In this week’s highlights, new proposed guidance from the feds would allow default renewals to lower cost plans and bring enhanced transparency to Qualified Health Plan rate increases; open Enrollment hits its stride – including in several states with new or revamped Marketplaces; D.C. survives a court challenge that threatened its self-sustainability, and Rhode Island seeks state budget support to shore it up as federal dollars for operating expenses wane; and while Alaska and Kansas contemplate Medicaid expansion, Arizona, New Hampshire and Pennsylvania seek changes to their current expansion programs. Read on for more details.
FEDERAL NEWS:
CMS Releases NPRM Regarding 2016 Marketplace Benefit and Payment Parameters
CMS issued a proposed rule outlining several new provisions related to transparency and uniform standards for issuers and Marketplaces for the 2016 benefit year. The rule seeks comments on allowing Marketplace enrollees to default renew into a lower cost plan as opposed to their current plan. It also proposes enhanced public access to information about Qualified Health Plan rate increases, a requirement that issuers provide up-to-date provider directories for their plans, an alternative to the existing standards for prescription drug coverage and other essential health benefits, and streamlined SHOP administration and rules. Comments are due 30 days after the date of publication.
CMS Releases September Medicaid and CHIP Eligibility and Enrollment Report; Finds 9.1 Million New Enrollees Since October 2013
CMS’ latest Medicaid/CHIP eligibility enrollment report found that approximately 9.1 million additional individuals have enrolled in Medicaid and CHIP since October 1, 2013, when the first round of ACA Marketplace Open Enrollment began. This represents a 16% increase compared to July through September of 2013. States that have implemented Medicaid expansion have experienced a 23% increase in enrollment, compared to a 6% increase in states that have not expanded their programs.
Estimates of 2015 ACA Marketplace Premium Increases Range from 2-5%
After CMS released data on 2015 Qualified Health Plans offered on the Federally Facilitated Marketplace, multiple sources estimated that premium prices will increase between 2% and 4% next year. Kaiser Family Foundation estimates that average premiums will increase by 2% for silver-level plans and 4% for bronze-level plans. According to the Washington Post, Avalere Health found that premiums will rise between 3 and 5% and the New York Times determined that average premiums have risen by approximately 4% each year since 2007.
Obama Administration Revises Marketplace Enrollment Figures
The Obama Administration revised its estimate of Marketplace plan enrollment from 7.3 million to 6.9 million after the House Committee on Government Oversight and Reform found that 400,000 of these individuals signed up for standalone dental plans as opposed to medical Qualified Health Plans, according to the Washington Post. HHS Secretary Burwell confirmed the mistake on Twitter, and suggested it would be communicated as “unacceptable” throughout the Department. The Administration expects the enrollment number to increase to 9.1 million by the end of the 2015 Open Enrollment season.
Report Finds Large Increase in Federal Funding for Medicaid in Fiscal Year 2014
A report released by the National Association of State Budget Officers found that federal funding for Medicaid increased by 17.8% in Fiscal Year 2014. State spending for the program was significantly smaller, increasing by just 2.7% during the same period. The Association concluded that the spending disparity is largely due to the influx of federal matching funds to support the ACA’s Medicaid expansion.
STATE HEALTH REFORM ACTIVITY:
Arkansas: Information Technology Committee Considers Procurement for State-Based Marketplace
The Arkansas Health Insurance Marketplace (AHIM) Information Technology (IT) Committee convened to review decision points related to procuring an IT solution for the State’s transition to a State-based Marketplace (SBM) for the individual market. Arkansas had previously released a request for proposals (RFP) to solicit a vendor to create a State-based SHOP Marketplace. The State is planning to transition to a State-based SHOP Marketplace in 2016 and an SBM for the individual market in 2017. AHIM also held a Marketing and Outreach Committee meeting to discuss SBM websites and branding.
D.C.: District Court Rules Broad-Based Assessment Legal
A lawsuit filed by the American Council of Life Insurers (ACLI) that challenged the broad-based assessment on all health carriers used to help fund the Marketplace has been dismissed. The U.S. District Court for the District of Columbia ruled on the basis that the ACA gives states broad authority to operate and provide adequate funding for Marketplaces.
Maine: Federal Appeals Court Blocks Governor’s Effort to Cut Young People from Medicaid
The U.S. Court of Appeals unanimously rejected a proposal from Governor LePage (R) that sought to drop Medicaid coverage for low-income 19- and 20-year-olds, stating that the proposal violated the ACA provision prohibiting states from tightening Medicaid eligibility until 2019. The State’s 2012 proposal, which was estimated by the Maine Department of Health and Human Services to save $3.7 million in state funds, was denied by the Centers for Medicare and Medicaid Services (CMS) the following year. Governor LePage has indicated the State will appeal the ruling.
Massachusetts: Marketplace Releases RFP for Small Business Marketplace
The Massachusetts Health Connector released an RFP soliciting bids to build a new Small Business Health Options Program (SHOP) website. The State seeks a vendor to build a consumer-facing website that will seamlessly integrate with back-end technology for ongoing administration and operational support. The new SHOP will offer three distinct health insurance product lines in addition to a stand-alone dental offering.
New York: Marketplace Announces New Tools to Assist Consumers Shopping for Health Plans
New York State of Health has enhanced the services and support tools available to consumers to assist with the enrollment process, including providing select informational materials in ten new languages and the launch of a Spanish version of the New York State of Health website. A new “Plan and Compare” feature will also be made available that summarizes available plans by county across the State to allow consumers to preview options before starting an application.
Rhode Island: Marketplace Requests $14.5 Million in State Budget Proposal
HealthSource Rhode Island (HSRI) director Christine Ferguson submitted a proposed FY 2016 budget to the Governor that forecasts total expenditures of $27.7 million, approximately $4 million more than the FY 2015 budget. According to the Providence Journal, $14.5 million of the forecasted expenditures must be generated by the State. In a letter accompanying the budget, Ferguson outlines potential strategies to generate the State’s portion, including broad-based claims assessments and the sale of HSRI tools and products to other states and entities.
South Carolina: New South Carolina Medicaid Director Takes His Post
Christian Soura, former deputy chief of staff to Governor Haley (R) during her first gubernatorial term, replaced outgoing Medicaid Director Tony Keck effective November 20. Mr. Soura previously served as the State Secretary of Administration in Pennsylvania and the chairman of the Board of Trustees for the PA Employee Benefits Trust Fund. The appointment requires State Senate approval.
Virginia: Cover Virginia Website Launches to Assist with Purchasing and Enrolling in Health Plans
Cover Virginia, a new website to assist consumers in applying for and renewing Qualified Health Plan coverage on the Federally Facilitated Marketplace or State public coverage, was launched. The website includes an eligibility screening tool to guide individuals to the appropriate program’s application website and links to a tool providing contact information for other assistors.
SPECIAL REPORT: MEDICAID EXPANSION
Alaska: Medicaid Expansion is a Top Priority of Governor-Elect
Governor-elect Walker (I), whose electoral victory was confirmed on November 15, is expected to put Medicaid expansion at the top of his agenda when he enters office in January, as reported by Modern Healthcare. While Governor-elect Walker has said he would immediately begin efforts to expand Medicaid upon taking office, it is unclear whether the GOP-controlled State Legislature will provide the approval needed to accept the federal funding, as well as to use state funds to invest in necessary infrastructure and workforce.
Arizona: Medicaid Agency Proposes Premiums and Cost-Sharing for Expansion Population
Arizona’s Medicaid Agency proposed to amend the State’s 1115 demonstration waiver to require Medicaid expansion beneficiaries between 100% and 133% of the Federal Poverty Level to pay premiums of no more than 2% of their household income and $200 co-pays for non-emergency use of the emergency room (ER). As noted in the proposal, the State is interested in imposing these requirements to include a measure of personal responsibility and to redirect non-emergency ER visitors to more appropriate and less costly community-based sites. Public comments are due December 18, 2014.
Iowa: Medicaid Expansion Saves State $30 Million
According to the Des Moines Register, the Iowa Hospital Association released the results of a survey of Iowan hospitals, which found a 46% decline in uninsured hospital patients between January and June of 2014. The report found that the drop in uninsured patients led to a 18.5%, or $32.5 million, decline in charity care costs.
Kansas: Kansas Hospitals Push for Medicaid Expansion
The Kansas Hospital Association released a report this week estimating that broadening Medicaid eligibility would provide coverage for 100,000 low-income adults in 2016 and an additional 144,000 in 2017. The report also finds that expanding Medicaid could allow the state to claim more than $330 million annually in federal aid and create nearly 4,000 jobs by 2020.
New Hampshire: New Hampshire Submits Premium Assistance Waiver for Medicaid Expansion
The State of New Hampshire submitted a waiver to CMS requesting permission to purchase Qualified Health Plans on the Federally Facilitated Marketplace for the Medicaid expansion population beginning in 2016. The premium assistance program, if approved, would replace an interim expansion program launched earlier this year that leveraged the State’s managed care program.
Pennsylvania: Governor Continues Healthy PA “Private” Expansion Despite Governor-Elect’s Plans for Traditional Expansion
Outgoing Governor Corbett (R) announced plans to continue his Healthy PA expansion – which would use Medicaid dollars to subsidize private insurance coverage – despite campaign commitments of Governor-Elect Wolf (D) to change course and move forward with a traditional Medicaid expansion. Mr. Wolf will be sworn into office on January 20 and has tapped former public welfare secretary Estelle Richman to serve on the transition team as its Medicaid adviser.
SPECIAL REPORT: MARKETPLACE ENROLLMENT
California: 69,245 Determined Eligible for Marketplace or Medicaid; Marketplace Announces SHOP Premium Rates
As of November 18, 69,245 individuals were determined eligible for Covered California or Medi-Cal. 11,357 of these individuals have selected plans through the Marketplace. Covered California’s Board also announced that premiums for plans in the Small Business Health Options Program (SHOP) will increase by 5.2%, but some consumers may see increases of less than 2%.
Connecticut: Over 12,000 New Enrollees in Marketplace and Medicaid
As of November 21, Access Health CT had enrolled nearly 2,700 Connecticuters in Qualified Health Plans through the individual Marketplace, over 1,000 employees through the SHOP Marketplace, and nearly 9,000 individuals in Medicaid.
Kentucky: 32,000 Website Visitors and 4,000 Applications Submitted
By November 17, over 32,000 unique visitors visited the Kynect website and over 4,000 submitted applications. With over 520,000 Kentuckians purchasing insurance through Kynect last year, Kentucky saw the second-highest reduction of uninsured individuals in the country.
Idaho: Open for Business After Transition to State-based Marketplace
This open enrollment period marks Idaho’s transition to a State-based Marketplace after relying on federal infrastructure as a State Partnership Marketplace in 2014. On November 18, the Spokesman-Review reported that Your Health Idaho had nearly 13,000 visitors and that call centers fielded 700 calls from consumers.
Maryland: 7,400 Enrollments Completed under New Marketplace System
Bouncing back from its troubled launch last year, the Maryland Health Connection website has completed 7,400 applications and seen 18,600 initiated applications and 117,000 visitors as of November 20, according to the Marketplace’s Twitter update.
Massachusetts: Revamped Marketplace Determines Eligibility for Nearly 52,000 in First Week
The revamped Massachusetts Health Connector determined eligibility for 51,967 consumers as of November 22. Of those determined eligible, 46% qualify for Medicaid, 24% each for ConnectorCare (subsidized coverage for individuals between 133% and 300% of the Federal Poverty Level) and unsubsidized Qualified Health Plan (QHPs), and the remaining 6% for subsidized QHPs. Additionally, 14,101 individuals and families had selected a qualified health plan (QHP) and the Connector’s website handled 334,108 visits during the same period.
Minnesota: Over 7,800 Enrolled in Marketplace or Public Coverage
As of November 21, 2,551 individuals enrolled in Qualified Health Plans through MNsure, more than four times the enrollment seen over the first two weeks of the 2014 open enrollment period. Additionally, 1,215 consumers have enrolled in MinnesotaCare (a publicly subsidized healthcare program) and 4,119 have enrolled in Medicaid.
Oregon: Marketplace Transition to Healthcare.gov Proceeds Smoothly
Reviews of Cover Oregon’s transition from operating a State-based Marketplace to using healthcare.gov have generally been positive since Open Enrollment Period began. Cover Oregon’s Executive Director noted he is appropriately cautious, but has heard the site is working well. “We haven’t had any problems at all,” said Ralph Prows, CEO of a CO-OP plan being offered on the Marketplace.
Vermont: 306 New and 1,515 Renewal Applications Submitted
As of November 17, Vermont Health Connect (VHC) reported handling 306 new applications for coverage and 1,515 renewal applications. VHC expects to receive between 3,000 and 8,000 new coverage applications during this year’s open enrollment period.
Washington: 25,000 Applications Submitted and 12,000 Calls Received
Nearly 25,000 residents completed applications through Washington Healthplanfinder as of November 18, with nearly 10,000 of those customers completing Qualified Health Plan applications. The Call Center received over 12,000 calls with an average wait time of 4 minutes, 2 minutes faster on average than during the first three days of 2014 open enrollment.