United States: Health Insurance Exchanges: State Of The States - Apr 10th, 2015

Last Updated: April 28 2016
Article by Cindy Gillespie

Once again, there were few notable federal developments this week and as a result, we are starting off with an interesting report from Avalere. This week, Avalere released an analysis showing that the Federally-facilitated Marketplace (FFM) retained more consumers in private health coverage from Open Enrollment 1 to Open Enrollment 2 than many State-based Marketplaces (SBM). On average, the FFM retained 78 percent of 2014 enrollees, while SBMs retained 69 percent of enrollees. Although Avalere’s report does not present any formal conclusions about why FFM states fared better than SBMs at holding onto their enrollees, it speculates that some persons in private coverage may have transitioned to Medicaid during Open Enrollment 2. As part of its report, Avalere includes an anecdote that Covered California shifted over 200,000 enrollees from private insurance to Medicaid between Open Enrollment 1 and Open Enrollment 2.

Moving into the states, after CMS reported last week that 36,000 persons had taken advantage of the tax season Special Enrollment Period (SEP) to sign up for 2015 coverage, Covered California reported this week that so far 18,000 persons have used its tax season SEP to sign up. However, despite the strong signup number, it's important to keep in mind that Covered California’s requirements to qualify for an SEP are significantly less stringent than the requirements used by the FFM. Specifically, Covered California only requires that individuals attest that they were unaware of the tax penalty for not having coverage in 2014, while to qualify for an SEP on the FFM, applicants must also attest that they owe the "shared responsibility payment" when they file their 2014 taxes.

Also in California this week, the Covered California Plan Management Advisory Group met to discuss various health insurance proposals developed by Covered California’s staff in consultation with stakeholders. Of the proposals discussed, additional details emerged on Covered California intentions regarding how insurers would cover specialty tier drugs. In the proposal, Covered California recommends modifying the 2016 Standard Benefit Designs to put a "maximum ceiling on the consumers' share of cost per prescription fill" for specialty tier drugs. Those maximum ceilings range from US$200 per script up to US$500 per script, depending on the metal level of the QHP. While some consumer advocacy groups said that US$500 per drug was still a significant amount of money for consumers in this income bracket, considering that some enrollees take multiple specialty tier drugs, there appeared to be consensus that this was a step in the right direction toward lower out-of-pocket prescription drug costs for consumers. Additionally, the Advisory Group discussed a proposed update to current regulations that allow carriers to have a second hospital tier that is non-primary, where the carrier has cost-sharing requirements that are different than the standard benefit plan designs.

Moving into the south, this week the Arkansas Health Insurance Marketplace awarded a US$5.8 million two-year contract to Arkansas-based Cranford Johnson Robinson Woods to perform marketing and outreach services for the Marketplace. The Marketplace’s board also approved a measure to accept US$22 million in federal exchange grant funding that had previously been awarded to the Arkansas Insurance Department, pending CMS’s approval of the transfer of funds. The Arkansas Marketplace will use that funding to continue its transition to a State-based Marketplace and according to staff, the Marketplace has until June 30, 2016 to expend the federal grant funding.

Staying on financial issues, there were a few notable developments this week by State-based Marketplaces as they continue to refine their budgets and revenue sources for next year. Earlier this week at Your Health Idaho’s Finance Committee meeting, the Committee approved a recommendation to raise the assessment levied on carriers selling plans on the Marketplace from 1.5 percent to 1.9 percent beginning in Plan Year 2016. The assessment recommendation will likely be discussed at the next Your Health Idaho board meeting on April 17. Also in the west, the Connect for Health Colorado (C4HC) Finance Committee met this week to review cost drivers that have increased the Marketplace's operating costs, and potential sources for additional revenue. A variety of revenue scenarios were presented and discussed by the Committee, including raising the administrative fee charged to insurers selling plans on C4HC from 1.4 percent to about 3.5 percent. Expect to hear more about Connect for Health Colorado’s revenue and budget options at Monday’s board meeting.

Finally, looking forward to next week, documentation for the Silver State Health Insurance Exchange’s (SSHIX) April 15 board meeting has already been posted. Of note, the SSHIX reports that effectuated coverage as of April 2015 has hit 58,459 in QHPs and 7,091 in QDPs. Compared to enrollment statistics from May 3, 2014, QHP enrollments increased over the 34,820 persons enrolled in a health plan, but the number of dental enrollments declined, with the SSHIX reporting 29,770 SADP members. The Marketplace also reports that it has reached an agreement with the attorneys involved in the Basich and Casale class action lawsuits and is no longer a party, though the plaintiffs retain the right to bring the SSHIX back into the lawsuit. These lawsuits were filed in 2014 after some Nevada Health Link enrollees complained that after signing up for coverage and paying premiums, they still lacked health insurance coverage. While most of the documentation for the SSHIX April board meeting has been posted, there may yet be a very good reason to tune in. The Executive Director’s summary mentions that the SSHIX sent a delegation to CMS this week to discuss “sustainability and associated concerns” regarding Nevada being a Supported State-based Marketplace, so exchange watchers may get lucky and hear an update on their meeting with CMS.

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.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Events from this Firm
18 Sep 2018, Other, Dubai, United Arab Emirates

In December 2017, FIDIC published new editions of the Red Book (Construction), the Yellow Book (Design and Build) and the Silver Book (Turn-key), the first re-write since 1999.

26 Sep 2018, Conference, New York, United States

Dentons is delighted to support a global IT services and consulting firm Miratech as an event host partner at their annual conference called M-Force18 New York on September 27th. The event will be held at Dentons New York office in the heart of Midtown Manhattan, opposite Rockefeller Center.

2 Oct 2018, Seminar, Dallas, United States

We are pleased to offer a program of five sessions designed specifically for in-house counsel. Topics will include:

  • In-house corporate ethical issues
  • What recent Supreme Court decisions mean for business
  • Keeping lawyers out of your benefit plans
  • Litigation tactics for in-house counsel
  • Employment issues in the age of #MeToo
Similar Articles
Relevancy Powered by MondaqAI
In association with
Related Topics
Similar Articles
Relevancy Powered by MondaqAI
Related Articles
Related Video
Up-coming Events Search
Font Size:
Mondaq on Twitter
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
Email Address
Company Name
Confirm Password
Mondaq Topics -- Select your Interests
 Law Performance
 Law Practice
 Media & IT
 Real Estate
 Wealth Mgt
Asia Pacific
European Union
Latin America
Middle East
United States
Worldwide Updates
Registration (you must scroll down to set your data preferences)

Mondaq Ltd requires you to register and provide information that personally identifies you, including your content preferences, for three primary purposes (full details of Mondaq’s use of your personal data can be found in our Privacy and Cookies Notice):

  • To allow you to personalize the Mondaq websites you are visiting to show content ("Content") relevant to your interests.
  • To enable features such as password reminder, news alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our content providers ("Contributors") who contribute Content for free for your use.

Mondaq hopes that our registered users will support us in maintaining our free to view business model by consenting to our use of your personal data as described below.

Mondaq has a "free to view" business model. Our services are paid for by Contributors in exchange for Mondaq providing them with access to information about who accesses their content. Once personal data is transferred to our Contributors they become a data controller of this personal data. They use it to measure the response that their articles are receiving, as a form of market research. They may also use it to provide Mondaq users with information about their products and services.

Details of each Contributor to which your personal data will be transferred is clearly stated within the Content that you access. For full details of how this Contributor will use your personal data, you should review the Contributor’s own Privacy Notice.

Please indicate your preference below:

Yes, I am happy to support Mondaq in maintaining its free to view business model by agreeing to allow Mondaq to share my personal data with Contributors whose Content I access
No, I do not want Mondaq to share my personal data with Contributors

Also please let us know whether you are happy to receive communications promoting products and services offered by Mondaq:

Yes, I am happy to received promotional communications from Mondaq
No, please do not send me promotional communications from Mondaq
Terms & Conditions

Mondaq.com (the Website) is owned and managed by Mondaq Ltd (Mondaq). Mondaq grants you a non-exclusive, revocable licence to access the Website and associated services, such as the Mondaq News Alerts (Services), subject to and in consideration of your compliance with the following terms and conditions of use (Terms). Your use of the Website and/or Services constitutes your agreement to the Terms. Mondaq may terminate your use of the Website and Services if you are in breach of these Terms or if Mondaq decides to terminate the licence granted hereunder for any reason whatsoever.

Use of www.mondaq.com

To Use Mondaq.com you must be: eighteen (18) years old or over; legally capable of entering into binding contracts; and not in any way prohibited by the applicable law to enter into these Terms in the jurisdiction which you are currently located.

You may use the Website as an unregistered user, however, you are required to register as a user if you wish to read the full text of the Content or to receive the Services.

You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these Terms or with the prior written consent of Mondaq. You may not use electronic or other means to extract details or information from the Content. Nor shall you extract information about users or Contributors in order to offer them any services or products.

In your use of the Website and/or Services you shall: comply with all applicable laws, regulations, directives and legislations which apply to your Use of the Website and/or Services in whatever country you are physically located including without limitation any and all consumer law, export control laws and regulations; provide to us true, correct and accurate information and promptly inform us in the event that any information that you have provided to us changes or becomes inaccurate; notify Mondaq immediately of any circumstances where you have reason to believe that any Intellectual Property Rights or any other rights of any third party may have been infringed; co-operate with reasonable security or other checks or requests for information made by Mondaq from time to time; and at all times be fully liable for the breach of any of these Terms by a third party using your login details to access the Website and/or Services

however, you shall not: do anything likely to impair, interfere with or damage or cause harm or distress to any persons, or the network; do anything that will infringe any Intellectual Property Rights or other rights of Mondaq or any third party; or use the Website, Services and/or Content otherwise than in accordance with these Terms; use any trade marks or service marks of Mondaq or the Contributors, or do anything which may be seen to take unfair advantage of the reputation and goodwill of Mondaq or the Contributors, or the Website, Services and/or Content.

Mondaq reserves the right, in its sole discretion, to take any action that it deems necessary and appropriate in the event it considers that there is a breach or threatened breach of the Terms.

Mondaq’s Rights and Obligations

Unless otherwise expressly set out to the contrary, nothing in these Terms shall serve to transfer from Mondaq to you, any Intellectual Property Rights owned by and/or licensed to Mondaq and all rights, title and interest in and to such Intellectual Property Rights will remain exclusively with Mondaq and/or its licensors.

Mondaq shall use its reasonable endeavours to make the Website and Services available to you at all times, but we cannot guarantee an uninterrupted and fault free service.

Mondaq reserves the right to make changes to the services and/or the Website or part thereof, from time to time, and we may add, remove, modify and/or vary any elements of features and functionalities of the Website or the services.

Mondaq also reserves the right from time to time to monitor your Use of the Website and/or services.


The Content is general information only. It is not intended to constitute legal advice or seek to be the complete and comprehensive statement of the law, nor is it intended to address your specific requirements or provide advice on which reliance should be placed. Mondaq and/or its Contributors and other suppliers make no representations about the suitability of the information contained in the Content for any purpose. All Content provided "as is" without warranty of any kind. Mondaq and/or its Contributors and other suppliers hereby exclude and disclaim all representations, warranties or guarantees with regard to the Content, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. To the maximum extent permitted by law, Mondaq expressly excludes all representations, warranties, obligations, and liabilities arising out of or in connection with all Content. In no event shall Mondaq and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use of the Content or performance of Mondaq’s Services.


Mondaq may alter or amend these Terms by amending them on the Website. By continuing to Use the Services and/or the Website after such amendment, you will be deemed to have accepted any amendment to these Terms.

These Terms shall be governed by and construed in accordance with the laws of England and Wales and you irrevocably submit to the exclusive jurisdiction of the courts of England and Wales to settle any dispute which may arise out of or in connection with these Terms. If you live outside the United Kingdom, English law shall apply only to the extent that English law shall not deprive you of any legal protection accorded in accordance with the law of the place where you are habitually resident ("Local Law"). In the event English law deprives you of any legal protection which is accorded to you under Local Law, then these terms shall be governed by Local Law and any dispute or claim arising out of or in connection with these Terms shall be subject to the non-exclusive jurisdiction of the courts where you are habitually resident.

You may print and keep a copy of these Terms, which form the entire agreement between you and Mondaq and supersede any other communications or advertising in respect of the Service and/or the Website.

No delay in exercising or non-exercise by you and/or Mondaq of any of its rights under or in connection with these Terms shall operate as a waiver or release of each of your or Mondaq’s right. Rather, any such waiver or release must be specifically granted in writing signed by the party granting it.

If any part of these Terms is held unenforceable, that part shall be enforced to the maximum extent permissible so as to give effect to the intent of the parties, and the Terms shall continue in full force and effect.

Mondaq shall not incur any liability to you on account of any loss or damage resulting from any delay or failure to perform all or any part of these Terms if such delay or failure is caused, in whole or in part, by events, occurrences, or causes beyond the control of Mondaq. Such events, occurrences or causes will include, without limitation, acts of God, strikes, lockouts, server and network failure, riots, acts of war, earthquakes, fire and explosions.

By clicking Register you state you have read and agree to our Terms and Conditions