Michigan

Less than two years ago it looked like my home state of Michigan might be the latest to join the growing list of states which have moved off of the HealthCare.Gov mothership onto their own state-run ACA marketplace (SBM) (aka "exchange"):

The Michigan Legislature is considering joining the 18 other states that have established state-run health insurance marketplaces through HB 6112. Having an exchange run by the state instead of the federal government, supporters of the bill say, will save Michiganders money by leaving the “rigid and inflexible” federal market for a Michigan-tailored market that can be more responsive and potentially lower premiums. The bill is still in the early days of the legislative process, awaiting a vote from the House Health Policy Committee.

...It's particularly noteworthy that not only is a Republican legislator the primary sponsor of the bill (Mark Tisdel), but so are 4 of the other 7 cosponsors (John Roth, Bradley Slagh, Jim Lilly and Gary Howell)...along with three Democratic state Representatives (Jim Ellison, Sara Cambensy and Kevin Hertel).

I didn't catch this press release a few days ago but it sounds like a pretty Big F*cking Deal, to use the words of President Biden:

via the Centers for Medicare & Medicaid Services (CMS):

The Biden-Harris Administration today unveiled a final rule that will protect and improve how millions of eligible people apply for, renew, and maintain health care coverage through Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program (BHP). The Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes rule will remove red tape and barriers to enrollment, update and build on the Affordable Care Act’s (ACA’s) coverage protections and ensure that millions of Americans can get and keep their coverage. With this rule, millions of Americans will benefit from a modernized, less cumbersome enrollment process with reduced red tape, helping more people keep coverage. 

(Note: This was actually announced the day before CMS posted the December Medicaid Unwinding transition data.)

Via the Centers for Medicare & Medicaid Services (CMS):

HHS Extends Special Enrollment Period to Help People Transition to the Marketplaces, Issues New Resources for Partners, and Publishes Guidance Reinforcing Key Federal Requirements

Honestly not sure how to feel about this, but it was inevitable...

via Nevada Health Link:

Nevada Health Link Spearheads AI Implementation, Championing Cutting-Edge Technology for Unparalleled Consumer Engagement

  • The first State Based Marketplace to receive Centers for Medicare & Medicaid Services approval for implementing AI technology

MOUNTAIN VIEW, Calif. – In a groundbreaking move towards enhancing consumer experiences and setting new standards in health insurance exchange technology, Nevada Health Link proudly announces the successful integration of Artificial Intelligence (AI) into its State-Based Marketplace (SBM) platform. This first-of-its-kind initiative underscores Nevada Health Links's unwavering commitment to innovation, transparency, and consumer-centric strategies.

The implementation of a purpose-built interactive virtual agent (IVA) by the team at GetInsured marks a significant milestone in Nevada Health Links's journey. Nevada Health Link is the first marketplace to have Centers for Medicare & Medicaid Service’s (CMS) approval for the use of AI-based Interactive Virtual Agents to enhance the customer service experience. The state worked collaboratively with the CMS and GetInsured security teams for several months to ensure that all federal privacy and security requirements were met. This approval signifies a high level of confidence in the technology that the marketplace has implemented.

via the Centers for Medicare & Medicaid Services (CMS):

  • In December 2023, 85,094,448 individuals were enrolled in Medicaid and CHIP, a decrease of 785,863 individuals (0.9%) from November 2023
    • 77,913,798 individuals were enrolled in Medicaid in December 2023, a decrease of 786,068 individuals (1.0%) from November 2023.
    • 7,180,650 individuals were enrolled in CHIP in December 2023, an increase of 205 individuals (0.0%) from November 2023.
  • As of December 2023, enrollment in Medicaid and CHIP has decreased by 8,773,558 individuals (9.3%) since March 2023, the final month of the Medicaid continuous enrollment condition under the Families First Coronavirus Response Act (FFCRA) and amended by the Consolidated Appropriations Act, 2023.
    • Medicaid enrollment has decreased by 8,816,761 individuals (10.2%).
    • CHIP enrollment has increased by 43,203 individuals (0.6%).
  • Between February 2020 and March 2023, enrollment in Medicaid and CHIP increased by 22,992,937 individuals (32.4%) to 93,868,006.
    • Medicaid enrollment increased by 22,6350,766 individuals (35.3%).
    • CHIP enrollment increased by 342,171 individuals (5.0%).

Normally, states will review (or "redetermine") whether people enrolled in Medicaid or the CHIP program are still eligible to be covered by it on a monthly (or in some cases, quarterly, I believe) basis.

However, the federal Families First Coronavirus Response Act (FFCRA), passed by Congress at the start of the COVID-19 pandemic in March 2020, included a provision requiring state Medicaid programs to keep people enrolled through the end of the Public Health Emergency (PHE). In return, states received higher federal funding to the tune of billions of dollars.

As a result, there are tens of millions of Medicaid/CHIP enrollees who didn't have their eligibility status redetermined for as long as three years.

Every month for years now, the Centers for Medicare & Medicare Services (CMS) has published a monthly press release with a breakout of total Medicare, Medicaid & CHIP enrollment; the most recent one was posted in late February, and ran through November 2022.

Since December 2022, however, they haven't sent out the normal press release; instead, they included a brief note leading to a Medicaid/CHIP data slideshow , along with another note leading to their new Medicare Monthly Enrollment database.

In any event, according to the spreadsheet I exported, as of December 2023:

February 16th:

I strongly suspect that at least one of the remaining holdout states will join the expansion crowd this year, most likely Georgia, Mississippi or Alabama...but it likely will be some state-specific variant as described above. Stay tuned...

...As I noted, however, in all three [states] it's pretty likely they'll go with at least a partially privatized version as Arkansas has instead of a "clean" expansion of Medicaid proper.

Of course, as one Alabama-based advocate put it...

Mississippi better not beat us to expand.

— Jane Adams (@janeadamsid) February 16, 2024

Well, it looks like Ms. Adams may end up being disappointed...

BREAKING: The Mississippi House just passed Medicaid expansion by a 96-20 vote.
That's more than enough to overcome a veto from Gov. Tate Reeves.
It now heads to the Senate.

It's been about a week since the Centers for Medicare & Medicaid Services published the official 2024 ACA Open Enrollment Period Public Use Files, and I'm still digging through the mountain of data & demographics.

Today I want to address the question of Actuarial Value (AV)...that is, what percent of medical expenses (in aggregate) a given healthcare policy actually pays for. As a quick reminder, ACA policies are generally broken into four AV categories, labeled by metal levels: Bronze, Silver, Gold and Platinum, which generally cover roughly 60%, 70%, 80% or 90% of enrollees in-network medical expenses per year (there's a fifth category in front of Bronze called Catastrophic plans, but these have limited eligibility and hardly anyone enrolls in them anyway).

I say generally because there's a bit of wiggle room here:

...as of 2023, the de minimus range has been reduced, imposing the following actuarial value ranges for metal-level plans:

This has been a long time coming, with lots of Sturm und Drang along the way, but it's finally here:

President Biden Announces New Landmark Rule to Protect Americans from Junk Health Insurance

  • Latest action to deliver better health care and prevent consumers from getting ripped off

Today, the Biden-Harris Administration is taking a major step to crack down on junk health insurance for American families and consumers and deliver better health. As the President has said, people hate being played for suckers and the current practice of offering low-quality insurance that people pay into, but then provides no coverage when people need it, is a bait and switch. That’s why the Biden-Harris Administration is issuing a final rule that protects consumers from junk health insurance and makes sure Americans aren’t scammed into low-quality coverage that leaves consumers on the hook for thousands of dollars in medical bills or denies life-saving care right before treatment. The President is committed to building on the promise of the Affordable Care Act and its critical consumer protections that ensure meaningful coverage for people’s health care needs.

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