It's been a long time since I've reported on any significant cybersecurity problems at any of the ACA exchanges. The last one I can think of off the top of my head was nearly a decade ago, and even that was about how some early flaws had been fixed.

Still, this story by Julie Appleby of KFF definitely isn't good news:

Unauthorized enrollment or plan-switching is emerging as a serious challenge for the ACA, also known as Obamacare. Brokers say the ease with which rogue agents can get into policyholder accounts in the 32 states served by the federal marketplace plays a major role in the problem, according to an investigation by KFF Health News.

New York's implementation of the ACA's Basic Health Plan provision (Section 1331 of the law) is called the Essential Plan. It currently serves 1.2 million New Yorkers, or over 4x as many residents as ACA exchange plans do.

Whenever I write about BHPs I always throw in a simple explainer about what it is, with an assist from Louise Norris:

Under the ACA, most states have expanded Medicaid to people with income up to 138 percent of the poverty level. But people with incomes very close to the Medicaid eligibility cutoff frequently experience changes in income that result in switching from Medicaid to ACA’s qualified health plans (QHPs) and back. This “churning” creates fluctuating healthcare costs and premiums, and increased administrative work for the insureds, the QHP carriers and Medicaid programs.


Less than two years ago it looked like my home state of Michigan might be the latest to join the growing list of states which have moved off of the HealthCare.Gov mothership onto their own state-run ACA marketplace (SBM) (aka "exchange"):

The Michigan Legislature is considering joining the 18 other states that have established state-run health insurance marketplaces through HB 6112. Having an exchange run by the state instead of the federal government, supporters of the bill say, will save Michiganders money by leaving the “rigid and inflexible” federal market for a Michigan-tailored market that can be more responsive and potentially lower premiums. The bill is still in the early days of the legislative process, awaiting a vote from the House Health Policy Committee.

...It's particularly noteworthy that not only is a Republican legislator the primary sponsor of the bill (Mark Tisdel), but so are 4 of the other 7 cosponsors (John Roth, Bradley Slagh, Jim Lilly and Gary Howell)...along with three Democratic state Representatives (Jim Ellison, Sara Cambensy and Kevin Hertel).

I didn't catch this press release a few days ago but it sounds like a pretty Big F*cking Deal, to use the words of President Biden:

via the Centers for Medicare & Medicaid Services (CMS):

The Biden-Harris Administration today unveiled a final rule that will protect and improve how millions of eligible people apply for, renew, and maintain health care coverage through Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program (BHP). The Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes rule will remove red tape and barriers to enrollment, update and build on the Affordable Care Act’s (ACA’s) coverage protections and ensure that millions of Americans can get and keep their coverage. With this rule, millions of Americans will benefit from a modernized, less cumbersome enrollment process with reduced red tape, helping more people keep coverage. 

(Note: This was actually announced the day before CMS posted the December Medicaid Unwinding transition data.)

Via the Centers for Medicare & Medicaid Services (CMS):

HHS Extends Special Enrollment Period to Help People Transition to the Marketplaces, Issues New Resources for Partners, and Publishes Guidance Reinforcing Key Federal Requirements

Honestly not sure how to feel about this, but it was inevitable...

via Nevada Health Link:

Nevada Health Link Spearheads AI Implementation, Championing Cutting-Edge Technology for Unparalleled Consumer Engagement

  • The first State Based Marketplace to receive Centers for Medicare & Medicaid Services approval for implementing AI technology

MOUNTAIN VIEW, Calif. – In a groundbreaking move towards enhancing consumer experiences and setting new standards in health insurance exchange technology, Nevada Health Link proudly announces the successful integration of Artificial Intelligence (AI) into its State-Based Marketplace (SBM) platform. This first-of-its-kind initiative underscores Nevada Health Links's unwavering commitment to innovation, transparency, and consumer-centric strategies.

The implementation of a purpose-built interactive virtual agent (IVA) by the team at GetInsured marks a significant milestone in Nevada Health Links's journey. Nevada Health Link is the first marketplace to have Centers for Medicare & Medicaid Service’s (CMS) approval for the use of AI-based Interactive Virtual Agents to enhance the customer service experience. The state worked collaboratively with the CMS and GetInsured security teams for several months to ensure that all federal privacy and security requirements were met. This approval signifies a high level of confidence in the technology that the marketplace has implemented.

via the Centers for Medicare & Medicaid Services (CMS):

  • In December 2023, 85,094,448 individuals were enrolled in Medicaid and CHIP, a decrease of 785,863 individuals (0.9%) from November 2023
    • 77,913,798 individuals were enrolled in Medicaid in December 2023, a decrease of 786,068 individuals (1.0%) from November 2023.
    • 7,180,650 individuals were enrolled in CHIP in December 2023, an increase of 205 individuals (0.0%) from November 2023.
  • As of December 2023, enrollment in Medicaid and CHIP has decreased by 8,773,558 individuals (9.3%) since March 2023, the final month of the Medicaid continuous enrollment condition under the Families First Coronavirus Response Act (FFCRA) and amended by the Consolidated Appropriations Act, 2023.
    • Medicaid enrollment has decreased by 8,816,761 individuals (10.2%).
    • CHIP enrollment has increased by 43,203 individuals (0.6%).
  • Between February 2020 and March 2023, enrollment in Medicaid and CHIP increased by 22,992,937 individuals (32.4%) to 93,868,006.
    • Medicaid enrollment increased by 22,6350,766 individuals (35.3%).
    • CHIP enrollment increased by 342,171 individuals (5.0%).

Normally, states will review (or "redetermine") whether people enrolled in Medicaid or the CHIP program are still eligible to be covered by it on a monthly (or in some cases, quarterly, I believe) basis.

However, the federal Families First Coronavirus Response Act (FFCRA), passed by Congress at the start of the COVID-19 pandemic in March 2020, included a provision requiring state Medicaid programs to keep people enrolled through the end of the Public Health Emergency (PHE). In return, states received higher federal funding to the tune of billions of dollars.

As a result, there are tens of millions of Medicaid/CHIP enrollees who didn't have their eligibility status redetermined for as long as three years.

Every month for years now, the Centers for Medicare & Medicare Services (CMS) has published a monthly press release with a breakout of total Medicare, Medicaid & CHIP enrollment; the most recent one was posted in late February, and ran through November 2022.

Since December 2022, however, they haven't sent out the normal press release; instead, they included a brief note leading to a Medicaid/CHIP data slideshow , along with another note leading to their new Medicare Monthly Enrollment database.

In any event, according to the spreadsheet I exported, as of December 2023:

February 16th:

I strongly suspect that at least one of the remaining holdout states will join the expansion crowd this year, most likely Georgia, Mississippi or Alabama...but it likely will be some state-specific variant as described above. Stay tuned...

...As I noted, however, in all three [states] it's pretty likely they'll go with at least a partially privatized version as Arkansas has instead of a "clean" expansion of Medicaid proper.

Of course, as one Alabama-based advocate put it...

Mississippi better not beat us to expand.

— Jane Adams (@janeadamsid) February 16, 2024

Well, it looks like Ms. Adams may end up being disappointed...

BREAKING: The Mississippi House just passed Medicaid expansion by a 96-20 vote.
That's more than enough to overcome a veto from Gov. Tate Reeves.
It now heads to the Senate.