MAJOR UPDATE: NEW YORK: Health Republic enrollees MAY have one more option...

Sat, 11/07/2015 - 8:28pm

IMPORTANT DISCLAIMER: I COULD BE COMPLETELY WRONG ABOUT THIS OPTION.

Just this morning I posted some significant updates in the ongoing, increasingly messy saga of Health Republic of New York, one of the ACA-created Co-Ops which is being shut down due to severe financial issues (partly due to the Risk Corridor Massacre debacle, but other reasons as well).

Once again, the short version is:

Most of the Co-Ops which are being shut down are at least able to cover their policies through the end of December, giving their current enrollees plenty of time to shop around and switch to a different insurance carrier. This was supposed to be the case for Health Republic of NY as well.

However, on October 30th, there was a surprise announcement by the NY Dept. of Financial Services (which includes insurance regulation) that instead of December 31st, the HRoNY policies are being yanked effective November 30th. Furthermore, current enrollees have only until November 15th to find a replacement to tide them over for December.

While one month may not sound like a big deal, it's a huge problem for at least some of the 200,000-odd people currently enrolled via HRoNY (note: I thought this number was down to 166K, but may be mistaken about the figure).

It's a major problem for some enrollees who are undergoing chemotherapy, for instance, or have other recurring medical services/treatments (many of which are expensive) which can't be "paused" for 31 days.

Making things worse, while notifications to those enrollees of the new situation were supposed to have been sent out by email and regular mail to all 200K last weekend, there's ample evidence that a good portion of the enrollees never received a notice (some may have thrown it out by accident; perhaps the email notice got caught in their spam filter; they might not have opened it yet; it might have been sent to the wrong address; etc, etc...)

It's a bit unclear whether responsibility for notifying the enrollees of the situation (and/or helping them resolve it) lies with HRoNY itself, the state exchange (NY State of Health), the NY DFS or all three...although my guess would be that the DFS has the ultimate authority given the situation. After all, the exchange has no connection with anyone who enrolled off-exchange, while Health Republic is presumably not in a position to be in charge of anything at the moment.

Finally, I found one development kind of curious: One of the reasons that the other insurers, as well as the NY Health Plan Association, is giving for being reluctant to take on any of HRoNY's enrollees is that they apparently don't have access to the deductible/out of pocket payment status of these folks. While I'm sure that's true, it seems odd that Health Republic wouldn't have that information on hand...which makes me wonder whether anyone has actually requested it yet.

OK, so that brings things up to this now.

Earlier this evening, there was one further development. I found myself embroiled in a lengthy group Twitter conversation with Politico NY reporter Dan Goldberg; insurance broker/blogger Louise Norris; Senior Analyst at healthcare software developer hCentive Josh Schultz; LifeHealthPro reporter Allison Bell; and healthcare blogger Andrew Sprung.

On Twitter, of course, you tend to end up with a bunch of partial sentences and interrupted thoughts; this discussion bounced around a lot of different HRoNY issues, but there's one thread in particular which jumped out at me. Here's the main point:

@charles_gaba 45 CFR 155.420 (b)(2)(iv) and (d)(1) allow a person to select a new QHP on or before Nov 30, and have a Dec 1 effective date.

— Josh Schultz (@joshschultzdc) November 7, 2015

Here's the relevant statutes Schultz is referring to:

(b) (2) (iv) In a case where a consumer loses coverage as described in paragraph (d)(1) or (d)(6)(iii) of this section, if the plan selection is made before or on the day of the loss of coverage, the Exchange must ensure that the coverage effective date is on the first day of the month following the loss of coverage. If the plan selection is made after the loss of coverage, the Exchange must ensure that coverage is effective in accordance with paragraph (b)(1) of this section or on the first day of the month following plan selection, at the option of the Exchange;

(d) The Exchange must allow a qualified individual or enrollee, and, when specified below, his or her dependent, to enroll in or change from one QHP to another if one of the following triggering events occur:

(1) The qualified individual or his or her dependent either:

(i) Loses minimum essential coverage. The date of the loss of coverage is the last day the consumer would have coverage under his or her previous plan or coverage.

Got that? OK, getting back to the discussion...

@joshschultzdc hmmm if that's the case, why the 11/15 cut-off, *especially* given the circumstances here?

— Charles Gaba (@charles_gaba) November 7, 2015

@charles_gaba @joshschultzdc The reason they're pushing 11/15 is b/c it's going to be technically difficult to use a SEP during general OE.

— LouiseNorris (@LouiseNorris) November 7, 2015

@joshschultzdc @charles_gaba it so their coverage is effective w/o a gap, using the SEP rules, for those who fall through the cracks.

— LouiseNorris (@LouiseNorris) November 7, 2015

@LouiseNorris @charles_gaba exactly - not an IT question or a system question. It's a human question of how they interact with the website

— Josh Schultz (@joshschultzdc) November 7, 2015

@louisenorris @joshschultzdc From the back-and-forth, it sounds like you guys are saying that legally, people *do* have until 11/30…

— Charles Gaba (@charles_gaba) November 7, 2015

@louisenorris @joshschultzdc …but TPTB are pushing the hell out of the 11/15 date to minimize how many squeeze in after that (11/16 - 11/30)

— Charles Gaba (@charles_gaba) November 7, 2015

@louisenorris @joshschultzdc …due to both the logistical time crunch as well as those people getting confused about SEP vs. OEP...

— Charles Gaba (@charles_gaba) November 7, 2015

@louisenorris @joshschultzdc If so, I understand the reasoning…but at the same time, they're scaring the living shit out of people as well

— Charles Gaba (@charles_gaba) November 7, 2015

@charles_gaba @joshschultzdc Yes, on all points.

— LouiseNorris (@LouiseNorris) November 7, 2015

@charles_gaba @LouiseNorris pretty much.

— Josh Schultz (@joshschultzdc) November 7, 2015

@joshschultzdc @charles_gaba @LouiseNorris would NYS have to declare an SOP or does it happen automatically because HR is going out of biz?

— Dan Goldberg (@DanCGoldberg) November 7, 2015

@DanCGoldberg @charles_gaba @LouiseNorris loss of MEC/loss of coverage is a federal SEP. At discretion, other SEPs can be opened as well.

— Josh Schultz (@joshschultzdc) November 7, 2015

@joshschultzdc @charles_gaba Yep. The DOIs basically said they didn't want to mention the SEP provision, but would work with people to make

— LouiseNorris (@LouiseNorris) November 7, 2015

@joshschultzdc @charles_gaba to avert a situation where lots of people attempt SEP enrollment during general OE.

— LouiseNorris (@LouiseNorris) November 7, 2015

@louisenorris @joshschultzdc @dancgoldberg So what we have here is a massive game of Hot Potato…but with real people's lives at stake.

— Charles Gaba (@charles_gaba) November 7, 2015

...and so on.

I think I understand the situation now. technically, legally speaking, it sounds like HRoNY enrollees are not actually required to select alternate December coverage by November 15th, but can actually do so right up until November 30th. However, if they do so between November 16th - 30th, they'd have to treat it as a (one month only) Special Enrollment Period instead of as a "normal" enrollment (not that there's anything "normal" about this situation). And, if I'm understanding this correctly, it sounds like the reason why the NY DFS, NYSoH and HRoNY are all pushing the Nov. 15th deadline is twofold:

First, people are confused enough already about the "normal" enrollment process for December coverage (ie, 11/15 deadline); trying to explain that enrolling for December only between 11/16 - 11/30 requires a different procedure/categorization will just confuse them further.

Second, and more importantly, it sounds like they're concerned that if the HR enrollees know that they have until 11/30, a whole bunch of them will do just that, causing a massive bottleneck/backlog of enrollment paperwork/data to be processed all at once, in time for coverage the very next day.

I debated about whether I should publicize this development or not. I mean yes, it's already public in the sense that a half-dozen of us were discussing it quite publicly via Twitter already, so presumably various healthcare/insurance pundits/junkies already know about it now...but that's quite different from deliberately blogging about it here in a permanent entry.

Normally, both of these reasons--especially the second one--would make total sense; let as many people as possible take care of their December coverage before the 15th, and then let the rest know that yeah, you actually have another 15 days after all. That spreads the process out so it doesn't clog things up too badly.

HOWEVER, given the incredibly tight timeframe that we're talking about (only 8 days at this point), along with the genuine fear/panic which some folks are dealing with (this isn't a game at all for a lot of people), I decided that it's better to get it out there after all.

It's important to stress that I am not a lawyer, nor am I an insurance industry or insurance reguation professional. Perhaps New York state law/insurance regulation policy is unique, or perhaps there's been some sort of special additional regulation added which I'm unaware of. In short, it's possible that November 15th really is the final deadline to get coverage for December. Furthermore, any Health Republic of New York enrollee who is able to secure coverage before the 15th is strongly advised to do so.

HOWEVER, if you're one of those who is genuinely concerned that you won't be able to hit the 11/15 deadline, find out whether the 11/30 SEP scenario laid out above is accurate. If so, that might be an option to consider.

Good luck.