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CMS published proposed rule on Medicaid eligibility system funding

Posted on April 14, 2015 | No Public Comments

The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would indefinitely extend the federal government’s 90 percent funding for states to improve their Medicaid eligibility and enrollment systems. The proposed rule would also extend the government-enhanced contribution of 75 percent of costs for maintenance and operations activities. Additionally, the rule proposes changes to the standards and conditions that state Medicaid systems must meet to qualify for the continued funding.

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CMS issues proposed rule on mental health parity

Posted on April 8, 2015 | No Public Comments

The Centers for Medicare and Medicaid Services (CMS) published a proposed rule that applies the Mental Health Parity and Addiction Equity Act to Medicaid and the Children’s Health Insurance Program (CHIP). The federal mental health parity law requires that health plans providing behavioral health care coverage do so with the same terms covering medical and surgical care. The CMS proposed rule applies the law to Medicaid enrollees who receive services through managed care organizations and alternative benefit plans. It applies it to all CHIP participants regardless of whether their care is provided through fee-for-service or managed care.

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Avalere releases report on exchange enrollment

Posted on April 8, 2015 | No Public Comments

A new analysis by Avalere Health finds that federally-facilitated exchanges retained a higher percentage of 2014 enrollees and enrolled a higher percentage of new enrollees in 2015 than state-based exchanges. Exchanges run by the federal government reenrolled an average of 78 percent of 2014 enrollees in 2015, compared to 69 percent of 2014 enrollees in state run exchanges. Additionally, states with federal-run exchanges saw 2015 sign-ups increase by 61 percent from 2014 while state-run exchange enrollment only rose by 12 percent. According to the report, some of the higher 2015 enrollment may be attributed to technological issues with HealthCare.gov that depressed enrollment in 2014, however, Avalere contends that this alone does not explain why such significant discrepancies exist between state and federally run exchanges.

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RWJF report looks at Medicaid expansion

Posted on April 7, 2015 | No Public Comments

A report released by the Robert Wood Johnson Foundation (RWJF) examines Medicaid expansion in eight states- Arkansas, Colorado, Kentucky, Michigan, New Mexico, Oregon, Washington, and West Virginia. Researchers found that these states are seeing large budget savings without reducing services. Savings and revenues by the end of 2015 are expected to exceed $1.8 billion across all eight states, and in Arkansas and Kentucky these savings and revenue gains are expected to offset expansion costs through 2021. The report suggests that these savings come from less state spending on programs for the uninsured, more federal dollars for newly eligible enrollees, and higher revenue from existing insurer and provider taxes. The authors contend that these findings will apply to every state that has expanded Medicaid.

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GAO releases report on CHIP

Posted on March 28, 2015 | No Public Comments

The Government Accountability Office (GAO) issued a report finding that coverage of services in the selected State Children’s Health Insurance Program (CHIP) plans was generally comparable to that of the selected private qualified health plans (QHP) under the Affordable Care Act (ACA). However, GAO found notable exceptions with pediatric dental and certain enabling services, such as translation and transportation services, which were covered more frequently by CHIP plans. Selected CHIP plans and QHPs were also similar in terms of the services on which they imposed day, visit, or dollar limits, although the five selected CHIP plans generally imposed fewer limits than the selected QHPs. Additionally, GAO found that consumers’ costs for services (deductibles, copayments, coinsurance, and premiums) were almost always less in the selected CHIP plans when compared to their respective QHPs, despite the application of subsidies authorized under the ACA that reduce these costs.

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GAO issues new report on premium tax credits and ACA coverage

Posted on March 26, 2015 | No Public Comments

The Government Accountability Office (GAO) released a new report finding that premium tax credits have likely contributed to an expansion of health insurance coverage in 2014 by significantly reducing the cost of exchange plans’ premiums for those eligible.  The GAO report cited surveys finding that the uninsured rate declined significantly among households with incomes eligible for the premium subsidies. One survey found that the rate of uninsured individuals with household incomes eligible for premium tax credits fell 5.2 percentage points between September 2013 and September 2014. However, many still face challenges maintaining coverage. GAO found most nonelderly adults had access to affordable plans through their employer, Medicaid, the exchanges, or other sources as of March 2014, although about 16 percent of nonelderly adults remained uninsured.

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Health Affairs blog analyzes King v. Burwell oral arguments

Posted on March 9, 2015 | No Public Comments

A new Health Affairs blog examines the oral arguments in King v. Burwell, focusing on the plantiffs’ reading of the Affordable Care Act (ACA) regarding states establishing their own exchanges for the benefit of federal subsidies. Under this interpretation,the law was intended to encourage states to create their own exchange, or else receive no federal subsidy funds, which may be viewed as coercive by the Court. The blog draws parallels between the Medicaid coercion argument in NFIB v. Sebelius, where the Supreme Court ruled that requiring states to expand Medicaid under the ACA at the price of withdrawing federal funding would be unconstitutionally coercive, and the similar argument of coercion brought up in the King case. The author contends that potentially the Court will realize the deeper constitutional implications of upholding the plantiffs’ reading of the law and allow federal subsidies to continue flowing through federally facilitated exchanges.

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Paper examines potential King v. Burwell fallout

Posted on March 4, 2015 | No Public Comments

A perspective piece published in the New England Journal of Medicine predicts potential fallout from a ruling in favor of King in the King v. Burwell case currently being decided by the Supreme Court. If the challengers prevail, the U.S. Treasury will likely have to stop issuing tax credits to users of federal exchanges. Enrollees who are unable or unwilling to pay the full cost of their insurance premiums could see their coverage terminated. The authors suggest that states could choose to set up their own exchanges and delegate some responsibilities to private contractors, in order to avoid some of the technological challenges. However, the authors also note that some states may be unwilling to set up their own exchanges, in the same way they chose not to expand Medicaid.  This could lead to substantial coverage gaps for many Americans.

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Supreme Court transcript of King v. Burwell arguments posted

Posted on March 4, 2015 | Public Comment (1)

The Supreme Court of the U.S. heard oral arguments today in the King v. Burwell case, which challenges the availability of tax subsidies for individuals who purchase their health insurance on a marketplace created by the federal government. The case centers around language in the Affordable Care Act (ACA) which states that an individual is eligible for a premium subsidy, via a tax credit, if he or she is “enrolled through an exchange established by the State.” Based on this statutory language, those in state based exchanges are not at risk of losing their subsidies. The Supreme Court’s decision will apply only to the 34 states that have federally facilitated exchanges. The oral arguments featured two high-profile lawyers, Michael A. Carvin of the Washington, D.C., law firm of Jones Day, for the challengers, and U.S. Solicitor General Donald B. Verrilli, Jr., defending the Administration.

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IRS releases new ACA rules

Posted on February 24, 2015 | Comments Off

The Internal Revenue Service (IRS) issued final temporary regulations for how it will assess the health insurance tax in 2015, including how it defines a covered entity, which is subject to the fees. The IRS also released guidance on the excise tax on high cost employer-sponsored health coverage, or “Cadillac tax”, which is scheduled to go into effect in 2018. This notice is intended to initiate and inform the process of developing regulatory guidance on the tax.

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