Good News: HC.gov still not launching open #COVID19 SEP, but they've widened the eligibility window back to January 20th!

Thu, 08/20/2020 - 7:28pm

Back in April, in the midst of the earlier stages of the COVID-19 pandemic sweeping through much of the nation, there was a loud outcry for the various ACA health insurance exchanges, including the federal exchange at HealthCare.Gov which hosts enrollment for over 3 dozen states, to re-open enrollment to anyone who missed the official Open Enrollment Period which had ended several months earlier.

Eventually, twelve of the thirteen state-based exchanges did just that, launching COVID-19-specific Special Enrollment Periods of varying time periods for any resident who would normally be eligible to enroll during Open Enrollment to do so. Many of those SBEs would go on to extend the deadlines of their SEPs by a month...or two months...or even more. As of this writing, in fact, California, Maryland, New York and the District of Columbia are are still offering "open" COVID-19 SEPs.

The only ACA exchanges which didn't do this are Idaho's and the Big One, HealthCare.Gov. However, even they kind of, sort of modified the rules earlier this year by waiving the normal documentation requirement for residents to prove that they lost qualifying healthcare coverage within the past 60 days.

In Idaho's case, they were quite up front about it: There's an explanatory note on the exchange website, as well as issuing a press release, stating that you simply have to fill out a form declaring that you lost coverage within the 60-day period and they'll take you at your word. This is hardly the same as opening it up to anyone who's currently uninsured, but it's still better than having to dig up the appropriate documentation to verify your status.

As for HealthCare.Gov, they basically started doing the same thing in mid-April, waiving the verification requirement...but they were a lot quieter about it:

Via Andrew Sprung of Xpostfactoid, CMS is indeed doing the same thing for HealthCare.Gov that Idaho is doing for Your Health Idaho (waiving documentation and just requiring enrollees to attest that they lost their existing healthcare coverage)...but unlike Idaho, CMS doesn't appear to be going out of their way to advertise this fact either.

Here's the verbatim statement from CMS's official CCIIO (Center for Consumer Information & Insurance Oversight) representative during the training webinar that Sprung refers to while discussing Qualifying Life Events (QLEs) which make someone eligible for a Special Enrollment Period enrollment:

“I do want to point out that right now the Marketplace is not requiring consumers to upload supporting documentation to verify their eligibility to enroll in a Special Enrollment Period. So instead, consumers may attest to that information that they provide on the application while they are applying for a SEP.”

I don't know where exactly in the application process the attestation step is, but this is welcome news. As I noted above, it's still not nearly as good as a full "open" SEP given the circumstances, but it should help streamline the process for many enrollees.

Note that you still have to actually have experienced a QLE to be eligible; if you do get busted lying, it's still a violation of HealthCare.Gov's terms of service, so those living in the 38 HealthCare.Gov states should still only utilize a SEP if they actually did lose their employer coverage have one of the other QLEs.

Unfortunately, CMS appears to have quietly reversed this policy as of late July, and went back to requiring full documentation of coverage loss for Special Enrollment Period enrollments again:

Now, that limited but important accommodation has ended. Jenny Hogue, a health insurance broker based in Murphy, Texas, got wind of the change early this week. Shelli Quenga, director of programs at the South Carolina-based Palmetto Project, which provides marketplace enrollment assistance as a nonprofit brokerage, confirmed this to me, as did Jodi Ray, Director of the Florida Covering Kids and Families Project at the University of South Florida. "We have had appointments in the past week where consumers were asked for documentation to be uploaded," Ray emailed.

...CMS confirms that it has reverted to the standard pre-crisis SEP verification process, "as part of its efforts to safeguard taxpayer funds, promote market stability, and ensure affordable premiums." As noted below, insurers were not calling for this change -- they are not concerned that looser SEP verification at this point will worsen the risk pool. As for safeguarding taxpayer funds, inhibiting marketplace enrollment will always do that. Meanwhile, HHS has been showering billions in CARES Act relief funds on the nation's wealthiest hospital systems, many of which hold huge reserves, while safety net hospitals go begging.

That leads to yesterday's latest development on this front, via Sara Hansard of Bloomberg News:

People who have lost their health coverage since the beginning of the year now have a streamlined pathway to sign up for Obamacare.

The Department of Health and Human Services recently changed a question on the application for Affordable Care Act insurance to indicate that losing coverage since the start of the year allows people to sign up outside of the normal open enrollment period, according to people following ACA coverage.

Previously, the application for such coverage on the federal HealthCare.gov website used in 38 states asked if people had lost their coverage in the last 60 days—and the agency hasn’t made any announcement of the change.

The change reopens the door to Obamacare to many people who didn’t sign up within 60 days because they thought they would be back at work before then. It also eliminates some of the hoops people have to jump through in signing up for coverage.

...However, it doesn’t allow people who were uninsured before the pandemic to get coverage—as congressional Democrats have called for and as 12 of the exchanges run by states have done.

In short, HealthCare.Gov appears to have flipped things around: Instead of having to fall within the 60-day window but not having to provide documentation of it, they're now opening up the coverage-loss window to 7 months but are requiring documentation.

Again: It would likely be better if they just threw out the "coverage loss" requirement altogether under the circumstances for the remainder of the year (as Maryland did last week, and as California, New York and DC appear to be on the verge of doing), but this is still a lot better than the strict 60-day/documentation requirement given that we're in the middle of a pandemic.

As for the exact justification for implementing this policy, that's kind of interesting as well:

The HHS’s Center for Consumer Information and Insurance Oversight, which operates HealthCare.gov, based its change on regulatory guidance the Trump administration issued in 2018, allowing for special enrollment periods when the Federal Emergency Management Agency declares a disaster, Straw said.

FEMA declared a nationwide disaster due to the Covid-19 pandemic in January. The provision extends until 60 days after the end of the FEMA incident period, Straw said.

More specifically, it looks like FEMA officially declared the COVID-19 disaster on March 13th but backdated the starting date to January 20th, so technically speaking, I suppose if you lost your healthcare coverage between January 1st - January 19th you don't qualify. I can't imagine there's too many people who fall into that category, though.

The FEMA special enrollment period, or SEP, isn’t specific to Covid, Straw said. “If there’s a FEMA-declared disaster, then there’s an extension on your ability to enroll” as long as enrollees qualify due to life changes such as loss of coverage, moving, or having a baby, she said.

Bingo. I wrote about the FEMA SEPs several times back in late 2017, when the Trump Admin's CMS Dept., to their credit, opened up a FEMA disaster SEP for victims of Hurricanes Harvey, Irma and Maria. They also declared a similar SEP for a portion of Alaska after an earthquake hit the region, and the very next day did so for the state of Maine after a windstorm knocked out power to a large chunk of the state.

Frankly, the fact that they waited this long to declare a similar FEMA disaster SEP is mind-boggling given that precedent. Hell, my own Governor here in Michigan, Gretchen Whitmer, even referenced the 2017 Hurricane SEP in her plea to CMS to do so back in late March.

(sigh) Anyway, I'm glad they're doing this, although, again, they're still being extremely coy about it: