California

This article pretty mostly is a more in-depth explanation of the Medicaid/Medi-Cal situation in California that I wrote about the other day. However, the final line in the article also addresses my other post from a couple of days ago, asking when the heck CA and NY are going to release updated enrollment data (including renewals from 2014, which should account for around 960K in CA alone):

Medi-Cal Ranks Grow by Nearly 500K

...New enrollment numbers from Covered California for the rest of December will be released next week, exchange officials said, before the exchange board meets Jan. 15.

Woo-hoo! Today is the 10th, tomorrow is Sunday, so they should be coming out with fully-updated (I hope) data from the largest state in the country sometime between Monday & Wednesday.

Stay tuned...

LA Times reporter Chris Megerian has posted an important story about California's looming healthcare budget crisis. It mostly deals with the headaches facing the state budget as it tackles major increases in both Medi-Cal (CA's name for Medicaid) and the cost of caring for public employee retirees, and is a good read for healthcare/budget wonks.

What caught my eye, however, was this line about halfway through:

Over the next year, total Medi-Cal enrollment is expected to reach 12.2 million, he said — about one-third of the state's population. It was less than 8 million in 2013.

Hmmm...that sounds a bit high to me, so I ran the numbers against my own current estimates and came up with the following:

Yesterday I publicly declared that total QHP selections nationally had reached the 9 million milestone. I based this on 4 data points:

  • The 6.59 million confirmed by the HHS Dept. for the 37 states run through HC.gov,
  • The 980K confirmed by the 14 assorted state-run exchanges,
  • The unreported renewals (both active and automatic) from California & New York, and
  • Another roughly 150,000 scattered amongst all 50 states & DC since the date of their most recent updates until today (which varies from as little as 1 day to as much as 25 days in the case of Idaho).

If you do the math, you'll see that the biggest missing piece here is the 3rd item above: Covered California and New York State of Health have, to date, still refused to give out any re-enrollment/renewal data for 2014 QHP enrollees. Not just autorenewal numbers, but active renewals as well.

THIS JUST IN...

As CoveredCA has noted before, they have no plans on posting renewed policy enrollments until January, but this at least gives data on the new additions:

COVERED CALIFORNIA AND DEPARTMENT OF HEALTH CARE SERVICES RELEASE EARLY RESULTS FOR FIRST MONTH OF OPEN ENROLLMENT THROUGH HEALTH INSURANCE EXCHANGE

Demand for Coverage Continues to Be Strong, with Applications Submitted for More Than 592,000 People Through Dec. 15

SACRAMENTO, Calif. — More than 592,000 people sought coverage and were determined eligible for private health insurance and eligible or likely eligible for Medi-Cal in the first month of open enrollment, Covered California and the California Department of Health Care Services announced Wednesday.

The consumers, who applied for coverage through Covered California since open enrollment began on Nov. 15, include 157,361 eligibility determinations and an additional 144,178 plan selections for private coverage, as well as 216,423 enrollments into Medi-Cal coverage and 74,965 who are likely eligible for Medi-Cal. So far in 2014, Medi-Cal has enrolled more than 2.2 million consumers.

As you can see from the graphic I posted yesterday (and had to revise several times throughout the day), the official enrollment deadline for private policies starting on January 1st, 2015 has now passed for all 37 states operating via HealthCare.Gov, as well as residents of DC, Hawaii and Kentucky. It's certainly possible that any or all of these will announce some sort of "special circumstances" allowance for those who didn't make the midnight cut-off (10pm in Alaska), but I'm assuming those would be done strictly on a case-by-case basis.

OK, so what about the remaining 11 states?

Well, 4 of them (MD, MA, RI & WA) had later deadlines for January coverage all along: Maryland on 12/18 (Thursday) and the other 3 on 12/23 (next Tuesday).

New York and Idaho bumped their deadlines out from yesterday until 12/20 (Saturday), although Idaho had previously claimed that their deadline was 12/23, but are now claiming that it was originally 12/15. I still don't understand what happened there, but so be it: 12/20 it is for ID.

Earlier today Connecticut and Minnesota announced deadline extensions; now CoveredCA has done so as well...

California’s health insurance exchange extended its deadline for consumers wanting Obamacare coverage in effect by Jan. 1.

Peter Lee, executive director of Covered California, said people who start the application process or make some “good faith effort” by Monday will have until Dec. 21 to finish signing up. Monday at midnight had previously been the hard deadline.

“We are providing this window to get people across the finish line,” Lee said at an exchange board meeting Monday. “We know many of the people applying have never had insurance before, and these are individuals who need to sit down and talk with someone.”

Lee said many insurance agents and enrollment counselors were already fully booked with applicants Monday. He said the deadline extension will allow people to make appointments through Dec. 21.

A nice update out of California...but still a frustrating one. They held an executive board meeting today at which they posted an updated QHP selection total for 2015: 91,693 as of 12/11/14. Unfortunately, this still doesn't include any renewal data for existing enrollees.

As I noted last week, however, I'm extremely confident that CA's renewals/re-enrollments are running easily at the same rate (or potentially as high as 4x as many) as new additions, so I'm very comfortable doubling this number to at least 184,000 total QHP selections as of the 11th.

Just moments ago, CoveredCA head Peter Lee held a conference call in which he issued the first full 2015 open enrollment period data (until now, the only number released was 11,357 QHPs in the first 4 days...except that only included new enrollees, not renewals).

As I noted yesterday, I estimated appx. 397K QHPs through Monday (12/08). I'm also guessing it'll be about a 55/45 split between renewals of existing enrollees & new additions.

The actual number of NEW QHP enrollments turns out to be: From 11/15 - 12/03: 130K determined elgiible, of whom 48,950 have selected plans...

Hmmm. Well, now...on the surface, this makes it look like I was way off, overestimating by a whopping 8-fold factor.

HOWEVER, there are two rather important (and unexpected) points which make that comparison impossible:

I've received official confirmation that CoveredCA will give their first official 2015 Open Enrollment Period data report tomorrow (Wednesday) morning.

I'm gonna take a stab at their number:

  • IF I'm correct that Healthcare.Gov hit 1.35 million QHP selections as of 12/05, and
  • IF I'm further correct that Healthcare.Gov is consistently making up appx. 75% of the national total at any given time, and
  • IF I'm further correct that the total QHP selections as of 12/08 hit around 2.21 million, and
  • IF I'm also correct that CoveredCA is making up appx. 18% of the national total, THEN...

...CoveredCA's total through 12/08/14 should be around 397,000 QHP selections.

We'll see how close I come.

(sigh) OK, I wasn't gonna post any more updates today but this is kind of a big one..CoveredCA:

Obamacare: @CoveredCA says 11,357 enrolled in health plans in 4 days of open enrollment Nov 15-18 #ACA #OE2

— Chad Terhune (@chadterhune) November 20, 2014

For comparison...

Obamacare enrollment: @CoveredCA signed up 11,357 in first 4 days, took 15 days to hit that in Oct 2013 #ACA #OE2

— Chad Terhune (@chadterhune) November 20, 2014

It's also important to remember that unlike HC.gov, CoveredCA was (for the most part, anyway) fully operational from the beginning last year, which makes this a reasonable apples-to-apples comparison.

In addition, Terhune clarifies:

When I last checked in on ACA Medicaid expansion in California back in mid-September, it had reached a whopping 2.2 million...or possibly as high as 2.55 million, depending on whether the number included a massive backlog of 350,000 CA residents.

Well, it now seems that not only has that question been answered, but the grand total is a bit higher yet: 2.6 million low-income Californians can thank Obamacare for their newfound healthcare coverage:

The state Medi-Cal system has taken on 2.7 million more Californians since October 2013.

That's an increase of 31% from the 8.6 million previously enrolled. The jump brings the current number of Californians in the Medi-Cal program to 11.3 million -- roughly 30% of the state's population. Medi-Cal is California's Medicaid program.

There's been a lot of fuss made about 2015 ACA exchange premium rates not being available at Healthcare.Gov until after the election. The presumption, of course, is that this is being done for political reasons. While this may be true, it could also simply be that there's a lot of different policy figures to plug into the federal system, and some states haven't even finalized their rates yet.

That being said, residents of some states can check out the 2015 premiums now and compare them against their current premium:

IDAHO: Idaho is the only state moving from HC.gov to their own exchange. Idaho residents can check out their 2015 rates directly via the state exchange site.

CALIFORNIA: CoveredCA has 2015 rates available right now as well.

WASHINGTON: Health Exchange leaders are trying to solve the problems from the first sign-up period

CLARKSTON, WA – Leaders with Washington’s Health Care Exchange are preparing for the second open enrollment period, but at the same time they are still working on resolving billing and computer problems for 1,300 accounts from the first sign-up period.

IOWA: Three health insurers get OK to increase rates

This is very confusingly worded, because it makes it sound like all 3 companies have been operating on the HC.gov exchange when it turns out that only 2 of them have. Wellmark did not participate in the ACA exchange; the 19,000 customers referred to here have off-exchange policies which are still ACA-compliant:

Commissioner Nick Gerhart said today that he has approved premium increases from Wellmark Blue Cross and Blue Shield, CoOportunity Health and Coventry Health.

OK, I've started a new entry since the last one was getting pretty long.

I still have to sort through a bunch of data, but the main takeaway is this:

  • I projected the total California QHP enrollment figure to be around 1.68 million. The actual number is 1,414,668 (as of 4/15...see update at bottom of this page) plus 200,000 off-season enrollments from 6/1 - 9/30 plus an unknown number from the 46 days between 4/16 - 5/31.
  • I have no idea why they left those 46 days out of the press conference. Very odd.
  • There were 200,000 people who enrolled from June 1st - September 30th (122 days), or 1,639 people per day.
  • Assuming the missing 46 days saw a similar rate to the rest of the off-season period, that would be 1,639 x 46 = 75,394 additional enrollees.
  • Assuming this is correct, that's 1,614,668 + 75,394 = 1,690,062
  • That would make my projection 99.4% accurate.

Regular readers know that given the HHS Dept's going radio silent on the total ACA enrollment figures since the last official report was released back in May (which only ran through April 19th), I've been patching together bits and pieces of enrollment data from a handful of state exchanges, plus the occasional snippet of info from other states which has managed to find daylight from time to time.

Based on this, I've been projecting roughly 9,000 QHP enrollments being added per day during the off-season, translating into around 270,000 per month, of which about 90% eventually pay their first months premium. That translates to around 240K paid enrollees being added per month, which in turn is being roughly cancelled out by people dropping their policies after the first few months as they move on to other types of coverage (Medicare, ESI, Medicaid and so forth). Based on these estimates, there should now be a gross total of around 9.6 million enrollments, of which around 8.3 million have paid their first premium, and around 7.4 million who are currently enrolled as of October.

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