According to the essential Louise Norris, there are currently just six states where being pregnant in and of itself makes someone eligible for a Special Enrollment Period outside of the official Open Enrollment Period:
In most states, pregnancy does not trigger a special enrollment period. HHS considered this, but clarified in 2015 that they had decided not to include pregnancy as a qualifying event. This means that in most states, the special enrollment period tied to having a baby does not begin until the baby is born.
But state-run exchanges (there are 18 of them as of 2022) can set their own rules for qualifying events and special enrollment periods. Some of them do allow a special enrollment period triggered by pregnancy. This gives a pregnant person access to health coverage during the pregnancy, rather than having to wait until the baby is born to obtain coverage. As of 2022, pregnancy is a qualifying event in the following state-run exchanges:
Back in May, I first wrote about news that two additional states, Oregon and Kentucky, had decided to join New York and Minnesota in launching a Basic Health Plan (BHP) program under a provision allowing them to do so in the Affordable Care Act:
The Basic Health Program (BHP) – section 1331 of the ACA — was envisioned as a solution, although most states did not establish a BHP. Under the ACA (aka Obamacare), states have the option to create a Basic Health Program for people with incomes a little above the upper limit for Medicaid eligibility, and for legal immigrants who aren’t eligible for Medicaid because of the five-year waiting period.
Voters in Kansas rejected a proposed state constitutional amendment Tuesday that would have said there was no right to an abortion in the state, according to The Associated Press.
Kansas was the first state to vote on abortion rights since the U.S. Supreme Court handed down its ruling in Dobbs v. Jackson's Women's Health Organization.
President Joe Biden hailed Tuesday's vote and called on Congress to pass a law to restore nationwide abortion rights that were provided by Roe.
"This vote makes clear what we know: the majority of Americans agree that women should have access to abortion and should have the right to make their own health care decisions," Biden said in a statement.
The statewide abortion ban ballot proposal, in a fairly solidly red state, ended up failing by a massive 18 points, with 544,000 voting against it and only 378,00 in favor of it.
The projected population consists of expected retention of existing policies and new sales. The sources of new entrants include the previously uninsured population, grandfathered and transitional policies voluntarily migrating to ACA-compliant plans, and previously insured populations from other markets or carriers. The morbidity adjustment reflects projected Anthem and market changes in morbidity, including changes driven by economic conditions and from the expiration of the enhanced ACA premium tax credits available under The American Rescue Plan Act (ARP) as of December 31, 2022. Membership projections reflect contraction similar to pre-ARP population in 2021. Exhibit E shows the morbidity factor.
States will have an additional year to use American Rescue Plan funds to strengthen the home care workforce and expand access to services
Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is notifying states that they now have an additional year — through March 31, 2025 — to use funding made available by the American Rescue Plan (ARP) to enhance, expand, and strengthen home- and community-based services (HCBS) for people with Medicaid who need long-term services and supports. This policy update marks the latest action by the Biden-Harris Administration to strengthen the health care workforce, help people receive care in the setting of their choice, and reduce unnecessary reliance on institutional care.
Today, the U.S. Department of Health and Human Services (HHS) through the Centers for Medicare & Medicaid Services (CMS) approved California, Florida, Kentucky, and Oregon actions to expand Medicaid and Children’s Health Insurance Program (CHIP) coverage to 12 months postpartum for a total of an additional 126,000 families across their states, annually—supporting 57,000; 52,000; 10,000; and 7,000 parents, respectively.
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.
Every year since the very first ACA Open Enrollment Period (OEP) in 2013-2014, at least a few of the state-based exchanges (and sometimes the federal exchange) have made last-minute deadline extensions. It's actually turned into a bit of a running joke with me.
The 2022 OEP has been no exception: Already during the 2022 OEP we've seen Idaho, New Mexico, Connecticut and Kentucky bump out their December deadline (for January coverage).
Sure enough, a couple of days ago the Kentucky exchange, kynect, posted the following:
Due to the December 11th natural disaster throughout the Commonwealth and reports of technical issues during Open Enrollment, a Special Enrollment Period (SEP) for kynect health coverage is now available to impacted residents.
A Special Enrollment Period allows enrollment dates to be extended or added. Prior to this Special Enrollment Period announcement, the deadline to enroll for a Qualified Health Plan with coverage starting January 1st, 2022 was December 15th, 2021.
The Special Enrollment Period will be granted for citizens with the following circumstances:
Any person who attests that their ability to enroll in a Qualified Health Plan was affected by severe weather in December 2021.
Any person who attests that they encountered system errors, including long wait times with the call center, that prevented them from enrolling in a Qualified Health Plan prior to December 15th, 2021.