Rhode Island

Usually I'm able to track down my data either by myself or with the help of several people who send me data links on a fairly regular basis. This has resulted in my being able to fill in off-season QHP enrollment data for almost 20 states.

However, there are several states whose data has eluded me so far...and unfortunately, this includes the two largest state-run exchanges: California and New York. I've contacted both exchanges; CoveredCA told me that updated enrollment numbers would be released "soon" but that was a good month ago. The New York State of Health exchange flatly stated that they, like HHS, would not be giving out any sort of official off-season enrollment update. There's also the Rhode Island exchange, which hasn't responded to my requests at all. (Update: Never mind that last one; just heard directly from the RI exchange, hopefully they'll be able to provide an update soon...)

I know I said I wouldn't be posting during the Netroots Nation convention unless something significant happened. Well, thanks to the Kaiser Family Foundation, I've learned of a pretty important development. The state of Rhode Island just released their decision on the APPROVED insurance premium rates for Blue Cross Blue Shield in 2015. Check it out:

As you can see, BCBSRI asked for an average rate increase of 8.9%. The state insurance commissioner approved...4.5%.

Obviously this may not be typical of what will happen in other states or for other companies, but the point is made: the preliminary rate requests are just that: Preliminary. You can REQUEST anything; that doesn't mean you'll get it.

UPDATE: I've found the market share breakout for both companies (the third one is new to the exchange), and it looks like BCBSRI made up almost all of it (98%), so the weighted average looks to come in at around 4.3%.

"But, but...how many have PAID???" in Rhode Island?

Christine Ferguson, executive director of HealthSource RI, said 91% of the 27,968 individuals who signed up for private plans during the open enrollment period from Oct. 1 to March 31 paid their first premiums by the April 23 deadline. Analysts have pointed to that percentage as a key test of whether the enrollment figures were as strong as they looked.

“My takeaway of that 91% is that we have work to do to keep them, but that’s a high conversion rate, and it’s a testament to the work that the staff’s done to really work with people,” Ferguson told WPRI.com.

“I think it’s a reflection of the work that’s been done in the marketplace, the care that we took in the kinds of plans we offered and the range, and I think it is a reflection of the system working reasonably well,” she said. “I think for us the real issue – and I think the thing that people have not paid enough attention to nationally – is retention.”

Rhode Island's ACA Medicaid expansion was at around 65K a couple of weeks ago, so this is a nice small bump:

Through April 19, 70,243 people had signed up for Medicaid under the Affordable Care Act rollout, according to state figures, with federal dollars paying for about two-thirds of those people and state and federal dollars roughly splitting the cost for the other third, because they were already eligible before Obamacare entered the picture.

This doesn't change the actual total number of Rhode Island's Medicaid expansion numbers, but it does specify the ratio between "strict expansion" and the "woodworker" enrollees...66% to 34%. Interestingly, this is virtually identical to the Washington State ratio (again, 67% to 33%).

This isn't enough to apply to the other expansion states yet, but if it does prove to be the case, that should be helpful in figuring out how accurate my current estimates are. I currently have "strict expansion" at roughly 3.7 million, while "woodworkers" are at 2.05 million. A strict 67/33 ratio would have the "woodworker" number at around 1.82 million...except that the non-expansion states also have some woodworkers as well, which should account for the additional 230K or so.

Figures obtained from the Chafee administration by WPRI.com show that out of the 64,590 Rhode Islanders who signed up for Medicaid from October through March using the state’s new HealthSource RI marketplace, 34% were eligible before the new law expanded the rules for who could sign up.

Sean Parnell sent me a clarification of the 64.6M Medicaid number out of Rhode Island from the OHHS in Rhode Island (which did seem a bit high to me, but surge and all...)

New Medicaid enrollment figures through March 31, 2014

Medicaid enrollment:  64,590 (through HealthSource RI from October 1, 2013 through March 31, 2014)

Of that number, 42,320, or 65.5 percent, represent adults in Medicaid’s new eligibility group, adults 19-64 without dependent children who were not previously eligible for Medicaid but became eligible on January 1, 2014.    The new eligibility group is authorized under the Affordable Care Act’s Medicaid expansion and is financed with 100 percent federal dollars for its first three years, 2014-2017.

The other roughly one-third represents those enrolling who were eligible for Medicaid under previously existing rules.

Unfortunately they don't specify how many of the remaining 22.5K are renewals vs. "woodworkers". I'm going to go with about half (11K, or around 17% of the 65K total) unless I receive further clarification one way or the other. This reduces the current "woodworker" estimate of 16.6K by about 5,600.

Since I'm shifting the "Paid/Unpaid" tally to a simplified "93% Paid or Will Pay Within a Reasonable Time" model, I'm no longer distinguishing the paid/unpaid factor for states which do so (although I am still listing them when released by the states):

Enrollment data (Oct. 1, 2013 through March 31, 2014)

Total HealthSource RI enrollments (including those who have not yet paid): 27,961

Paid enrollments: 21,097

Medicaid enrollments (per EOHHS): 64,590

Small employer applications initiated: 1,319

Small employer enrollment: 175 (based on their submitted census, these employers represent 700 covered employees and 1,110 covered lives)

Small employers who enrolled in Full Employee Choice: 103

As a follow-up to my follow-up last night, HuffPo healthcare reporter Jeffrey Young tweets:

About 3/4 of the 28K @HealthSourceRI enrollees had paid a premium as of 3/31. People who signed up after 3/23 have until 4/23 to pay.

— Jeffrey Young (@JeffYoung) April 3, 2014

@asymmetricinfo And the paid rate through 3/8 was 83%, including people whose bills were due later.

— Jeffrey Young (@JeffYoung) April 3, 2014

Interim CEO of @MNsure, Scott Leitz, to tell U.S. House subcommittee that 95% of its 47,000 enrollees have paid, and the rate will rise.

— Jeffrey Young (@JeffYoung) April 3, 2014

A lot of good info here, mostly about off-exchange enrollments, but also about the "Paid/Unpaid" question:

That total breaks down as 27,968 individuals who used HealthSource RI to sign up for plans from Blue Cross or Neighborhood Health Plan of Rhode Island, along with 11,271 who bypassed HealthSource and boughtObamacare-compliant policies directly from Blue Cross, the two organizations told WPRI.com.

Those 11,271 direct-purchasers are important to Blue Cross because they will be combined with those who bought through HealthSource RI to make up the insurer’s 2014 risk pool for individual insurance. The size and shape of the risk pool is crucial to determining how much premiums will cost.

...Roughly four in five of those who bought insurance through HealthSource by March 8 had paid their first premiums at that point.

Here we go...Rhode Island is the first state-based exchange out of the gate with an (unofficial, but specific) final tally of 3/31 QHP enrollments: Nearly 28,000 by midnight yesterday.

HealthSource RI spokeswoman Dara Chadwick said 27,968 individuals signed up for private plans through the new marketplace between Oct. 1 and the 11:59 p.m. deadline for 2014 enrollment, 1,840 of whom signed up Monday. The number is expected to rise as those who encountered technical difficulties or weren’t able to speak to a representative on Monday finish getting processed.

There's no update on the Medicaid number since March 8th, unfortunately, but this still locks down at least one key number. More to come, no doubt...

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