended offering the HMO option to eligible hourly staff and budgeting the employer expense in the HR budget.

Commissioners discussed employee cost‑sharing assumptions. HR outlined an internal approach: if the county accepts a 12% rate increase from CareFirst and continues the existing premium split practice, employees would pay 15% of premiums while the county would cover the balance; that allocation was described as the working assumption during the meeting. HR also reviewed a draft recommendation to modify vision benefits to allow annual exams and eyewear replacement, and a proposal to change how vacancies are budgeted (reducing assumed family coverage on vacant positions to reflect historical uptake), which HR estimated could save roughly $245,000 based on current vacancy patterns.

At the end of the presentation commissioners signaled support for HR’s approach. They asked staff to budget the estimated $177,162 for offering the HMO to eligible hourly employees in the HR budget and to return with finalized numbers reflecting whatever CareFirst renewal option the board selects.

Why this matters: the renewal and ACA compliance approach will change FY17 county operating costs and affect employees’ out‑of‑pocket costs. HR’s recommended path is intended to limit premium growth while meeting federal employer‑mandate rules.

Ending: HR will apply the chosen CareFirst option to the FY17 budget and return with the final premium numbers and the tracking plan for hourly employees who become eligible under the ACA.