Colorado’s uninsured rate is down 9 percentage points in four years; Michigan requests increased cost-sharing for its Medicaid expansion population above the federal poverty line; and, HHS’s proposed guidance strengthens anti-discrimination protections in the ACA.

MEDICAID NEWS:

Colorado: Uninsured Rate Declines Notably

Findings from the 2015 Colorado Health Access Survey indicate that the State's uninsured rate has fallen from 15.8% to 6.7% over the past four years, spurred by the State’s decision to expand Medicaid. According to the report, Colorado has added 450,000 new Medicaid beneficiaries since 2013 and Connect for Health Colorado, the State’s online Marketplace, has enrolled 155,000 consumers. Despite predictions about the impacts of increased enrollment on access, the report finds only a slight increase in the percentage of people who were unable to make an appointment with a provider when needed. The Colorado Health Institute’s health access report also includes analysis of Marketplace enrollment, churn across all sources of insurance and access and affordability of coverage.

Michigan: State Submits Medicaid Expansion Waiver Amendment to CMS

Governor Rick Snyder’s (R) administration submitted a Section 1115 waiver amendment to CMS requesting changes to coverage options for “Healthy Michigan” (Medicaid expansion) enrollees above 100% of the federal poverty level with 48 continuous months of enrollment. If approved, the State would provide these enrollees with two options for continued coverage. Under Option 1, the beneficiary would enroll in a Qualified Health Plan (QHP) and pay premiums and cost-sharing consistent with the QHP’s standards, while the State would contribute an amount comparable to the beneficiary’s advance premium tax credits and cost-sharing reductions. Option 2 allows beneficiaries to remain enrolled through the Healthy Michigan managed care organizations, with higher premiums and an increased limit on total cost-sharing of up to 7% of income (higher than what CMS has approved in other states to-date). Michigan intends to pursue expanding healthy behavior activities—which can reduce out-of-pocket costs—for enrollees affected by the increased expenses. Enrollees who do not select either option will be defaulted into Option 2. State law requires the waiver amendment to be approved by December 31, 2015 and requests implementation as of April 1, 2018, the first date at which an enrollee could reach 48 months of enrollment. If the waiver is not approved, State law requires that the Medicaid expansion program terminate.

MARKETPLACE UPDATES:

9.9 Million Consumers Effectuated Marketplace Coverage

CMS released new data indicating that approximately 9.9 million consumers have active enrollments (that is, they selected a plan and paid their premiums) through the Federally-facilitated and State-based Marketplaces as of June 30th, 2015. This is a slight reduction from the 10.2 million who had coverage as of March 2015, largely due to the 306,000 consumers whose coverage was terminated this quarter because of outstanding citizenship or immigration issues. Of the total effectuated enrollments, 7.2 million consumers receive coverage through the Federally-facilitated Marketplaces and 2.7 million through State-based Marketplaces. The data also indicate that 84% of consumers receive advanced premium tax credits, 56% of consumers receive cost sharing reductions, and 68% were enrolled in a Silver plan.

Washington: Marketplace Appoints Interim CFO

The Washington Health Benefit Exchange appointed Carole Holland as interim CFO, effective immediately. Holland replaces Robert Nakahara, who resigned as CFO last month. Previously, Holland held senior fiscal positions in State government and worked as a healthcare consultant.

HHS GUIDANCE & GRANTS:

Proposed Regulations Strengthen Anti-Discrimination Protections in ACA

The Department of Health and Human Services (HHS) issued a notice of proposed rulemaking (NPRM) that clarifies anti-discrimination protections provided in the Affordable Care Act, including by prohibiting gender identity discrimination, enhancing language assistance for those with limited English proficiency and requiring effective communication with individuals with disabilities. The regulation applies to all health programs and activities that receive funding from HHS, all health programs and activities administered by HHS including the Federally-facilitated Marketplaces, and all health programs and activities administered under entities established under Title I of the ACA including the State-based Marketplaces. HHS is seeking comment as to whether the prohibition against sex discrimination, as defined in the ACA, should include discrimination on the basis of sexual orientation. Comments are due by November 9, 2015.

Navigator Groups Receive $67 Million in Funding

CMS announced $67 million in grants to 100 organizations in the 34 states that operate Federally-facilitated Marketplaces and State Partnership Marketplaces to fund their in-person assistance navigator programs. The largest grant was awarded to the University of South Florida for $5.9 million to increase their focus on individuals with Limited English Proficiency, people living with HIV and AIDS, Hispanics and Latinos, and other uninsured populations. The anticipated award amount is on an annual basis and the grants are being awarded for a three year project period, running through September 1, 2018.