Manatt on Health Reform: Weekly Highlights

Ohio’s Medicaid expenditures came in $2 billion below estimates despite enrollment growth after Medicaid expansion; California extends full Medicaid benefits to more pregnant women; and nearly one million have enrolled in HealthCare.gov through Special Enrollment Periods since mid-February.

STATE MEDICAID ACTIVITY

Ohio: Despite Enrollment Growth, State Medicaid Spending $2 Billion below Estimates

Ohio’s total Medicaid spending for Fiscal Year (FY) 2015 was $23.5 billion, a figure 7.6% less than originally anticipated despite expanded Medicaid eligibility, the Governor's Office of Health Transformation reported. Overall, Medicaid expansion enrollment in Ohio exceeded estimates by 150,000 people, bringing the State’s number of Medicaid beneficiaries to 3 million. Several new cost-cutting initiatives, including capitated reimbursement policies and expanded managed care, and an automated eligibility system were credited with the lower-than-expected costs. Medicaid spending growth decreased from 4.6% in FY 2014 to 3% in FY 2015.

California: State Extends Full Medicaid Benefits to Pregnant Women

CMS approved California’s waiver request to extend full-scope Medicaid benefits to pregnant women with household incomes between 109% and 138% of the Federal Poverty Level (FPL). While the State previously expanded Medicaid to adults, including pregnant women, up to 138% FPL, California had historically provided only limited scope benefits to pregnant women. The approved waiver amendment also enables the State to require pregnant women up to 138% FPL to enroll in a managed care plan in counties where plans are available.

Alabama: Legislature Ends Special Session without Budget Agreement

The Alabama legislature ended its special session this week without passing a 2016 budget after the Senate rejected a House budget that would have cut Medicaid funding by $156 million. Governor Robert Bentley (R) said he will call a second special session before the start of the 2016 fiscal year on October 1.

MARKETPLACE UPDATES

Maryland: SHOP Now Open on "Maryland Health Connection" Website

Maryland's Small Business Health Options Program (SHOP) Marketplace, which launched in April 2014, is now available online through portals established by three third-party administrators the State selected last year. The SHOP’s online presence was delayed until this month because the State was addressing technical glitches related to the individual Marketplace website. In 2015, 11 insurers are offering 110 health plans through the SHOP.

STATE HEALTH STAFFING NEWS

Illinois: Marketplace Executive Director Resigns

Karin Zosel, Executive Director at Get Covered Illinois, resigned from the post she has held since March 2015, returning to previous employer MacMurray College as its vice president of institutional advancement. Mark Chudzinski, the Marketplace’s general counsel and chief privacy officer, has been named acting director. Zosel’s resignation comes during a time of transition, as Get Covered Illinois moves from the governor’s office to the Illinois Department of Insurance with reduced resources, including fewer staff positions.

Utah: Governor Appoints Joseph Minor to Lead Health Department

Governor Gary Herbert (R) announced the appointment of Dr. Joseph Kay Minor as the new Executive Director of the Utah Department of Health, replacing Dr. David Patton, who stepped down from the role on July 31 to pursue private sector opportunities. Dr. Minor has more than 30 years of experience directing the Utah County Health Department—one of the largest departments of health in the State—and has served numerous clinical consulting and board membership roles. Dr. Minor's appointment is subject to the approval of the Utah State Senate.

FEDERAL ELIGIBILITY & ENROLLMENT UPDATES

Nearly 1 Million Enrolled through Special Enrollment Periods

According to data released by CMS, since the 2015 open enrollment period closed in mid-February, nearly 944,000 consumers have enrolled in coverage through HealthCare.gov. Most plan selections occurred due to three types of Special Enrollment Periods (SEPs): 50% due to loss of minimum essential coverage, 19% due to loss of Medicaid coverage, and 15% due to the tax season SEP. The tax season SEP was for individuals who became aware of the requirement to obtain coverage when they filed their 2014 taxes. On average, plan selections due to a SEP ranged between 5,000 and 6,000 per day, though plan selections peaked to 38,000 on the final day of the tax season SEP (45% of these plan selections were due to the tax season SEP). The data also indicate that SEP enrollees are younger than those who signed up during open enrollment—47% of SEP enrollees were between 17 and 34 years of age, as compared to 31% of open enrollment enrollees.

Number of Uninsured Continues to Decline

The National Center for Health Statistics released new data showing a steady, on-going decline in the number of uninsured since 2013. From first quarter 2014 to first quarter 2015, uninsurance decreased by nearly 7 million people, reducing the overall rate of uninsurance from 11.5% to 9.2%. Long-term trends show an even more dramatic drop. In the first three months of 2010, 22.3% of adults aged 18-64 were uninsured, compared to just 13% (roughly 29 million people) in 2015.

HealthCare.gov Medicaid Special Enrollment Period Glitch

CMS alerted enrollment assisters earlier this month that HealthCare.gov is experiencing a technical glitch that prevents individuals who have lost Medicaid or CHIP coverage to obtain the Special Enrollment Period they are eligible for through the online platform, according to Politico. CMS is conducting outreach to impacted individuals to help them get coverage through the Marketplace call center. Consumers seeking other special enrollment periods, such as due to marriage or loss of employer sponsored coverage, are not impacted.

OIG Claims Some HealthCare.gov Verification Controls Were Ineffective in 2013 and 2014

The HHS Office of Inspector General (OIG) reviewed 90 applications for 2013 and 2014 coverage to assess the effectiveness of HealthCare.gov’s verification processes and found that some “controls” were ineffective for determining eligibility and for resolving inconsistencies. The report recommends CMS redetermine the eligibility of applicants impacted by the ineffective controls and improve internal controls and procedures. CMS concurred with the recommendations and stated that system issues identified have been rectified.

ADDITIONAL FEDERAL NEWS

HHS Announces $169 Million to Fund Health Centers

The Department of Health and Human Services announced $169 million in Affordable Care Act funding to establish 266 new health center sites for the delivery of primary healthcare services in 46 states, the District of Columbia, and Puerto Rico. The Department projects that the new sites will increase access to healthcare services for over 1.2 million patients. This funding is in addition to the $101 million previously awarded to 164 health center sites in May.

CMS Delays Release of Risk Corridor Data

While CMS had planned to publish preliminary estimates of program-wide payments and charges associated with the temporary risk corridor program by August 14, the agency announced it is postponing the release due to data inconsistencies. The risk corridor program was established as one of several mechanisms to spread insurers’ risk for participating in Marketplaces and is set to expire in 2016. CMS acknowledged it had received timely submissions of data from nearly all Marketplace insurers, but required additional time to conduct data validation. The agency did not indicate when it expects to publish the preliminary program results.

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