CMS is committed to protecting consumers in the Marketplace. CMS has received reports of consumers in HealthCare.gov states whose coverage was switched by agents and brokers without their knowledge. In response, CMS is taking swift actions to protect consumers from unauthorized activity by agents and brokers, and to root out bad actors who are violating CMS rules.
At least 20,104,000 Medicaid enrollees have been disenrolled as of April 11, 2024, based on the most current data from all 50 states and the District of Columbia. Overall, 31% of people with a completed renewal were disenrolled in reporting states while 69%, or 43.6 million enrollees, had their coverage renewed (one reporting state does not include data on renewed enrollees). Due to varying lags for when states report data, the data reported here undercount the actual number of disenrollments to date.
I'm obviously a major proponent of making the enhanced ACA premium subsidies originally included in the American Rescue Plan (and later extended by another three years by the Inflation Reduction Act) permanent...or at the very least bumped out by another few years.
Even so, healthcare reform advocacy organizations like Families USA are making the strongest case they can for getting Congress to extend the subsidies for at least one year as soon as possible for practical reasons. Via Amy Lotven of Inside Health Policy:
It was just a week ago that Nevada Health Connect announced they'll be integrating a form of artificial intelligence software into their enrollee engagement system.
Covered California Collaborates with Google Public Sector to Accelerate and Simplify Health Insurance Enrollment Using AI
Google Cloud AI integration will enable Covered California to verify more than 50,000 health care documents with an 84 percent verification rate monthly, providing residents with affordable, high-quality health care options at unprecedented speed.
SACRAMENTO, Calif. – Covered California, California’s health insurance marketplace, announced today that it is leveraging Google Cloud’s AI solutions to help streamline the organization’s efforts to provide California residents with affordable, quality health insurance.
Today, Governor Cooper announced that more than 400,000 North Carolinians now have access to health care through the state’s Medicaid expansion following record enrollment numbers and a coordinated campaign to enroll North Carolinians across the state.
“So many younger, working people desperately need affordable health insurance and Medicaid Expansion fills the bill for thousands of them and with people all the way through age 64,” said Governor Roy Cooper. “This milestone and the speed at which we’ve reached it shows just how lifechanging Medicaid expansion is for our state and we will continue to get more eligible North Carolinians enrolled.”
DENVER – Last Thursday, Connect for Health Colorado’s Board of Directors took a support position on House Bill 24-1258 Credit Covered Person Expenses Insurer Insolvency. This bill will require a covered individual’s new health insurance company to credit out-of-pocket expenses paid if their current health insurance company leaves the market mid-plan year and can no longer provide coverage. This bill also provides methods for health insurance companies to recoup any expenses and increase in claims liability because of crediting out-of-pocket expenses. Connect for Health Colorado has released the following statement:
Effective January 1, 2025, Waiting Periods Will No Longer Be Permitted for the Majority of Adult Dental Services Offered Through the Marketplace
New York State Continues to Explore Improvements to Adult Dental Benefits for 2026 and Beyond
ALBANY, N.Y. (April 4, 2024) – The New York State Department of Health, NY State of Health, and the Department of Financial Services announced today that, effective January 1, 2025, there will no longer be waiting periods for the majority of adult dental services for Individual Stand-Alone Dental Plans available to purchase on the Marketplace. This change is the first of a multi-phased initiative to improve dental products and to improve the dental plan shopping experience for consumers.
The Affordable Care Act includes a long list of codified instructions about what's required under the law. However, like any major piece of legislation, many of the specific details are left up to the agency responsible for implementing the law.
While the PPACA is itself a lengthy document, it would have to be several times longer yet in order to cover every conceivable detail involved in operating the ACA exchanges, Medicaid expansion and so forth. The major provisions of the ACA fall under the Department of Health & Human Services (HHS), and within that, the Centers for Medicare & Medicaid (CMS)
Every year, CMS issues a long, wonky document called the Notice of Benefit & Payment Parameters (NBPP) for the Affordable Care Act. This is basically a list of proposed tweaks to some of the specifics of how the ACA is actually implemented for the following year.
The Affordable Care Act includes a long list of codified instructions about what's required under the law. However, like any major piece of legislation, many of the specific details are left up to the agency responsible for implementing the law.
While the PPACA is itself a lengthy document, it would have to be several times longer yet in order to cover every conceivable detail involved in operating the ACA exchanges, Medicaid expansion and so forth. The major provisions of the ACA fall under the Department of Health & Human Services (HHS), and within that, the Centers for Medicare & Medicaid (CMS)
Every year, CMS issues a long, wonky document called the Notice of Benefit & Payment Parameters (NBPP) for the Affordable Care Act. This is basically a list of proposed tweaks to some of the specifics of how the ACA is actually implemented for the following year (actually, it's the year after the following year, since the final rule is generally released in mid-December).
The enhanced federal subsidies provided by the Inflation Reduction Act (set to expire at the end of 2025);
Some states (but not most yet, unfortunately) fully embracing robust Premium Alignment w/maximized Silver Loading policies; and
About half the states which operate their own full ACA exchange offering supplemental financial subsidies to either reduce premiums, reduce cost sharing or both.
The last bullet includes California, Colorado, Connecticut, Maryland, Massachusetts, New Jersey, New Mexico, Vermont and Washington State. In addition, both Minnesota and New York have large numbers of enrollees in their respective Basic Health Plan programs (New York just expanded theirs), which may or may not be considered "state-based subsidies" depending on your perspective.
Earlier today I noted that New York has officially implemented their expansion of the Essential Plan, their branding of the ACA-funded Basic Health Plan (BHP) program that currently covers 1.2 million New Yorkers, from residents earning under 200% of the Federal Poverty Level up to those earning as much as 250% FPL.
In doing so, around 100,000 additional people are now enrolled in the BHP program, with roughly 62,000 of them now saving an average $4,700/year versus the ACA exchange plans they were previously enrolled in, plus another ~32,000 who I presume are completely new to either program.
It's been a long time since I've reported on any significant cybersecurity problems at any of the ACA exchanges. The last one I can think of off the top of my head was nearly a decade ago, and even that was about how some early flaws had been fixed.
Unauthorized enrollment or plan-switching is emerging as a serious challenge for the ACA, also known as Obamacare. Brokers say the ease with which rogue agents can get into policyholder accounts in the 32 states served by the federal marketplace plays a major role in the problem, according to an investigation by KFF Health News.
New York's implementation of the ACA's Basic Health Plan provision (Section 1331 of the law) is called the Essential Plan. It currently serves 1.2 million New Yorkers, or over 4x as many residents as ACA exchange plans do.
Under the ACA, most states have expanded Medicaid to people with income up to 138 percent of the poverty level. But people with incomes very close to the Medicaid eligibility cutoff frequently experience changes in income that result in switching from Medicaid to ACA’s qualified health plans (QHPs) and back. This “churning” creates fluctuating healthcare costs and premiums, and increased administrative work for the insureds, the QHP carriers and Medicaid programs.
The Michigan Legislature is considering joining the 18 other states that have established state-run health insurance marketplaces through HB 6112. Having an exchange run by the state instead of the federal government, supporters of the bill say, will save Michiganders money by leaving the “rigid and inflexible” federal market for a Michigan-tailored market that can be more responsive and potentially lower premiums. The bill is still in the early days of the legislative process, awaiting a vote from the House Health Policy Committee.
...It's particularly noteworthy that not only is a Republican legislator the primary sponsor of the bill (Mark Tisdel), but so are 4 of the other 7 cosponsors (John Roth, Bradley Slagh, Jim Lilly and Gary Howell)...along with three Democratic state Representatives (Jim Ellison, Sara Cambensy and Kevin Hertel).
The Biden-Harris Administration today unveiled a final rule that will protect and improve how millions of eligible people apply for, renew, and maintain health care coverage through Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program (BHP). The Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes rule will remove red tape and barriers to enrollment, update and build on the Affordable Care Act’s (ACA’s) coverage protections and ensure that millions of Americans can get and keep their coverage. With this rule, millions of Americans will benefit from a modernized, less cumbersome enrollment process with reduced red tape, helping more people keep coverage.
HHS Extends Special Enrollment Period to Help People Transition to the Marketplaces, Issues New Resources for Partners, and Publishes Guidance Reinforcing Key Federal Requirements
Nevada Health Link Spearheads AI Implementation, Championing Cutting-Edge Technology for Unparalleled Consumer Engagement
The first State Based Marketplace to receive Centers for Medicare & Medicaid Services approval for implementing AI technology
MOUNTAIN VIEW, Calif. – In a groundbreaking move towards enhancing consumer experiences and setting new standards in health insurance exchange technology, Nevada Health Link proudly announces the successful integration of Artificial Intelligence (AI) into its State-Based Marketplace (SBM) platform. This first-of-its-kind initiative underscores Nevada Health Links's unwavering commitment to innovation, transparency, and consumer-centric strategies.
The implementation of a purpose-built interactive virtual agent (IVA) by the team at GetInsured marks a significant milestone in Nevada Health Links's journey. Nevada Health Link is the first marketplace to have Centers for Medicare & Medicaid Service’s (CMS) approval for the use of AI-based Interactive Virtual Agents to enhance the customer service experience. The state worked collaboratively with the CMS and GetInsured security teams for several months to ensure that all federal privacy and security requirements were met. This approval signifies a high level of confidence in the technology that the marketplace has implemented.
