A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

Tag: Exchanges

CMS allows “flat files” to be used as enrollment applications for Medicaid

Posted by Nikki Hurt on November 29, 2013

In a letter sent to State Medicaid Directors, the Centers for Medicare and Medicaid Services (CMS) stated the agemcy would allow states to use “flat files,” or files with very little information about new Medicaid enrollees, to intermittently count as full applications in terms of enrolling individuals into state Medicaid programs under the Affordable Care Act (ACA). The ACA permits states, if they so choose, to expand their Medicaid population, and provides the opportunity for individuals to enroll in Medicaid through the health insurance Exchanges. Currently, the federal government cannot transfer complete Medicaid applications to states, which prevents states from enrolling their constituents into Medicaid in a timely fashion. CMS is addressing this issue by allowing the “flat files” to count as enrollment applications so that states may ensure these new enrollees have Medicaid coverage by January 2014. This fix is a transitional policy, and states must apply for a waiver in order to use the flat files for enrollment.

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Will People Who Enroll in Health Insurance Marketplace QHPs be Able to Qualify for Premium Assistance if they Enroll Directly through an Insurer’s Website?

Posted by Mark Dorley on November 20, 2013

The Administration recently announced that its improvements to Healthcare.gov, the federal Health Insurance Marketplace, will include a new direct purchase feature that enables individuals to buy an Exchange-certified qualified health plan (QHP) directly at the website of the insurer who sells the plan. A question has arisen as to whether such an arrangement is lawful from a subsidy perspective: that is, whether direct enrollment at the QHP issuer website counts as…

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Commonwealth study finds 17% of potentially eligible Americans visited ACA marketplaces in October

Posted by Nikki Hurt on November 4, 2013

A new survey conducted by The Commonwealth Fund indicated that 17% of individuals possibly eligible for insurance under the Affordable Care Act (ACA) visited the law’s online marketplace. The survey, performed October 9th-27th via the Commonwealth Fund Affordable Care Act Tracking Survey, also found that 20% of those that visited the marketplaces were between ages 19-29, and 20% of those that visited actually enrolled in a plan. The survey additionally reported that 60% of those in the sample group were aware of the purpose of marketplaces and 37% of those that did not enroll in coverage cited healthcare.gov‘s technical malfunctions as the reason for not enrolling.

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Section 1557 of the ACA and Non-Discrimination: The HHS Request for Information

Posted by Nikki Hurt on August 12, 2013

Section 1557 of the Affordable Care Act (ACA) establishes a non-discrimination standard that is unprecedented in U.S. civil rights law. This Implementation Brief examines a recent Request for Information (RFI), issued by the U.S. Department of Health and Human Services (HHS), representing the initial step in implementation of the standard. Although the non-discrimination standard takes effect on the same schedule as other ACA provisions, the RFI signals only the beginning of what might be expected to be a complex regulatory development process.

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Kaiser Family Foundation simulates impact of Medicaid expansion on local communities

Posted by Nikki Hurt on August 1, 2013

A new interactive feature released by the Kaiser Family Foundation indicates how the Affordable Care Act (ACA) may impact Medicaid enrollment and the uninsured demographic at the local community level. The interactive tool is accompanied by a report, as well as other interactive features, that describes how the Medicaid population will change after the ACA is implemented and how the uninsured population will decrease both in and amongst states post-ACA.

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Update on Eligibility for Exemptions from the Personal Responsibility Tax Penalty and Designating Certain Health Benefits Coverage as Minimum Essential Coverage

Posted by Nikki Hurt on July 31, 2013

On July 1, 2013, HHS issued final implementing regulations that specify which individuals may be eligible for exemptions from the Shared Responsibility penalty payment, a special tax established under the Affordable Care Act (ACA) that applies to non-exempt individuals who have access to affordable insurance but fail to purchase it. The final rule also explains the role of Exchanges in granting “certificates of exemption” from the penalty payments, and identifies the range of health benefits that the government will consider as satisfying the Act’s “minimum essential coverage” rule. The final rule shows some, but not a lot, of changes from its original proposed form.

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CBO estimates cost of delaying employer shared responsibilty requirements to be $12 billion

Posted by Nikki Hurt on July 30, 2013

In a letter addressed to Rep. Paul Ryan, the Congressional Budget Office (CBO) stated that the administration’s decision to delay the employer shared responsibility (employer mandate) provisions of the Affordable Care Act (ACA) would cost the government $12 billion over 10 years. CBO estimated that around $10 billion would be lost from the one-year delay in collecting penalties from employers that did not offer comprehensive, affordable coverage. An additional $3 billion is projected to be lost from the government over-allocating subsidies to individuals qualifying for premium assistance. CBO did, however, project the delay to generate around $1 billion in savings as a result of taxable compensation from people enrolling in Exchanges that would have otherwise received employer-sponsored coverage.

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OIG releases report concerning implmentaion of CO-OP programs

Posted by Nikki Hurt on July 25, 2013

A new report released by the US Department of Health and Human Services Office of Inspector General (OIG) purports that Consumer Operated and Oriented Plan (CO-OP) issuers have achieved 90% of their implementation goals. Under the Affordable Care Act (ACA), CO-OP loans were provided to create non-profit health plans that were effectively consumer initiated and executed in 24 states. Although these CO-OPs have been successful in development, much uncertainty and concern still remains around the ultimate success of these programs. The report, Early Implementation of the Consumer Operated and Oriented Plan Loan Program, found that many factors, such as competition in state insurance Exchanges and the health status of enrollees, will determine whether or not CO-OPs will be beneficial for plan participants.

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Urban Institute report highlights how states engage insurerer participation and competition

Posted by Nikki Hurt on July 12, 2013

A new Urban Institute analysis purports that insurance Exchanges are already exhibiting competition that will result in reasonably-priced premiums. Insurer Participation and Competition in Health Insurance Exchanges: Early Indicators Show Healthy Competition, funded by the Robert Wood Johnson Foundation, found that the six states studied have incentivized participation from multiple insurers and have relied upon market forces to drive down costs. Moreover, the report explains how the federal government may benefit from the approaches utilized by these states, as lower premiums correlate to fewer subsidies from the government in the form of premium assistance.

 

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HHS blog attempts to debunk myths regarding Exchange implementation

Posted by Nikki Hurt on July 11, 2013

A blog post created by Marilyn Tavenner, the Administrator of the Centers for Medicare and Medicaid Services (CMS), clarifies concerns surrounding Exchange operability after last week’s release of new Affordable Care Act (ACA) regulations. In the post, Tavenner proclaimed that the Exchanges will be fully operational by the October 1st enrollment deadline. Of chief import, Tavenner responded to concerns about whether or not the Exchanges will verify an applicant’s submitted income information and if there are safeguards in place to prevent applicants from fraudulently receiving subsidies. Tavenner responded in the affirmative to both, stating that an applicant’s income will be compared against tax filings, social security data, and income reports. Tavenner found that individuals who falsely apply for subsidies will run the risk of receiving a penalty for perjury, and that the Internal Revenue Services (IRS) already has mechanisms in place to recollect subsidies that were overpaid or provide subsidies to those that did not initially receive the correct amount.

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