Charles Gaba's blog

via the NJ Dept. of Banking & Insurance:

New Jersey Department of Banking and Insurance Establishes Extended Special Enrollment Period at Get Covered New Jersey for Individuals Losing NJ FamilyCare Coverage

TRENTON – New Jersey Department of Banking and Insurance Commissioner Marlene Caride today announced the creation of an extended Special Enrollment Period for individuals who are no longer eligible for NJ FamilyCare and qualify for health insurance through Get Covered New Jersey, the state’s Official Health Insurance Marketplace.

Per federal law, the Department of Human Services is restarting eligibility reviews for NJ FamilyCare as of April 1, which will result in some individuals who are no longer eligible being disenrolled from the program. For those who no longer qualify for NJ FamilyCare because their income is too high, they may be eligible to obtain health coverage through Get Covered New Jersey and may be able to get help paying for premiums.

via Rylee Wilson of Beckers Payer Issues:

Oscar Health will exit the California individual ACA insurance market for plan year 2024 as part of a push to make its insurance business profitable. 

On a May 9 call with investors, transcribed by Seeking Alpha, Oscar Health CEO Mark Bertolini said the company is exiting underperforming markets to improve its profitability. 

"The company has been disciplined in managing its portfolio and improving the sustainability of our margins over time," Mr. Bertolini said.

Oscar Health plans to reenter the California market in the future, Mr. Bertolini said. 

Interim CFO Sid Sankaran said the California market represents less than 5 percent of Oscar Health's membership, with around 35,000 members in the state. 

This suggests that Oscar has roughly 700,000 ACA exchange enrollees nationally, FWIW.

via the Pennsylvania Dept. of Human Services website:

Shapiro Administration Working With Community Organizations To Help All Pennsylvanians Amid Major Federal Changes To Medicaid Renewals

Reading, PA - Pennsylvania Department of Human Services (DHS) Acting Secretary Dr. Val Arkoosh joined representatives from the Berks Community Health Center and Pennie® today to highlight how the Shapiro Administration, Pennie, and community organizations are collaborating to support Pennsylvanians through federal changes to Medicaid and CHIP renewal requirements so they can protect their health and stay covered.

via Amy Lotven of Inside Health Policy:

CMS will beef up its outreach strategy and scale up a pilot program that connected navigators to specific consumers who are not eligible for Medicaid but could enroll in an Affordable Care Act plan through to help ensure people who lose benefits during the ‘unwinding’ maintain their coverage, according to a slide-deck from a recent webinar.

As part of the effort, will send those consumers additional reminder letters about enrolling in ACA coverage, with the first batch slated to go out in mid-May, and the assisters will contact those customers shortly afterward.

HHS has estimated that about 2.7 million of the 15 million or so Medicaid beneficiaries expected to lose coverage during the redetermination may be eligible for subsidized coverage through the marketplaces.


October 2022:

Texas: Friday Health Plans Bails; Another ~230K Enrollees Will Have To Pick A Different Day Of The Week

It was just four days ago that Bright Healthcare, which had been aggressively expanding their individual market coverage area footprint as recently as a year ago, suddenly announced that they were doing a complete 180 and instead pulling out of virtually the entire individual & small group markets nationally starting in January 2023.

...Well, just one day after the Bright Healthcare bombshell news broke, Texas-based health insurance broker Jenny Chumbley Hogue sounded the alarm on another large carrier bailing on Texas next year:

via the Washington Health Benefit Exchange:

Apple Health (Medicaid) renewal letters have begun mailing

The Washington State Health Care Authority (HCA), Washington Health Benefit Exchange (Exchange), and the Department of Social and Health Services (DSHS) have begun mailing letters to Washington Apple Health (Medicaid) clients reminding them to update their contact information and renew coverage to see if they still qualify.

For the first time in over three years, people on Apple Health could lose coverage if their family income has gone up. Federal requirements during the COVID-19 public health emergency (PHE) led to income checks being suspended to keep clients enrolled in Apple Health during the pandemic. However, last December’s federal omnibus spending bill directed states to resume evaluating eligibility of Medicaid enrollees on April 1 to wind down COVID-19 pandemic emergency measures.

Just a quick roundup of a whole series of COVID pandemic "winding down" actions which have taken place or are about to take place:

On March 13th, 2022, the Consolidated Appropriations Act was signed into law, formally setting March 31st, 2023 as the end date for the Medicaid Continuous Coverage provision of the Families First Coronavirus Response Act; since April 1st, so-called "Medicaid Unwinding" has begun.

On January 30th of this year, the Biden Administration announced that the COVID-19 Public Health Emergency would formally end on May 11th, 2023. In light of this, a few days ago, Dan Diamond of the Washington Post reported that federal COVID vaccination mandates will also end less than a week from today:

Most of the time when another state extends postpartum Medicaid coverage from two months to a full year, as allowed for under the American Rescue Plan from two years ago, I simply cross-post the official press release from the Centers for Medicare & Medicaid Services.

This time, however, I have a heads isn't official yet, but it looks like Missouri and Alaska are about to become the 33rd & 34th states to do so. Via David Lieb of the Associated Press:

JEFFERSON CITY, Mo. (AP) — Lower-income new mothers could gain a full year of Medicaid health-care coverage in Missouri under legislation given final approval Friday as part of a national push to improve maternal health.

Medicaid Expansion by State & Month, 2014 - 2022

Back in January, as the 2023 Open Enrollment Period wound down, I posted a colorful graph which tracked ACA Qualified Health Plan (QHP) enrollment over ten years of Open Enrollment Periods.

Today I'm doing the same thing for ACA Medicaid Expansion. The data comes from the Centers for Medicare & Medicaid Services monthly Medicaid Budget & Expenditure System reports.

Unfortunately the MBES reports only run through September 2022; my best guess is that the national total as of March 2023 was up to around 24.4 million or so, roughly 900K higher than what's shown below.

Also keep in mind that if the remaining 10 states had expanded Medicaid under the ACA by now, the grand total would have been up to 3.5 million higher (around 27.9 million nationally).

Aside from various holdout states jumping in as the years have passed, the most notable milestone was the month that the COVID pandemic hit the U.S. in full force, shutting businesses down across the country in March 2020.

No further analysis or comment here; I just think this is a pretty cool graphic...and keep in mind that most of the ~23.5 million people represented here (again, likely over 24M today) would have been utterly screwed without the Affordable Care Act being in place when the pandemic hit. Click the image for a higher-resolution version; the states are listed on the right-hand side, though they might be difficult to make out:

via the Centers for Medicare & Medicaid Services:

  • Newly proposed standards and requirements would better ensure access to care, accountability, and transparency for Medicaid or CHIP services, including home and community-based services. 

The Centers for Medicare & Medicaid Services (CMS) today unveiled two notices of proposed rulemaking (NPRMs), Ensuring Access to Medicaid Services (Access NPRM) and Managed Care Access, Finance, and Quality (Managed Care NPRM),that together would further strengthen access to and quality of care across Medicaid and the Children’s Health Insurance Program (CHIP), the nation’s largest health coverage programs. These rules build on Medicaid’s already strong foundation as an essential program for millions of families and individuals, especially children, pregnant people, older adults, and people with disabilities.