Enrollment and coverage expansion tops the news this week. Federal officials announced 6.5 million people have enrolled through the Federally-facilitated Marketplace and released the first in a monthly series of detailed reports on health plan selection by state. State-based Marketplaces began releasing promising enrollment numbers for “coverage as of January 1.” And Medicaid expansion activity continues in the states, with CMS approving Arkansas’ use of Health Savings-Like Accounts in their Medicaid “Private Option,” questions from Texas’s incoming governor causing a stir, and state legislators offering an expansion counter-proposal in Montana.

FEDERAL NEWS:

7.1 Million Americans Enroll in Health Plans through Marketplaces

As of December 26, 6.5 million people enrolled in health plans through the Federally-facilitated Marketplace, according to an HHS press release. The first Open Enrollment monthly report, which provides the first detailed state specific enrollment numbers, additionally indicates that 633,000 have enrolled through State-based Marketplaces as of December 15 – including new enrollees, people actively re-enrolling, and previous enrollees whose plans were automatically renewed. According to the Washington Post, HHS clarified that this may be an underestimate, as many states have not reported complete re-enrollment numbers. The Open Enrollment report also indicated that 87% of those with coverage beginning January 1 have been determined eligible for financial premium assistance, an increase from 80% during a similar time period in 2013.

CMS Awards $563 Million Healthcare.gov Contract

After being hired by the Obama Administration to fix major problems with healthcare.gov in 2014, Accenture has been granted a new five-year $563 million contract to continue its work on the site. Over the past year, the firm was tasked with improving the website, maintaining the application and eligibility and enrollment functions, in addition to supporting states that transitioned from State-based to Federally-facilitated Marketplaces.

STATE HEALTH REFORM NEWS:

Arizona: State Supreme Court Allows Challenge to Medicaid Expansion to Proceed

The Arizona Supreme Court unanimously overturned a Maricopa County Superior Court ruling that would have dismissed a challenge to the State’s method for financing the Medicaid expansion for lack of legal standing. The 36 Republican lawmakers that brought the case contended that the 2013 law financing the expansion through a hospital tax required a supermajority of votes. The case will now return to the county court for a full hearing.

Arkansas: CMS Approves Health Savings-Like Account Amendment to Private Option 1115 Demonstration

CMS approved an amendment to Arkansas's Private Option 1115 Medicaid expansion waiver. The amended Special Terms and Conditions permit Arkansas to:

• Implement health savings-like accounts for Private Option enrollees with incomes from 50 to 133% of the federal poverty level (FPL)
• Institute cost sharing for individuals with incomes between 50 to 100% FPL, and
• Impose prior authorization requirements for non-emergency transportation

These changes were mandated by the Private Option enabling legislation and the State's 2014 Department of Human Services appropriations bill.

California: Insurance Commissioner Issues Emergency Regulation on Network Adequacy Requirements

Insurance Commissioner Dave Jones issued an emergency regulation to strengthen network adequacy requirements for health plans. Under the new regulation, health plans are required to monitor appointment wait times, provide accurate provider directories to the public, and make arrangements to provide in-network prices for out-of-network care when there is insufficient in-network provider capacity. The Commissioner issued the emergency regulation in response to concerns from consumers about appointment wait times and lack of access to in-network care.

Iowa and Nebraska: Insurance Departments Remove “CoOportunity Health” Health Plans from Marketplaces

Iowa’s and Nebraska’s Insurance Commissioners removed “CoOportunity Health” health plans from their State Marketplaces after Iowa Insurance Commissioner placed CoOportunity Health “in rehabilitation” due to financial concerns. In “frequently asked questions” documents for CoOportunity Health policyholders, both States indicate that current policyholders who enrolled on or before December 15 have insurance through CoOportunity Health beginning January 1; however, those who enrolled on or after December 16 are required to sign up for another plan before the end of the open enrollment period. According to USA Today, Iowa’s Insurance Commissioner explained that CoOportunity Health had 120,000 members in Iowa and Nebraska and approximately $17 million in cash and assets.

Montana: Republican Legislators Release Medicaid Reform Proposal, Including Partial Medicaid Expansion

Expansion debates continue in Montana, where Republican legislators released a Medicaid reform proposal that includes a partial expansion of coverage to the disabled, parents with incomes below the Federal Poverty Level, and some veterans. The proposal, according to a report from NPR, would not expand the program to most childless adults and would garner the regular Medicaid match rate, in contrast with Governor Steve Bullock’s (D) proposal, which would use a Third Party Administrator to expand the program to an estimated 70,000 Montanans and draw down enhanced federal matching funds. Legislators have not yet introduced a specific bill related to the proposed framework.

Rhode Island: Governor-Elect Appoints New Marketplace Director

Governor-elect Gina Raimondo (D) announced that Anya Rader Wallack will serve as the new executive director of HealthSource Rhode Island (HSRI), as reported by the Providence Journal. Wallack has an established career in health policy, having previously served under two Vermont governors, and worked on healthcare reform in Massachusetts. Wallack will replace Christine Ferguson, who has acted as HSRI director since its launch.

Texas: Governor-Elect's Private Inquiry about Utah's Medicaid Expansion Creates Buzz

During a private meeting with State lawmakers, Governor-elect Greg Abbott (R) requested information about the negotiations between CMS and Governor Gary Herbert (R) of Utah to expand Medicaid in a tailored state-specific way, according to The Houston Chronicle. The Chronicle’s report resulted in broad media coverage and speculation regarding the possibility of interest in Medicaid expansion in Texas. State Representative John Zerwas (R) is expected to lead a Medicaid expansion campaign this year that will push “The Texas Way” – which could include work incentives and required cost-sharing – though Legislative opposition to expansion remains high.

Wyoming: Governor Appoints New Insurance Commissioner

Paul Thomas Glause was appointed by Governor Matt Mead (R) as the new Wyoming Insurance Commissioner, replacing Tom Hersig. According to Wyoming Public Media, Mr. Glause, in one of his first statements as Commissioner, indicated interest in the State Innovation Waiver option under the Affordable Care Act, and noted that such a waiver could help provide financial aid to residents over 400% of the Federal Poverty Level. Mr. Glause was previously the vice chairman of the Wyoming Board of Equalization.

SPECIAL REPORT: STATE MARKETPLACE ENROLLMENT FOR JANUARY 1 COVERAGE:

Maryland: Marketplace Enrolled More than 136,000

Governor Martin O’Malley (D) announced that 136,685 individuals have enrolled in January 1 coverage through Maryland Health Connection since the beginning of open enrollment. Of the 79,987 individuals who signed up for qualified health plans (QHPs), approximately 77% were found eligible for premium tax credits. The remaining 56,698 individuals enrolled in Medicaid. QHP enrollment figures for January 1 coverage nearly match last year’s total QHP enrollment, which Maryland leadership credits to improved enrollment systems.

Massachusetts: Marketplace Announces Over 50,000 Covered

The Massachusetts Health Connector announced that more than 50,000 people selected and paid for a qualified health plan (QHP) by the December 28 deadline for coverage beginning January 1. The State noted that there may be up to a two week delay in receipt of membership materials and is conducting outreach with health plans, providers, pharmacies, and other stakeholders to make enrollees aware of their coverage. In addition, just over 139,000 have been enrolled in MassHealth during the first six weeks of open enrollment.

Minnesota: Enrollment through Marketplace Exceeds 68,000

As of December 31, 68,851 individuals have enrolled in coverage through MNsure. Of the 31,159 Minnesotans who enrolled in commercial coverage, 10,530 were renewed enrollees, and 7,172 were 2014 PreferredOne enrollees who enrolled in a new MNsure plan following PreferredOne's exit from the Marketplace. Additionally, 11,152 consumers enrolled in MinnesotaCare (a publicly subsidized healthcare program) and 26,540 have enrolled in Medicaid.

New York: New Enrollment in State's Marketplace Tops 225,000

New York State of Health announced new enrollment of 225,244 residents in health plans with coverage beginning January 1, but has not yet released figures for individuals renewing plans selected during last year's open enrollment.

Vermont: Marketplace Announces Nearly 7,000 New Consumers

Vermont Health Connect (VHC) announced 6,881 new consumers have selected health plans with a January 1 coverage start date, falling within the State's projection of 3,000 to 8,000 new applicants, reports the VT Digger. Returning consumers selecting a health plan totaled 23,356, representing approximately 73% of enrollees who purchased insurance during the 2014 open enrollment period.