Manatt on Health Reform: Weekly Highlights

HHS ramps up for the final week of open enrollment. Families buying into CHIP in Pennsylvania are granted tax relief, and though Medicaid expansion efforts seem to have hit a wall in Tennessee and Wyoming, Arkansas assures funding for the Private Option while Alaska and Idaho move their expansion debates forward.


Average Monthly Tax Credit Totals $268 Per Qualified Individual for 2015 Open Enrollment

HHS’ newly-released report indicates that over 80% of new and renewed Federally-facilitated Marketplace enrollees as of January 30 qualify for an advance premium tax credit (APTC). For the 6.5 million that qualify, the average APTC covers approximately 72% of gross premium, providing an average of $268 in monthly subsidies per individual. The agency’s announcement comes amidst a push to enroll individuals during the final week of this year’s open enrollment period and as the legality of the subsidies are being challenged in the Supreme Court King v. Burwell case.

As HHS Gears Up for Final Week of Open Enrollment, Agency Estimates Nearly 10 Million Enrollees and Ramps up Call Center Staff

Obama Administration officials estimated that 9.9 million individuals have enrolled or re-enrolled in coverage nationwide, with 7.5 million signed up through the Federally-facilitated Marketplace (FFM) and at least 2.4 million through State-based Marketplaces. HHS offered a more detailed breakdown of FFM enrollment in its latest weekly enrollment report, showing cumulative plan selections by metro area in several states using Miami-Fort Lauderdale-West Palm Beach in Florida and Atlanta-Sandy Springs-Roswell in Georgia had the most enrollees, with 637,500 and 296,900, respectively. Finally, HHS officials indicated that they are increasing call center staff by 40% to prepare for the expected increase in visitors as the February 15 deadline nears.


Alaska: Governor Unveils Medicaid Expansion and Reform Analysis

Governor Bill Walker (I) unveiled two reports, “The Healthy Alaska Plan: A Catalyst for Reform" and an economic analysis of Medicaid expansion, that estimate the impacts of Medicaid expansion and reform in Alaska. The reports project that more than 41,000 low-income Alaskans would be eligible under the expansion, and that in Fiscal Year (FY) 2016, the State would save $6.1 million, with additional savings projected each year through FY 2021. The reports also estimate that by FY 2021 the State would have received $1.1 billion in new federal revenue and created 4,000 jobs. The Governor pledged to evaluate various strategies for increasing use of preventive services and shared responsibility, including cost sharing requirements, health savings accounts, incentives for healthy behavior and work assistance benefits.

Arkansas: Governor Signs Appropriation Bill for Private Option

Governor Asa Hutchinson (R) signed SB101 into law, appropriating fiscal year (FY) 2016 funding for the State's Private Option for Medicaid expansion, after the House passed the bill by a bipartisan 82 to 16 margin on the bill's first vote, exceeding the 75% supermajority required for passage. Still awaiting the Governor’s signature is SB96, a bill to implement his vision for health reform which: creates a taskforce to study health reform; permits the State to apply for a Medicaid transformation waiver by July 2016; and, eliminates requirements to impose cost-sharing on those below 100% of the federal poverty level and to transition CHIP enrollees to the Private Option.

Idaho: Workgroup Presents Medicaid Expansion Recommendations to Legislative Committees

Governor C. L. “Butch” Otter's (R) workgroup on Medicaid Redesign presented its recommended alternative Medicaid expansion approach, the Healthy Idaho Plan, to the House and Senate Health and Welfare Committees. The plan provides coverage to new adults below 100% of the federal poverty level (FPL) through care management and patient centered medical homes, and for those above 100% FPL through qualified health plans (QHPs) on the State’s Marketplace. The plan, which the workgroup estimates will save the State $173.4 million over 10 years, includes recommendations to charge maximum allowable co-pays for all enrollees and premiums for those in QHPs, refer all enrollees to job training services, and permit opting out of the program if federal funding conditions change.

Massachusetts: Newly-Elected Governor Proposes Major Medicaid Funding Cuts

Governor Charlie Baker (R) unveiled a proposed budget that aims to close a deficit ten times higher than the previous Administration’s January estimate. Governor Baker indicated that the largest contributor to the deficit is $230 million in Medicaid spending and attributed much of the shortfall discrepancy to the cost of providing temporary Medicaid coverage to individuals whose 2014 eligibility determinations could not be completed by the Massachusetts Health Connector. Governor Baker’s budget includes $168 million in cuts to the Medicaid program budget; he explains that savings will partly come from ensuring Medicaid enrollees are, in fact, eligible for the program.

New Mexico: CMS Denies Exchange Application for Funding to Develop Eligibility and Enrollment System

A New Mexico Health Insurance Exchange (NMHIX) application for $97 million in federal funding to advance its development of a State-based Marketplace (SBM) was denied by CMS, reported the Albuquerque Journal. NMHIX, a Federally Supported State-based Marketplace, applied for the funding to retool its eligibility and enrollment system. Despite a statement of support for NMHIX’s goal, CMS denied the State, citing a lack of detail in certain sections of the application (including the IT workplan and cost allocation sections), slow progress of Exchange development thus far, and wavering support from the State's leadership. The NHMIX board is currently considering whether to use funds leftover from previous federal grants or to remain a Federally Supported SBM for the foreseeable future.

New York: Two Million Enrollees through the Marketplace Represent High Renewal Rates

Governor Andrew Cuomo (D) announced that over two million New Yorkers have enrolled in health insurance through the State's Marketplace for 2015 coverage. Much of the 2015 enrollment represents individuals renewing 2014 coverage; the New York State of Health achieved an 85% renewal rate in private coverage. Of the approximately 430,000 new enrollees, nearly 70% were determined eligible for Medicaid.

Pennsylvania: Residents with CHIP Buy-In Coverage Granted Tax Penalty Exemption

Governor Tom Wolf (D) announced federal tax penalty relief for families enrolled in the State's CHIP Buy-In program, which permits enrollees with incomes above 300% of the federal poverty level (and thus ineligible for subsidized CHIP) to purchase CHIP coverage at full cost. Because the program does not meet minimum essential coverage (MEC) as set forth in the Affordable Care Act, enrollees would have been subject to the shared individual responsibility tax penalty. Under this new relief, through April 15 individuals will not be subject to the tax penalty and will be able to switch to a plan that does meet MEC during an extended special enrollment period.

Pennsylvania: Governor Announces Transition to Traditional Medicaid Expansion

Governor Tom Wolf (D) announced he has initiated the transition to a traditional Medicaid expansion from ex-Governor Corbett's Healthy PA expansion, which uses Medicaid dollars to subsidize private insurance coverage. The Governor directed the Department of Human Services to submit a letter to CMS to begin consolidating the three benefit packages under Healthy PA to one and emphasized to current Healthy PA enrollees they do not need to take any action at this time. It is unclear over what time frame the transition to the new Adult package would take place, who the carriers for that plan would be, and if premiums imposed under Healthy PA would be changed or eliminated.

Tennessee: Insure Tennessee Is Defeated in Senate Committee

During a special legislative session, the Senate Health Committee defeated Governor Bill Haslam’s (R) Insure Tennessee proposal on a 7-4 vote. Objections to the proposal included a lack of detail regarding the consequences to the State should it pull out of the program early, as well as the prospect of contributing to the federal debt by drawing down over $2.8 billion in support. Having failed to clear the Senate, it appeared unlikely that the House would move forward with its version of the program, as House Majority Leader Gerald McCormick (R) noted that the Senate Committee had “heard from every side of this” and did not pass the bill.

Wyoming: Senate Rejects Medicaid Expansion, House Committee Withdraws Expansion Bill

After three days of debate and multiple amendments, the Wyoming Senate voted to reject the Medicaid expansion bill previously approved by the Senate's Labor, Health and Social Services Committee. Following the vote, the House Labor, Health and Social Services Committee also withdrew its version of the Medicaid expansion bill. At this time, no expansion legislation remains under consideration in either chamber. During debate by the full Senate and before this final vote, an amendment to require enrollees to work in order to qualify for coverage was added to the legislation. Many in the Legislature considered this policy to be a "poison pill" given CMS's refusal to approve similar work requirements in other states.


Michigan: Department Announces that Duals Demonstration Enrollment is Now Open

The Michigan Department of Community Health (MDCH) announced that enrollment is open for MI Health Link, the State's demonstration to create Integrated Care Organizations (ICOs) that offer a unified set of benefits for individuals dually eligible for Medicaid and Medicare. Enrollment will proceed in two phases according to county of residence with services either beginning March 1 or May 1. MI Health Link aims to improve health care quality and access and lower costs for dual eligibles by aligning and streamlining Medicare and Medicaid rules, services, and funding.



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