Manatt on Health Reform: Weekly Highlights

In this week’s news, many states’ Marketplaces have begun to communicate with current enrollees about how to renew their coverage during the 2015 Open Enrollment Period; meanwhile, the federal government announced the extension of several policies, including the use of paper-based eligibility appeals for Marketplaces and the funding and authority for Medicaid eligibility and enrollment system modernization and integration. Read on for more details.


Arkansas: Hospital Association Study Finds 47% Reduction in Hospitalizations of Uninsured Since Private Option Implementation

A study by the Arkansas Hospital Association and the Arkansas Chapter of the Healthcare Financial Management Association found that during the first six months of Arkansas’s implementation of Medicaid expansion, known as the Private Option, in 2014, the number of hospitalizations of uninsured patients declined by 46.5% as compared to the same six-month period in 2013. In addition, the number of emergency room visits by uninsured patients decreased by more than one-third. Hospitals estimate that their uncompensated care losses have declined by approximately 56% as a result of the 204,000 individuals who received coverage through the Private Option.

Colorado: Marketplace Enrollees Encouraged to Shop for Lower-Cost Coverage or Risk Receipt of Smaller Tax Credits

According to the The Denver Post, an analysis for the Colorado Division of Insurance anticipates that consumers enrolled in health plans through Connect for Health Colorado may receive smaller tax credits in 2015 because the premiums for the second lowest cost silver plan will be lower in 2015 than they were in 2014. According to the analysis, the average share of costs for receiving tax credits in 2014 was $162 per month. In 2015, the average share of costs after tax credits if an enrollee keeps the same plan will be $281 per month. Connect for Health Colorado is encouraging current enrollees to shop for plans through the Marketplace website, noting that if an enrollee chooses a lower-cost option, their average share of costs after tax credits could be as low as $133.

Nevada: Marketplace Releases Guide to 2015 Open Enrollment Period Indicating Auto-Renewal without Financial Assistance for Current Enrollees

The Nevada Health Link released a guide to the 2015 Open Enrollment Period (OEP) explaining that current enrollees receiving financial assistance who do not actively re-enroll in coverage through Nevada Health Link will be auto-renewed into a health plan for 2015 that does not offer financial assistance. Current enrollees who wish to remain in their current plan are encouraged to call their carrier for direct enrollment assistance. Additionally, the guide highlights a new pre-screener tool that helps applicants determine eligibility and links them directly to a qualified health plan on, a consumer option for direct billing and payment with insurance companies, and a Spanish language site.

New Hampshire: Five Carriers Will Offer Plans on the Marketplace in 2015; Three Release Sample Premium Rates

Five carriers, up from one in 2014, will offer qualified health plans (QHPs) on the Marketplace in New Hampshire for 2015, as reported by Covering New Hampshire. The five carriers - Anthem, Maine Community Health Options, Minuteman Health, Harvard Pilgrim Health Care and Assurant Health - will offer a total of 61 QHPs for individuals, up from 11 offered during 2014, and 21 QHPs for small businesses on the Small Business Health Options Program (SHOP) Marketplace. Of the three carriers that released premium rates, the monthly premiums for a silver-level QHP for a 40-year-old non-smoker range from $279 to $288 per month.

Vermont: Marketplace Encourages Current Enrollees to Submit New Application to Renew Coverage or Be Auto-Renewed

According to the Vermont Digger, Vermont Health Connect (VHC) plans to auto-renew current enrollees into the same health plans that they were enrolled in in 2014, unless an individual submits a new application. Due to previous technical difficulties with the online Marketplace, VHC is encouraging current enrollees who would like to change their coverage to submit new applications either on paper or through the call center. Individuals may also renew their coverage online when the VHC web portal is launched. VHC is preparing for 60% of its current 31,000 enrollees to seek a change in coverage during the upcoming Open Enrollment Period.

Vermont: State Officials to Assist Consumers with Shared Responsibility Payment Tax Form

Vermont State officials announced plans to assist Marketplace enrollees who are required to file an additional tax form, the 1095A, to ensure they do not owe the federal government a shared responsibility payment. According to the Vermont Digger, the State is preparing to train employees at the Tax Department and the Vermont Health Connect call center to address questions relating to this tax form. For further assistance, consumers will be referred to Volunteer Income Tax Assistance clinics and the Health Care Advocate's Office, a project of Legal Aid, among other local organizations. The State is also sponsoring informational sessions for tax practitioners across the State who may also be assisting clients with the shared responsibility payment tax form.

Washington: Exchange Board Discusses Establishment Grant Application and Reviews Eligibility Study

The Washington Health Benefit Exchange Board discussed its intent to submit an additional Level 1 Establishment Grant for approximately $40 million. Additionally, the Board reviewed initial findings from the Office of Financial Management's (OFM) medical and public assistance eligibility study, which suggested, among other findings, that the separation of Medicaid and public assistance applications created barriers to benefits. The OFM recommended several ways to further integrate the programs, including auto-enrolling SNAP beneficiaries into Medicaid and auto-renewing SNAP eligibility for Medicaid recipients receiving those benefits. Finally, the State reviewed updates on 2015 open enrollment readiness, carriers' system and data updates, and Exchange revenue sources, among other items.

Washington: Exchange Technical Advisory Committee Reviews Navigator and Broker Program Evaluation Recommendations

The Washington Health Benefit Exchange (HBE) Health Equity Technical Advisory Committee reviewed findings and recommendations from Wakely Consulting Group's evaluation of the HBE's Navigator and Broker programs. Recommendations include expanding the role of Community Health Centers for Medicaid outreach; expanding the use of Certified Application Counselors; utilizing Washington libraries as annual 'pop up' enrollment centers; and aligning navigator and broker programs in the HBE organizational structure. The State's next steps include identifying short-term recommendations to implement; assessing the success of navigator and broker pilots; and, developing a transition plan for 2016 open enrollment.


CMS Extends Paper-Based Eligibility Appeals for Marketplaces

CMS released sub-regulatory guidance that allows the Federally Facilitated Marketplace and State-based Marketplaces to use a paper-based eligibility appeals process through December 31, 2015. The extension applies to individual eligibility appeals, employer appeals, and Small Business Health Options Program (SHOP) Marketplace appeals. CMS noted in the issued guidance that this flexibility protects the rights of appellants while allowing states to complete systems development and processes needed to implement online appeals systems.

CMS Intends to Extend Funding and Authority for Medicaid Eligibility and Enrollment System Modernization and Integration

CMS announced its intent to issue new regulations to permanently extend the federal funding match provided to states for Medicaid eligibility and enrollment system modernization. The 90% match was introduced in 2011, increasing the level of federal support for eligibility and enrollment systems builds from 50%, alongside detailed standards that states must meet in order to receive the funds. The new regulations will codify the 90% match and propose updated standards to ensure states have continued support to implement high-functioning and streamlined systems.

In addition, CMS announced it will provide a three-year extension to the Office of Management and Budget Circular A87 cost allocation waiver that supports states' efforts to integrate eligibility and enrollment systems across health and human service programs, such as Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF). The waiver extension will be formalized in forthcoming guidance and will provide funds to states through December 2018.

Insurers Announce Expectation of Enrollment Increase during 2015 Open Enrollment Period

Six private and not-for-profit insurers interviewed by Reuters announced expectations for enrollment growth during the 2015 Open Enrollment year, basing predicted growth on consumer interest reported through call centers, sales forces, and brokers. Some insurers predicted increases of at least 20% in Marketplaces while some indicated they expect enrollment to double in specific states. Among the insurers interviewed were Florida-based Health First Health Plans, Pennsylvania- based Blue Cross and Houston-based Community Health Choice.

Early Testing of SHOP Marketplace Reveals Need for Improvements

One week after testing the federal Small Business Health Options Program (SHOP) Marketplace began in five states, small business owners, employers, insurance agents and brokers revealed several concerns with site functionality. Testers identified incompatibility with certain web browsers, inaccurate premium information and inconsistencies regarding which plans were approved for online sale and which appeared on the site. Federal officials responded to the concerns, stating that many of the issues will likely be resolved by November 15, the site’s official launch date at the start of Open Enrollment.


California: Department of Health Care Services Announces Stakeholder Groups for Medicaid Waiver Renewal Efforts

The Department of Health Care Services announced the formation of five stakeholder workgroups to support the State's efforts to renew its Medicaid 1115 waiver. Each group will be comprised of subject matter experts in Medicaid and delivery system reform and will focus on discrete topic areas, including: safety net reform; provider/managed care plan incentive programs; the Delivery System Reform Incentive Program; the potential for Medicaid-funded housing; and workforce development. The Department also announced the meeting schedule for the workgroups, and a one-day working session on financing and federal-state shared savings.

Louisiana: Department of Health and Hospitals Recommends Fifth Plan to Administer Bayou Health's Next Phase

The Louisiana Department of Health and Hospitals (DHH) officially announced its recommendation for five statewide health plans to administer the next three-year contract period for the Bayou Health Medicaid and CHIP program beginning February 1, 2015. Following an RFP process, DHH selected one new plan, Aetna Better Health of Louisiana, to add to the four plans currently in operation: Amerigroup, AmeriHealth Caritas, Louisiana Healthcare Connections, and UnitedHealthcare Community Plan. Bayou Health currently operate under two models, but beginning next February all plans must operate under one risk-bearing managed care organization model.

Massachusetts: Office of Health and Human Services Announces Medicaid Waiver Agreement with CMS

The Massachusetts Executive Office of Health and Human Services announced a $41.4 billion, five-year 1115 Waiver agreement with CMS, the first five-year agreement between the Commonwealth and CMS, to reform the State’s Medicaid program. The 1115 Waiver includes $230 million annually for delivery system transformation initiatives and $771 million for Medicaid-eligible state health programs that provide community-based health services. The Waiver also includes a 50% federal match for the temporary Medicaid coverage provided during 2014 to 300,000 individuals whose eligibility could not be determined by the Massachusetts Health Connector website.



pursuant to New York DR 2-101(f)

© 2020 Manatt, Phelps & Phillips, LLP.

All rights reserved