United States: Health Insurance Exchanges: State Of The States - Apr 24th, 2015

Last Updated: April 28 2016
Article by Cindy Gillespie

Earlier this week, news surfaced that some HealthCare.gov users may have received an incorrect subsidy or Medicaid eligibility determination from the Marketplace. According to reports, HealthCare.gov has been counting Social Security income received by children when calculating the Modified Adjusted Gross Income (MAGI) for a household. Once calculated, MAGI is then used to help determine a household's eligibility for Medicaid or subsidized private insurance. By including a child's Social Security Income in a household's income, the Federally-facilitated Marketplace (FFM) likely increased the overall household income, which could have resulted in some persons either not qualifying for Medicaid or an inaccurate tax credit determination. While CMS has acknowledged the error, the agency has so far not given an indication of how many households may be impacted.

CMS also announced this week that 68,000 persons had signed up for coverage during the Special Enrollment Period (SEP) that started on March 15 and runs through April 30. The primary reason CMS created this Special Enrollment Period was to allow persons that did not have coverage during Open Enrollment 1 and were impacted by the Shared Responsibility Payment to sign up for coverage after Open Enrollment 2 ended in order to avoid being fined again. The newly reported number is a significant increase over the 36,000 that had signed up for SEP coverage on the FFM as of March 29, but is not much larger than some of the numbers that State-based Marketplaces (SBMs) have reported. For example, as of April 12, Covered California reported that 22,659 persons had taken advantage of their SEP to enroll in coverage, though requirements to sign up for coverage differ from CMS's standards, and the Washington Health Benefit Exchange has reported that 13,000 persons have taken advantage of their SEP as of April 17.

Also at the federal level, there was an interesting report released by Treasury Inspector General for Tax Administration (TIGTA) last week that showed that as of March 6, the Internal Revenue Service had received 66.7 million individual returns, with only 737,000 returns claiming a premium tax credit to subsidize enrollment in private insurance. Using this data, according to external estimates, only about 18 to 30 percent of households that received premium tax credits for 2014 have so far filed their tax returns. However with the April 15 filing deadline passing last week, it's likely that many taxpayers have filed their returns since TIGTA completed its report.

Speaking of tax filers, CMS released additional guidance clarifying that current enrollees receiving tax credits will not be able to re-enroll in subsidized coverage for Open Enrollment 3 unless they "file an income tax return and reconcile the Advanced Premium Tax Credit." The guidance, which describes the annual eligibility redetermination and re-enrollment process for Marketplace coverage in 2016, also outlines the situations under which the Marketplace will send a Marketplace Open Enrollment Notice (MOEN) in advance of open enrollment and the content of that notice. In the guidance, CMS states that a MOEN will be "provided only for an application that includes current 2015 enrollees who do not have a future termination transaction on file," which would likely reduce the administrative burden on Marketplaces.

Moving into the states, there were few developments this week. To start things off in the Natural State, the board for the Arkansas Health Insurance Exchange met to approve a revised budget, including how the Marketplace will spend its remaining federal Exchange Establishment Grants. The new budget allocates less funding toward the Arkansas Marketplace's forthcoming IT enrollment platform, and more funding for exchange operations. The Marketplace had originally budgeted US$78 million for its online enrollment platform, but the revised budget now allocates US$64.1 million. Additionally, the Marketplace's call center budget received a US$5 million cut and the marketing and outreach budget was reduced from US$10 million to US$3 million. The Arkansas Health Insurance Exchange's revised budget now awaits final approval from CMS.

On the west coast, the board for the Washington Health Benefit Exchange (WHBE) met to discuss its budget, preparations for Open Enrollment 3 and strategies to improve the data metrics tracked by the Marketplace. As the WHBE prepares for Open Enrollment 3, it plans to improve the operations of the Healthplanfinder, perform various reviews to resolve defects in the system and conduct a code review of the Marketplace's online architecture. Besides tweaks to resolve operational issues for consumers in order to provide a smoother enrollment experience, the Healthplanfinder will also roll out Medicaid plan selection and remove premium aggregation for enrollees in the individual Marketplace by the launch of Open Enrollment 3. The Marketplace also itemized upcoming IT upgrades, with some of them being paid for with federal grants, while other enhancements, such as improvements to IPA/broker functionalities for Open Enrollment 4 and the Qualify Rating System, are still in need of a funding source. Also at the board meeting, staff presented a budget outlining the WHBE's operations for the upcoming fiscal years, depending on whether the House or Senate's biennial budgets were passed. This year, the House's budget authorizes the WHBE to spend $124 million, while the Senate's budget only authorizes US$85 million. Slide 3 of the Marketplace's analysis highlights the sharp contrast between both budgets and how they would impact the operations of the Marketplace, with the Senate's budget cutting the WHBE's "Outreach and Education" budget in half from US$4 million to US$2 million and significantly reducing the funding for various IT enhancements. Although the Marketplace's budget remains up in the air, the WHBE's staff along with its board and the Washington State Office of the Insurance Commissioner are hard at work behind the scenes developing improvements to the metrics gathered and tracked by the WHBE and its staff. While many other Marketplaces are also in the process of standardizing and formalizing their data requests and metrics reporting, the WHBE is one of the few that has gone through a very formal and public process seeking stakeholder input on what information should be gathered, how often, and how it should be presented. While many Marketplaces, including the WHBE, produce "Dashboard" updates for their boards and other stakeholders, the metrics proposal outlines a strategy to present more detailed data that could be used in the future to determine the WHBE's overall strategy when it comes to enrollee engagement and retention. Expect other Marketplaces, and stakeholders in other states, to rely on this metrics proposal as a resource as they evaluate their own data reporting capabilities.

Finally this week, I'm sad to announce that the primary author of State of the States: Health Insurance Exchanges is moving on to another opportunity. It's been an honor to work with you all watching the implementation of the ACA's vision to create online health insurance exchanges. It's been a fascinating past few years and I would like to thank all of you for your diligent readership, comments, ideas and corrections (you know who you are). Please feel free to connect with me on LinkedIn.

Dentons is the world's first polycentric global law firm. A top 20 firm on the Acritas 2015 Global Elite Brand Index, the Firm is committed to challenging the status quo in delivering consistent and uncompromising quality and value in new and inventive ways. Driven to provide clients a competitive edge, and connected to the communities where its clients want to do business, Dentons knows that understanding local cultures is crucial to successfully completing a deal, resolving a dispute or solving a business challenge. Now the world's largest law firm, Dentons' global team builds agile, tailored solutions to meet the local, national and global needs of private and public clients of any size in more than 125 locations serving 50-plus countries. www.dentons.com.

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