2018 MIDTERM ELECTION

Time: D H M S

Thursday Short Cuts: Up to 100K people to receive Special Enrollment Period

In addition to the normal off-season "Qualifying Life Events" which allow roughly 7,500 people to select a private policy nationally every day, it looks like up to 100K additional people might be added to either the QHP or Medicaid tally over the next month or so:

CMS will offer a special enrollment period to thousands of Healthcare.gov enrollees who were incorrectly told that they qualified for fewer subsidies than they should have received or none at all, due to a Social Security-related glitch in the eligibility system that inflated household income.

...Tricia Brooks, a senior fellow at Georgetown University's Center for Children and Families who frequently writes on the issue, estimates that the glitch affects around 40,000 households.

Assuming Brooks's estimate of 40K households is accurate, the average U.S. household has 2.58 people. That means about 100,000 people across the 37 states in question.

However, some of them might be enrolled in private policies already (but are paying more than they're supposed to), while others may end up being moved onto Medicaid instead once the issue is cleared up...which, ironically, could actually leave some people in states which didn't expand Medicaid high & dry:

Enrollees in states that have not expanded their Medicaid programs might be deemed ineligible for any financial assistance whatsoever. Those people would need to enroll in a QHP at full cost, CMS said.

...Anyone who was not already enrolled in a plan who qualifies for subsidies for the first time will either be given an SEP to enroll in a plan with a future start date, or can ask for an SEP with a retroactive effective date.

...Those who were already in a QHP but would newly receive subsidies or earn more can apply them forward on their current plan or a new plan. They may also retroactively apply them to an original coverage effective date.

Overall it doesn't sound like this will end up increasing either the QHP tally or the Medicaid rolls by more than 30,000 people or so apiece, but every addition helps...

UPDATE: Rachel Karas, who wrote the above SEP (special enrollment period) piece, also notes an additional life change added to the list of qualifying events for off-season enrollments (actually, this is just a strengthening of an existing one):

All victims of domestic abuse and spousal abandonment and their dependents can now enroll in separate Healthcare.gov insurance through a permanent special enrollment period effective immediately, CMS said in new guidance out Monday (July 27).

The update solidifies and broadens an initial SEP from spring 2014 to include any member of a household dealing with domestic violence instead of limiting it to spouses and dependents.

The special enrollment period is available for 60 days after someone first requests it. State exchanges can also put a similar 60-day policy in place, CMS said.

Those using the SEP who are married to their abuser or abandoner can still receive advanced premium tax credits and cost-sharing reductions as well.

Meanwhile, the Kaiser Family Foundation has released another one of their fantastically detailed surveys...this one is specific to California, even more specifically about Californians who were uninsured prior to the ACA exchanges & Medicaid expansion kicking into action a year and a half ago. Here's the results:

This report is the latest in the California Longitudinal Panel Survey series examining how previously uninsured Californians navigate the health care system as the Affordable Care Act (ACA) goes into effect. Prior to the enactment of the health care law, California had the largest non-elderly uninsured adult population in the nation, at nearly 6 million.1 The state eagerly adopted options under the ACA to expand coverage to more low- and moderate-income people, primarily through the development of Covered California, the state’s marketplace where people can shop for and compare health plans and access financial help to purchase insurance, and by expanding eligibility for Medi-Cal, the state’s Medicaid program, to include parents and adults without dependent children earning 138% of the federal poverty level (FPL) or less (about $33,465 annually for a family of 4 in 2015). As an early adopter with large numbers of uninsured, California is a particularly valuable place to track how the rollout of the health care law has impacted the state’s uninsured, and its progress and challenges can help inform future enrollment efforts state-wide and nationally.

...The third survey in the series, and the focus this report, returns to the same group of previously uninsured Californians a year later, after the second open enrollment period, to determine whether more of them had gained coverage, if some had moved out of coverage and back to being uninsured, and what their ongoing experience has been with their health insurance or the health care system more generally.

California’s health-care plan for the poor, serving one in three people in the state and almost half its children, is facing a $1.1 billion funding gap amid a squabble over how to replace a tax the federal government said is unfair.

To finance Medi-Cal, California charges 25 managed-care plans a 3.9 percent tax on their total Medi-Cal revenue. The U.S. Department of Health and Human Services has said the levy fails to comply with federal guidelines because it doesn’t apply to all managed-care providers.

If California doesn’t fix the system before its tax expires in June 2016, the state risks losing $1.1 billion in matching federal funds that help pay the health-care costs for 11.3 million people. Seven other states, including Georgia, Kentucky, Michigan, Missouri, Ohio, Oregon and Pennsylvania, levied taxes similar to California’s.

While I'm on a California run, the following article references the KFF study above:

When it comes to healthcare, California has been staunchly progressive, even aggressive, in its implementation of the Affordable Care Act. It set up its own health exchange, called Covered California, and expanded Medi-Cal, the state’s version of Medicaid. However, one area where California has struggled to make inroads in expanding health insurance is among undocumented immigrants, who account for at least 2 million people in the state.

The Golden State has sought to devise ways to legally skirt federal policies that hinder undocumented immigrants from accessing health insurance. Although it has made some progress in recent months, the overall effect is a patchwork of healthcare and medical resources for undocumented immigrants, who are vital to the state’s economy but, according to a study published Thursday, still constitute a significant proportion of the state’s uninsured population.

Normally I give QHP or Medicaid enrollment updates their own full entry, but this one is pretty minor so I'll throw it in here (the article itself isn't exactly flattering, but the enrollment number is specific and new to me, so I'm using it):

One reason that industry may be especially ripe for job training in Rhode Island is that the government is subsidizing it so heavily. When former Gov. Lincoln Chafee issued an executive order creating a state health benefits exchange under the federal Affordable Care Act (ACA) and the state’s bureaucracy signed on for the ACA expansion of Medicaid to able-bodied, childless adults, the government expected51,000 additional people to enroll in Medicaid within the first 18 months.

The state had nearly hit that number within a mere six months. According to the latest data, as of the end of June 2015, 211,146 individuals were enrolled in Medicaid– an increase of 81,252 from the end of December 2013.

This is actually the only Rhode Island-specific Medicaid expansion update that I've had for all of 2015; my last update for RI Medicaid was way back in April of last year, so it's welcome news. At the time, I had an even 70,000 (50K via expansion, 20K "woodworkers"), so this only bumps the net increase up by about 11,000 people. Still, everyone counts...

Finally, the Robert Wood Johnson Foundation has released their own in-depth report about how the State-Based Exchanges are doing after studying six of them closely:

Marketplace strategies for renewing existing enrollees are critical to the marketplaces’ survival. Most state-based marketplaces (SBMs) rely entirely or almost entirely on a premium assessment to fund their operations, and their budgets are set based on projected enrollment; lowerthan-expected enrollment could threaten the longterm financial sustainability of a marketplace. Though marketplaces will seek to grow enrollment by targeting the remaining uninsured, they must pay as much or more attention to retaining the enrollees they already have. This means choosing a renewal process that is easy for consumers while ensuring consumers will want to keep their coverage because it provides the right mix of benefits at the right price.

...To understand how SBMs experienced the first year of renewals and how their approaches affected overall enrollment and the consumer experience, we revisit six states whose approaches to marketplace renewals we studied in a previous brief.3 These states are California, Colorado, Kentucky, Maryland, Rhode Island and Washington. California, Colorado, Kentucky and Washington offered passive renewals and hoped to maximize retention, ensure continuous coverage, and reduce strain on marketplace information technology (IT) and consumer support capacity. Maryland and Rhode Island required active renewals, meaning enrollees had to return to the marketplace to maintain their coverage or financial assistance. Maryland used an active renewal process because it switched to a new IT system that could not transfer enrollee data. Rhode Island had two reasons for requiring active renewal: (1) the SBM did not get consent from enrollees to verify income for a redetermination, and (2) there were dramatic changes in plans and prices and the marketplace wanted consumers to shop for the best deal.4