Massachusetts

2018 MIDTERM ELECTION

Time: D H M S

So far there have been two comprehensive post-Open Enrollment Period reports released. The first was for Washington State, posted a couple of weeks ago; the second was for Massachusetts, posted last week. While both reports were chock full of all sorts of data-nuggety goodness, including updated paid QHP numbers, neither one included one crucial number: How many total QHP selections there have been in each state since Open Enrollment ended in February.

The Massachusetts Health Connector board held their monthly meeting today, which included an updated enrollment report which is chock-full of all sorts of data-nerd charts and graphs; a bonanza for folks like myself. Best of all, it runs all the way through 3/31, making the the most up-to-date report I have for any state at the moment.

This report is as compared with the 2/26/15 numbers, when Massachusetts reported 125,402 paid/effectuated QHP enrollees out of 144,362 total selected plans.

The main takeaways in today's report are:

We're in a bit of an in-between phase this week. Open Enrollment is officially over, and the Tax Season special enrollment period doesn't start until Sunday in most states.

However, the Massachusetts Health Connector has provided me with a handy report which gives some interesting drill-down data. Most of it is stuff I don't really track anyway, but some of it I do and the rest may be of interest to some. I'm only focusing on a few items, the PDF itself has a bunch more:

This isn't an exact apples-to-apples comparison, since the Massachusetts number includes the "overtime" extension period while the other 5 states only run through 2/15/15, but I thought it would be useful to see how the 6 exchanges which had widespread technical issues last year fared this time around. Obviously  other states like Washington and California had some snafus, but these are the ones which were seriously hosed last year to the point of requiring massive overhauls or which were completely scrapped in favor of a new platform (I'm not including HC.gov itself here since everyone already knows what massive technical improvements they've made).

The chart below refers specifically to QHP selections only (whether paid or not), and compares the 2015 open enrollment period (11/15/14 - 2/15/15...or 2/26 in the case of MA) against the 2014 open enrollment period (10/1/13 - 4/19/14). I've also included some notes for context.

As I noted earlier, I've been expecting final #OE2 numbers from at least two states, Massachusetts & Minnesota. MA has just come through with an extremely detailed report.

In addition, they've given me a partial answer to my earlier question: Yes, they do plan on releasing off-season enrollment data at least monthly (via their board meetings), and possibly weekly (I'm guessing daily would be too much to ask during the off-season). So, I can count on off-season data from at least 1 state...49+DC to go...

They also said that they don't know about a Tax Season Special Enrollment Period yet, and did not have any SHOP data or Medicaid expansion-vs-woodworker data yet.

Finally, one interesting MA-specific quirk: "ConnectorCare" enrollees...which are QHP enrollees but are heavily subsidized by the state as well (I think this is sort of like Arkansas' Medicaid "private option"?)...can be enrolled in year-round. This could be significant during the off-season, espeically since this makes up 64% of the total QHP number to date.

With that, in the end, Massachusetts final official numbers are:

It's important to stress that this is not the final enrollment report for Massachusetts; it's the final daily report, which only includes the number of people determined eligible to purchase a private policy (Medicaid enrollees, however, are instant-activation; the number listed here is the number actually enrolled as of that day).

For most of the open enrollment period, QHP selections were running around 45-50% of the total QHP determinations; the other half are people who hadn't actually completed the process or who accidentally submitted 2 applications or whatever.

However, for the final week, it's pretty safe to assume that anyone who bothered to create an account, fill out their info and submit their application was pretty likely to actually put a policy in their shopping cart and check out (as well as paying their first premium on the spot), since yesterday was the (extended) deadline to do so. Therefore, it's a pretty safe bet that all 2,816 of those listed below (of the 7,057 total, which also includes MassHealth), at a minimum, can be added to the total.

On Friday, the MA Health Connector confirmed 134,000 QHP selections out of 237,000 people determined eligible for QHPs as of 2/18. Since then they've added another 6,614 QHP determinations.

For most of the 2015 open enrollment period, the number of people actually selecting a plan has hovered between 45-50% of the total determinations. However, as of last Thursday it had shot up to over 56%, and given that today is the final day to enroll for most people, it's a pretty safe bet that anyone who has bothered going through the trouble of creating an account, logging in, plugging in all of their info and submitting an application is also going to complete the process by actually checking out a policy (and presumably paying their first premium, since today's the deadline for that as well).

Therefore, I'm pretty sure that the total is well above 140K by now, and likely somewhat higher than that (since that would still leave another 103,600 people who had previously submitted an application but not completed the process as well).

Here we go...I was actually pretty much dead-on target with MA this week; 134,037 QHP selections, of which 108,168 have paid their first premium (81%). Again, remember that something like 25% of these folks aren't starting coverage until March 1st, so their payments aren't due until Monday night, so the payment rate is fine for the moment.

In addition, Massachusetts has extended their full enrollment period out through Monday, there will still be new folks who submit an application over the next 4 days. On top of that, there's potentially another 103,000 approved applications already waiting for people to pull the trigger (6,707 of whom already have a plan in their shopping cart waiting to check out). Obviously not all of these will follow through, but if they did, that would shoot MA's total up to nearly 237K.

The numbers are starting to quetly ramp up again as we approach the MA Health Connector's extended enrollment deadline (February 23rd): 1,247 QHP determinations on Monday; 1,678 on Tuesday and 2,366 yesterday. Assuming at least 70% of these went on to actually enroll (I can't imagine it'd be any lower than that at this point...who would bother applying this late in the game if they don't plan on following through??), actual QHP selections should be up to 132.5K or higher at this point.

Medicaid in Massachusetts is now up to over 260,000.

Another 1,678 QHP determinations yesterday. At this point, I think it's safe to say that pretty much anyone who's bothering to go through the trouble of setting up an account and submitting an application is also following through and selecting a plan, but for the moment I'll just go with 60% and figure 1,000 people actually did so, for 131K or more total.

Meanwhile, Medicaid enrollment is up to over 256K.

OK, it's very important to note that the ratio of QHP selections to QHP determinations, which was consistently hovering between 45-50% throughout the entire Open Enrollment Period, likely shot up significantly over the final weekend. On the other hand, MA has bumped their deadline out by 8 extra days on account of the massive snowstorms, so perhaps not.

With that in mind, assuming at least a 50% ratio since Friday's official numbers (9,109 additional QHP determinations), that would mean a minimum of 4,600 additional selections, for a grand total of at least 130K to date.

In theory, it could be as high as 233,000 if every single person who has been determined eligible to enroll in a QHP has gone back and finished the process. Somehow I doubt it's that high, but that at least gives an idea of the potential ceiling here (and don't forget, there's still another full week for MA residents to start the process).

Meanwhile, Medicaid (MassHealth) has broken the 250K milestone.

I've confirmed that Rhode Island's weather-induced enrollment extension is indeed state-wide and is of the "full" variety (ie, people can start the application process, not just finish it), through February 23rd. This is exactly the same policy that the Massachusetts exchange announced the other day.

Also, a late-breaking extension announced from Maryland.

11:45pm: OK, add the DC exchange to the pile.

9:00am 2/16/15: OK, HHS/CMS has clarified the specifics for the 37 Healthcare.Gov states.

11:50am 2/16/15: Idaho's policy took some work to decipher...

2:24pm 2/16/15: ...and Minnesota...

OK, first, the official data updates: The MA Health Connector issued their weekly report, confirming 125,651 QHP selections to date, of which 82.2% have paid their first premium. The payment rate has gone down as expected, since the denominator (March 1st enrollments) has started shooting up while the numerator (payments made) has gone up more slowly...since those payments aren't even due until the 23rd anyway.

Compared to the past 2 weeks, you can see the final surge has definitely kicked in:

As of last Thursday, total QHP selections on the Massachusetts exchange were up to just shy of 119K. Between the weekend and the massive snowstorm that MA is digging out of, they went 5 days without a dashboard report, until today:

As always, I only have the QHP determinations to go by between their weekly reports. As of yesterday, those stood at 221,877, Subtract the 214,027 as of 2/05 and that's another 7,850 QHP determinations. Assuming 50% of those followed through with selecting a plan (a reasonable assumption at this point) and that's another 3,900 QHPs, or at least 122,600 QHPs to date.

Of course, that means that there's also another 99,000 people who started the process and have been approved for a private policy, but who may--or may not--have actually completed the process. Heading into the final 5 days, I presume that more and more of this enrollee pool will be scratched off the list; if, say, 80% of these folks follow through, Massachusetts would hit at least 200,000 QHPs by Sunday night.

OK, looks like my QHP estimate over the past week was fairly close, but a bit conservative...actual QHPs selected are up to nearly 119K, with just shy of 100K even having paid their first premium (thus completeing their enrollment).

100K / 119K = an 84% payment rate, but remember that anyone who has enrolled since 1/23 doesn't have to pay their first premium for over 2 weeks, so this isn't cause for concern.

Meanwhile, they have another 95,000 people who have been determined eligible for QHP selections waiting in the queue, of which nearly 6,000 have a plan in their shopping cart but just haven't pulled the trigger.

MA will have to have 51,274 more QHP selections to reach the 170K target (which, admittedly, was my interpretation of their target, not necessarily their target itself). That'd be 4,600/day, vs. the 1,447/day they've averaged so far. 

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