Charles Gaba's blog

Three days ago, in my "Calls growing for CMS to offer COVID-19 Special Enrollment Period via HealthCare.Gov" post, I noted that:

There's only two reasons why limited-time Open Enrollment Periods exist in the first place:

1. To help prevent people from gaming the system & causing premiums to skyrocket by waiting until they're sick/injured to sign up

2. To help goad/spur people into action (deadlines are proven to be very effective at getting people off their butts)

The thing is, this is a pandemic. "Ensuring a stable risk pool" isn't exactly a top priority for anyone at this particular moment, and the economic consequences of this disaster are going to be rampant for quite awhile no matter what anyway. Right now the top priority should be making certain as many people are covered as possible. And "deadly global pandemic" is likely to be pretty "inspirational", I'd imagine.

This just in via MNsure...

MNsure Announces Special Enrollment Period for Uninsured Minnesotans in Response to Growing COVID-19 Concerns

ST. PAUL, Minn.—Today MNsure announced a 30-day special enrollment period (SEP) for qualified individuals who are currently without insurance, in response to the potential growth of coronavirus (COVID-19) cases. This SEP that begins Monday, March 23, and runs through April 21, will allow uninsured individuals 30 days to enroll in health insurance coverage through MNsure.org.

“As more cases of COVID-19 are diagnosed throughout the state, we want to make sure every Minnesotan has the security of health insurance to ensure they can get the care they need if they contract this serious illness,” said MNsure CEO Nate Clark. “Uninsured Minnesotans can come to MNsure.org to sign up for coverage.”

Governor Tim Walz recently declared a peacetime emergency in response to the pandemic and stressed the importance of all Minnesotans to take care to avoid the spread of COVID-19.

California Responds to COVID-19 Emergency by Providing Path to Coverage for Millions of Californians

  • Covered California Expands Special Enrollment and Medi-Cal Seeks Waivers to Encourage Coverage
  • Effective immediately, anyone uninsured and eligible to enroll in health care coverage through Covered California can sign up through the end of June.
  • The Department of Health Care Services announces new steps to help those eligible for Medi-Cal sign up easily and get immediate coverage.
  • The moves come amid widespread disruption in the lives and livelihoods of Californians as public health officials seek to reduce the spread of COVID-19.
  • All medically necessary screening and testing for COVID-19 are free of charge, and all health plans available through Medi-Cal and Covered California offer telehealth options.
  • These actions build on increased state subsidies and the implementation of a state penalty, both of which took effect in January 2020

No one has been shouting from the rooftops louder than I have for HHS Secretary Alex Azar or CMS Administrator Seema Verma to join nearly all of the state-based ACA exchanges in announcing an official Special Enrollment Period (SEP) in light of the ongoing Coronavirus pandemic, and I'm still urging them to do so as soon as possible. The federal ACA exchange, HealthCare.Gov, hosts ACA enrollment for 38 states representing around 75% of the national population, so this is a pretty big deal.

Having said that, it's important to keep in mind that even without a COVID-19-specific SEP, many people already qualify to enroll in ACA-compliant healthcare coverage anyway, whether they're currently uninsured or because they're about to be...or because their personal circumstances are about to change. And none of these have anything to do with the COVID-19 crisis, although it's certainly going to cause a whole lot more people to qualify for two of those changes:

Special Enrollment Period (SEP)

This Just In via Vermont Health Connect...

The State of Vermont has made temporary changes to assure that Vermonters have access to health insurance. Please visit https://t.co/dXz4Cd2yQm for more information

— VT Health Connect (@VTHealthConnect) March 20, 2020

OK...that's about as vague and understated as you can get. Clicking the link doesn't make it any more obvious:

Stay informed and protect your health.

Last week I noted that House Democrats introduced the Families First Coronavirus Response Act, which includes a whole mess of important measures to deal with the economic and public health crisis fallout of the global pandemic. This act is by no means all that's needed, but it's an important start. The bill included, among other things, additional/emergency funding for:

via CMS:

Earlier today at the White House Task Force Press Briefing, the Centers for Medicare & Medicaid Services (CMS) announced that all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the 2019 Novel Coronavirus (COVID-19) outbreak.

As more healthcare providers are increasingly being asked to assist with the COVID-19 response, it is critical that they consider whether non-essential surgeries and procedures can be delayed so they can preserve personal protective equipment (PPE), beds, and ventilators. 

“The reality is clear and the stakes are high: we need to preserve personal protective equipment for those on the front lines of this fight,” said CMS Administrator Seema Verma.

I've only written about Montana State Auditor (which includes acting as the Insurance Commissioner, as far as I can tell) Matt Rosendale a couple of times before. The first was in October/November 2017, when he pulled a cynical, disingenuous dick move by deliberately framing a non-profit insurance carrier into losing money for purely political reasons:

Montana commissioner chides insurance companies for raising rates, despite earlier offers to help

BOZEMAN — Montana's insurance commissioner chided two companies for raising rates on health insurance policies offered under the Affordable Care Act after federal subsidies ended, despite earlier telling them they could modify their rates if circumstances changed, the Bozeman Daily Chronicle reported.

...Matt Rosendale said he was "extremely disheartened" that PacificSource and the Co-op increased their premiums, adding that he had been assured by the companies that with or without the cost-sharing reduction payments they would be able to honor the rates they first submitted.

via the Colorado Dept. of Regulatory Agencies Insurance Division, it looks like Connect for Health Colorado is about to go ahead and establish their own COVID-19 Special Enrollment Period after all (this is from an internal draft document...the dates could still change, and it's not 100% guaranteed that they'll go ahead with it yet):

DEPARTMENT OF REGULATORY AGENCIES Division of Insurance 3 CCR 702-4 LIFE, ACCIDENT AND HEALTH

DRAFT Emergency Regulation 20-E-02

CONCERNING ESTABLISHING A SPECIAL ENROLLMENT PERIOD FOR ENROLLMENT IN AN INDIVIDUAL HEALTH BENEFIT PLAN RELATED TO COVID-19

...This emergency regulation is promulgated and adopted by the Commissioner of Insurance under the authority of §§ 10-1-108(7)(a), (7)(b)(III), 10-1-109(1), 10-16-105(2)(b), 10-16-105.7(3)(a)(II)(G), 10-16-105.7(3)(b)(II)(F),10-16-108.5(8), and 10-16-109, C.R.S.

Section 2 Scope and Purpose

via Access Health CT:

Access Health CT Announces A New Special Enrollment Period For Uninsured Connecticut Residents

AS COVID-19 THREATENS PUBLIC HEALTH, ACCESS HEALTH CT ANNOUNCES A NEW SPECIAL ENROLLMENT PERIOD FOR UNINSURED CONNECTICUT RESIDENTS

New Special Enrollment Period starts Thursday, March 19 and ends Thursday, April 2

As I expected, Nevada Health Link is onboard as well:

The @NVHealthLink board just met to approve emergency regs for a one-time Exceptional Circumstance Special Enrollment Period which will run 3/17 - April 15th, 2020. This is for qualified inds. who did not enroll during open enrollment. More information https://t.co/PURxkKPkxp

— Heather K. (@HKORB) March 17, 2020

Special Enrollment Periods (SEP) allow for health insurance coverage enrollment any time during the year. Did you miss the opportunity to enroll in a Qualified Health Plan through Nevada Health Link? Although the deadline to enroll in coverage ended on Dec. 15th, you or a loved one may be eligible to enroll now if you report a life or income change.

Exceptional Circumstance Special Enrollment Period (ECSEP)

One week ago, in light of the growing COVID-19 crisis, I noted that California, the District of Columbia and Maryland were each offering Special Enrollment Periods which had nothing whatsoever to do with the pandemic.

California's SEP is for uninsured residents who didn't know that the state had reinstated the individual mandate penalty and expanded financial subsidies to those earning 400-600% of the Federal Poverty Line; DC is offering one for those who didn't know they had also reinstated the mandate penalty; and Maryland passed a clever law last year which lets residents check a box when they file their state taxes if they're uninsured which tells the state to contact them to help them enroll.

I concluded that:

...as far as I know, there's nothing preventing other state-based exchanges from establishing Special Enrollment Periods for the coronavirus crisis if they want to.

Louisiana's 2020 Presidential primary was scheduled for April 4th, but the other day Democratic Governor John Bel Edwards and Republican Secretary of State Kyle Ardoin agreed to reschedule it for June 20th...which is actually later than the last previously-scheduled primary in the U.S. Virgin Islands on June 6th:

The presidential primary elections in Louisiana slated for April will be delayed by two months, the latest in a series of dramatic steps government leaders have taken to slow the spread of the new coronavirus.

Secretary of State Kyle Ardoin, Republican, and Gov. John Bel Edwards, a Democrat, both said Friday they would use a provision of state law that allows them to move any election in an emergency situation to delay the primary.

The presidential primary elections, initially scheduled for April 4th, will now be held June 20th. Ardoin said in a press conference he does not know of any other states that have moved elections because of the new coronavirus, or COVID-19.

via the New York Dept. of Financial Services:

NY State of Health and New York State Department of Financial Services Announce Special Enrollment Period for Uninsured New Yorkers, as Novel Coronavirus Cases Climb

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