Vast Majority of Enrollees for Health Care through Exchanges are Obtaining Premium Assistance

January 5, 2015 at 1:53 pm | Posted in Affordable Care Act, Health Insurance Exchanges, Health Insurance Marketplace, HHS | Leave a comment
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Last week, HHS released a report on Affordable Care Act enrollment data via the state and federal Healthcare Marketplaces/Exchanges. It is reported that approximately 87 percent of people who selected health insurance plans through HealthCare.gov for coverage beginning Jan. 1, 2015 were determined eligible for financial assistance to lower their monthly premiums, compared to 80 percent of enrollees who selected plans over a similar period last year. In addition, more than 4 million people in both the state and federal Marketplaces signed up for the first time or reenrolled in coverage for 2015 during the first month of open enrollment. That includes more than 3.4 million people who selected a plan in the 37 states that are using the HealthCare.gov platform for 2015, and more than 600,000 consumers who selected plans in the 14 states that are operating their own Marketplace platform for 2015.

 

A complete copy of the HHS Release can be found here: 87 Percent of Those Who Selected 2015 Plans in First Month of Open Enrollment Are Getting Subsidies

 

The D.C. Circuit Court of Appeals Agrees to Rehear ACA State/Federal Exchange Argument: The Obama Administration Gets a Second Bite at the Apple

September 4, 2014 at 12:47 pm | Posted in Affordable Care Act, Health Insurance Exchanges | Leave a comment
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The D.C. Circuit Court of Appeals has agreed to rehear argument and revisit its earlier ruling striking down Affordable Care Act (ACA) subsidies issued through federal exchanges as opposed to state exchanges. The announcement of the second hearing is a procedural victory for the Obama administration, which suffered a defeat in late July when a three-judge panel voted 2-1 that subsidies issued through federal exchanges were not allowed under the ACA. The two judges voting to strike down the subsidy language were appointed by a Republican President. A decision by the full D.C. appellate court (11 judges), in which Democratic appointees outnumber Republican appointee, is scheduled for oral argument on December 17.

 

Thousands at Risk of Losing Health Insurance Acquired Through Federal Marketplaces

August 18, 2014 at 10:07 am | Posted in Affordable Care Act, Compliance, Health Insurance Exchanges, Health Insurance Marketplace | Leave a comment
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The Washington Post reported on August 14th that Federal health officials are warning hundreds of thousands of people who have bought health plans through the federal insurance exchange that their coverage will be cut off unless they quickly provide proof that their citizenship or immigration status makes them eligible to be insured through the new marketplace.

The warnings were mailed last week to 310,000 people in the three dozen states that rely on the exchange. The letters give the recipients until Sept. 5th to send copies of green cards, citizenship documents or other information showing that they qualify for the coverage. If they miss the deadline, their coverage will end on Sept. 30th.

This move is the first step the administration has taken to hold consumers accountable when information on their applications conflicts with records on file at federal agencies or is missing altogether.

The action will affect only people with lingering eligibility issues involving their citizenship or immigration status. They are included in about 2 million cases of several kinds of application discrepancies involving people who have obtained coverage through the exchange.

Federal health officials announced that they will take separate action soon to resolve an even larger group of cases with discrepancies: those in which the income people listed on their insurance applications is out of sync with their federal tax records. In cases of unresolved income inconsistencies, the government could reduce — or eliminate — people’s federal insurance subsidies but could not end their coverage.

Although First in Universal Healthcare Requirement…Massachusetts Remains Near Last in a Functioning Website/Exchange

July 14, 2014 at 11:44 am | Posted in Affordable Care Act, Health Insurance Exchanges, Health Insurance Marketplace | Leave a comment
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As reported in the July 10, 2014 article from the Associated Press that follows, frustration abounds on Beacon Hill as the state is still hoping for a soon to be operational health insurance exchange/marketplace.

By BOB SALSBERG, Associated Press:

BOSTON (AP) Software ordered by Massachusetts to fix its hobbled health care exchange passed initial tests, renewing hopes that the state could finally have a fully operational website by year’s end, officials said Thursday.

The breakdown dramatically slowed the state’s transition to the federal Affordable Care Act from its own first-in-the-nation universal health insurance law that provided a model for President Barack Obama’s plan.

Massachusetts severed ties earlier this year with the lead contractor on its health exchange, CGI Group, and has been forced to shuffle more than 200,000 of its residents into temporary Medicaid coverage.

In May, state officials unveiled a “dual-track” approach that called for buying software that has powered insurance marketplaces in other states while also laying the groundwork for a switch over to the federal government’s health insurance market, should that be necessary.

Maydad Cohen, a special assistant to Gov. Deval Patrick, told the Massachusetts Health Connector board that the software cleared several key tests after its initial release last month, prompting federal officials to authorize the state to continue pursuing its current strategy.

A final decision on whether to go forward with the software solution is expected early next month following the rollout of an enhanced version of the program.

Cohen said the goal was a fully functional exchange before the next ACA enrollment period beginning Nov. 15.

“I don’t know where we are going to be at open enrollment right now, but I am increasingly, cautiously optimistic about our ability to deliver the product,” Cohen told reporters after briefing the board.

The total cost to taxpayers for the website breakdown remained unclear.

The state initially estimated the cost of the dual-track approach at $121 million. Officials said they would not be able to produce a final cost estimate until it finalized contract negotiations with Optum, a health care technology firm that was retained by the state.

Cohen said state officials hope the federal government agrees to pay the full tab for repairs. A separation agreement reached with CGI calls for paying the Montreal-based firm an additional $35 million on top of the $17 million the state already had paid toward an original $89 million contract.

The state also had paid out $138 million in fees for medical services through June 30 for the 237,000 residents forced into “provisional” Medicaid coverage because the connector was unable to determine their eligibility for ACA-compliant programs, Secretary of Administration and Finance Glen Shor said Thursday.

That total was before federal reimbursement, and Shor insisted the overall costs would not have been much higher had the state been able to enroll more people into permanent coverage. Officials remain confident that all residents will be moved off temporary coverage by next year.

Massachusetts has been given a waiver from most requirements of the federal law until Dec. 31.

March 31 Exchange Open Enrollment Deadline Extended With Appeal and Honor System

March 26, 2014 at 9:19 am | Posted in Health Insurance Exchanges | Leave a comment
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The Washington Post is reporting today that the Obama administration will extend the March 31 open enrollment deadline for people who say they tried to sign-up for coverage on the new healthcare exchanges but failed to complete the process on time. “Open enrollment ends March 31,” Health and Human Services spokeswoman Joanne Peters said in an email Tuesday evening. “We are experiencing a surge in demand and are making sure that we will be ready to help consumers who may be in line by the deadline to complete enrollment – either online or over the phone.” Those that tried to sign up, but missed the March 31 deadline, can appeal for an extension that will allow them to complete the enrollment process into mid-April. An official said the rule change would apply to only a “limited number of situations.” However, the Washington Post report says the appeals process will run on the “honor system,” and that consumers need only claim they tried to sign-up before the deadline to be granted an extension.

ACA Exchange Enrollment Hits 4 Million

February 26, 2014 at 2:09 pm | Posted in Affordable Care Act, Compliance, Health and Human Services, Health Care, Health Insurance Exchanges, Health Insurance Marketplace, Medical, PPACA, Regulations | Leave a comment
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HHS announced Tuesday that approximately 4 million Americans have enrolled through the end of January for coverage through the Affordable Care Act Exchanges. A full enrollment report for February will be released in mid-March.

“With individuals and families enrolling in coverage every day, we continue to see strong demand nationwide from consumers who want access to quality, affordable coverage,” Centers for Medicare & Medicaid Services administrator Marilyn Tavenner wrote in a blog post Tuesday. “Our outreach efforts are in full force with community partners and local officials participating in hundreds of events each week and enrollment assistors are helping more and more people enroll in coverage,” she continued.

Only five weeks remain in the open enrollment period.

HHS Announces 53% Increase in Federal Exchange/Marketplace Enrollment

February 14, 2014 at 9:21 am | Posted in Affordable Care Act, Compliance, Health and Human Services, Health Care, Health Insurance Exchanges, Health Insurance Marketplace, Medical, PPACA | Leave a comment
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HHS Secretary Kathleen Sebelius announced on February 12 that enrollment in the Health Insurance Marketplace continued to rise in January, with a 53 percent increase in overall enrollment over the prior three-month reporting period, with young adult enrollment outpacing all other age groups combined.

Nearly 3.3 million people enrolled in the Health Insurance Marketplace plans by February 1, 2014 (the end of the fourth reporting period for open enrollment), with January alone accounting for 1.1 million plan selections in state and federal marketplaces. In January, 27 percent of those who selected plans in the Federally-facilitated Marketplace are between the ages of 18 and 34, a three percentage point increase over the figure reported for the previous three-month period. Young adult enrollment grew by 65 percent in January, from 489,460 at the end of December to 807,515 as of February 1, while all other age groups combined grew by 55 percent.

A copy of the HHS press release is here: http://www.hhs.gov/news/press/2014pres/02/20140212a.html

 

2014 Federal Poverty Guidelines Released… Will be Used to Determine Health Insurance Subsidy Eligibility at State and Federal Exchanges

January 24, 2014 at 9:44 am | Posted in Compliance, Employment Law, Health and Human Services, Health Care, Health Insurance Exchanges, Health Insurance Marketplace, Regulations | Leave a comment
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HHS has released 2014 federal poverty guidelines which, among other things, will establish income thresholds for health insurance subsidy eligibility on state and federal exchanges. The threshold (in the 48 contiguous states and DC) for one person will be $11,670, a $180 increase over the 2013 level. The 2014 guidelines reflect a 1.5 percent price increase between calendar years 2012 and 2013. If an employee qualifies for an exchange subsidy in 2015, the receipt of that subsidy might trigger a “large” employer (50 FTEs) shared responsibility penalty under internal revenue code section 4980H.

2014 Poverty Guidelines for the 48 Contiguous States and the District of Columbia

Persons in Family/Household

Poverty Guideline

1

$11,670

2

$15,730

3

$19,790

4

$23,850

5

$27,910

6

$31,970

7

$36,030

8

$40,090

For families/households with more than 8 persons, add $4,060 for each additional person.

A copy of the release as it appears in the Federal register is here:
http://www.gpo.gov/fdsys/pkg/FR-2014-01-22/pdf/2014-01303.pdf

The Massachusetts Affordable Care Act (ACA) Website Is Woefully Underperforming: Outside Review Ordered

January 10, 2014 at 11:52 am | Posted in Affordable Care Act, Compliance, Health Care, Health Insurance Exchanges, Health Insurance Marketplace, Massachusetts Health Connector, Medical | Leave a comment
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While much has been reported in the media about the problematic rollout of the federal government’s ACA website, Healthcare.Gov, Massachusetts officials have now acknowledged that the state’s website is beset by a blizzard of problems as well. The Boston Globe has reported that thousands of Massachusetts residents have been unable to enroll, and the website’s troubles also include poor communication and inconsistent enrollment data.

There are widespread reports of substandard customer service as well when individuals try to call the Massachusetts Health Connector in an effort to find an alternative means of enrolling. The state is exploring litigation against the website’s vendor, CGI, which is the same vendor who designed the federal government’s ACA website. Progress on the Massachusetts website has stalled and the state late last year stopped paying CGI’s $69 million contract because the firm failed to deliver pieces of the website and necessary fixes on time.

The Board for the Massachusetts Healthcare Connector announced yesterday that MITRE, an independent technology firm, will review the state’s failed health insurance website and make recommendations about how to move forward in rebuilding a system that allows people to easily shop for and buy coverage online.

HHS Announces Increase in Healthcare.Gov November Enrollment Figures: Significant Number Going to Medicaid Expansion

December 11, 2013 at 1:02 pm | Posted in Affordable Care Act, Compliance, Essential Health Benefits, Health and Human Services, Health Care, Health Insurance Exchanges, Health Insurance Marketplace, Medical, PPACA | Leave a comment
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This morning HHS reported that nearly 365,000 individuals have selected plans from the state and federal Marketplaces by the end of November. HHS reported, among other things, that:

  • November’s federal enrollment number outpaced the October number by more than four times.
  • Nearly 1.2 million Americans, based only on the first two months of open enrollment, have selected a plan or had a Medicaid or CHIP eligibility determination.
    • Of those, 364,682 Americans selected plans from the state and federal Marketplaces; and
    • 803,077 Americans were determined or assessed eligible for Medicaid or CHIP by the Health Insurance Marketplace.
  • 39.1 million visitors have visited the state and federal sites to date.
  • There were an estimated 5.2 million calls to the state and federal call centers.

What “may” be a troubling sign is that, to date, the majority of enrollees have been directed into Medicaid or CHIP coverage and are not paying premiums for their coverage. HHS is hopeful that the premium-paying, working “young invincibles” (ages 19-35), who are a key actuarial pillar to the Affordable Care Act, will enroll closer to the end of the enrollment period in March 2014.

A copy of the HHS Release and accompanying report is here: http://www.hhs.gov/news/press/2013pres/12/20131211a.html

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