Grab Bag: Avalere Medicaid projection, NV Off-Exchange market & WA Non-Extension Extension (UPDATED)
Thanks to deaconblues for all three of these items:
Avalere Health, with whom I've both clashed and agreed with on ACA-enabled Medicaid enrollments in the past, is projecting as high as a net gain of 4.3M Medicaid enrollees through the end of March:
700K to 1.3M Additional Medicaid Enrollees through March, If Current Trends Continue.
However, March and April figures could bring more dramatic increases if outreach and enrollment efforts targeting the end of exchange open enrollment translate into new Medicaid enrollees. Specifically, if Medicaid sign-ups follow a similar pattern as exchanges, new Medicaid enrollees could reach 4.3 million by the end of March. In addition, recent figures released by CMS do not account for individuals assessed eligible for Medicaid through HealthCare.gov who have yet to be determined eligible by states.
I think this may also explain the discrepancy between my 5M/7M "new to Medicaid" numbers and HHS's "over 3M newly enrolled since October" announcement. There's presumably a difference between being determined eligible for Medicaid and actually being enrolled in the program.
I admit that I never really thought about this one way or the other until a few weeks ago, but it makes total sense that insurance companies, no longer being allowed to snoop on the medical details of prospective enrollees, would be reluctant to sell policies to them year-round. The ACA exchanges essentially convert the entire individual healthcare market into one giant "group" system with a limited open enrollment period, like any other large corporate insurance program:
For months, consumers have been warned that they have to buy health insurance by the end of open enrollment or remain uninsured until next year. But a little noticed provision of the health law may give some consumers another chance.
Insurers that sell individual plans have to offer insurance to all comers during an annual open enrollment period, which this year ended for most people on March 31. However, the health law allows insurers to sell individual plans on the exchange outside the regular open enrollment if they wish to do so, as long as they don't discriminate against people who are sick.
...Still, at least one state is embracing the option. Under a Nevada law that took effect in January, any insurer that sells individual health plans outside the state's health insurance exchange has to offer those plans year round. To discourage people from waiting until they get sick to buy a plan, insurers can require a waiting period of up to 90 days for coverage to take effect.
UPDATE 4/09: Again, I'm not endorsing eHealth Insurance, but they did provide this handy guide to enrollment extensions both via the exchanges and through their own system. I'm not sure I understand why their off-exchange enrollments will only be extended through April 15/18/30 while other companies are offering them year-round directly, but it's still worth noting.
Finally, Washington State, which, along with CT, HI and RI, is officially not allowing any sort of enrollment extension period, actually is doing so in very rare cases:
The Exchange has already reviewed several groups of applications in the system based on application activity and will open a special enrollment period for individuals who have encountered technical problems on or before March 31. Individuals who have been approved for a special enrollment period will receive notification from the Exchange within the next week.
...Cases Will Be Reviewed: Staff will review cases in the order they are received. Please note that it may take two to three weeks on average to review these requests and verify eligibility for a special enrollment period.