Jackson Hewitt explores issue of “unbanked” Americans gaining ACA insurance coverage

Posted on May 24, 2013 | No Public Comments

A new study released by Jackson Hewitt Tax Service Inc. describes an issue that may arise when uninsured individuals without bank accounts enroll into the Affordable Care Act’s (ACA) health insurance Exchanges. Uninsured + Unbanked = Unenrolled= How Health Insurance Companies May Exclude 1 in 4 Eligible Americans from ACA Coverage- and What the Federal Government Can Do to Stop It finds that one quarter of Americans eligible for federal premium subsidies under the ACA, meaning their annual income falls between 100-400% of the federal poverty level, do not have a checking account. This presents an issue in regards to the types of premium payments insurers are willing to accept, as many insurers will not take debit or credit card as a payment form. The US Department of Health and Human Services (HHS) claimed they ameliorated this concern in their guidance letter issued last month by stating that insurance companies must “accept payment in ways that are non-discriminatory.”

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CA releases proposed premium rates for 2014

Posted on May 23, 2013 | No Public Comments

This morning, California published proposed premium rates from 13 issuers to be offered on the state’s health insurance Exchange, Covered California. California chose to negotiate rates with insurers through active purchasing, meaning that Covered California worked directly with the insurance companies on determining the plans that would be offered on the Exchange. Initially, 33 issuers had applied to offer plans through Covered California, but that number significantly dwindled in response to proposed premiums that were set too high and issuers that were not able to be the “active partners” Covered California required.

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NEJM article correlates decline in health spending to recession

Posted on May 23, 2013 | No Public Comments

According to an article published in the New England Journal of Medicine (NEJM), the observed trend in declining health care spending may not be permanent. The Gross Domestic Product and Health Care Spending examines data that compares changes in GDP to health spending from 1950 to 2011. During this time, GDP growth averaged 2% per year, while health care spending growth averaged 4.4% annually. The introduction of managed care in the mid-1990′s, however, stiffeled growth in health care spending while the GDP continued to rise. The article claims that managed care is a likely explanation for the decline in health care spending, but it is far too soon to rule out the recent economic downturn as a major contributor.

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EBRI study explores trends in part-time health coverage

Posted on May 22, 2013 | No Public Comments

A study released by the Employee Benefit Research Institute (EBRI) found the prevalence of health care insurance amongst part-time employees has been on the decline. Between 2007 and 2011, the likelihood of a full-time employee having employer-sponsored health care coverage decreased by 2.8%, while the coverage likelihood for part-time employees decreased by 15.7%. Similarly, the overall percentage of individuals employed part-time has increased by 5.5% during that same time period. In the wake of the Affordable Care Act (ACA), many fear that employers will choose to deny health care coverage to part-time employees, or increase the number of part-time employees to avoid incurring penalties under the ACA.

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CO releases 2014 Exchange rates

Posted on May 22, 2013 | No Public Comments

Colorado became the sixth state to post their proposed premium rates for plans entering the state’s 2014 state-based insurance Exchange. In total, 831 health insurance plans, including both individual and small-group options, have been proposed by 17 issuers. Reviews of the proposed plans are currently being conducted by the Colorado Division of Insurance and are scheduled to be completed by July 31st.

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Implementation Brief CMS State Resources FAQ: Medicaid Eligibility Determinations, Medicaid/Exchange Interactions, and §1115 Demonstrations that Use Enrollment Caps

Posted on May 22, 2013 | No Public Comments

The interaction between Medicaid and Exchanges around eligibility determination issues represents one of the most important and complex aspects of the ACA. An estimated 28 million adults, along with 19 million children, can be expected to transition at least once annually between insurance affordability programs, as Medicaid and premium subsidies are termed under implementing CMS regulations. Collaboration between Medicaid agencies and Exchanges is essential in order to avert unnecessary delays in eligibility determinations and breaks in coverage that in turn can affect not only the affordability of care but access itself, given the link between coverage and health care access through plans’ provider networks…

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CMS letter addresses enrollment strategies for Medicaid and CHIP

Posted on May 20, 2013 | No Public Comments

The Centers for Medicare and Medicaid Services (CMS) released a letter to state health officials and Medicaid Directors regarding enrollment of uninsured individuals into Medicaid and CHIP. With the looming enactment of the Affordable Care Act’s (ACA) provision on Medicaid expansion, CMS intends to assist states by providing optional tools that will aid in their transition to the new eligibility and enrollment models. The letter specifically addresses and provides guidance on these five enrollment strategies:

• Implementing the early adoption of Modified Adjusted Gross Income (MAGI)-based rules;
• Extending the Medicaid renewal period so renewals that would otherwise occur during the first quarter of calendar year 2014 will occur later;
• Enrolling individuals into Medicaid based upon Supplemental Nutrition Assistance Program (SNAP) eligibility;
• Enrolling parents into Medicaid based upon children’s income eligibility; and
• Adopting 12-month continued eligibility for parents and other adults.

CMS purports that states choosing to utilize one of these outlined approaches will be met with a streamlined review and approval process.

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WA releases Exchange premiums

Posted on May 20, 2013 | No Public Comments

The Washington State Office of the Insurance Commissioner (OIC) recently released proposed premium rates for their state-based health insurance Exchange, Washington Health Plan Finder. Fears of rate increases were assuaged, as the plans presented ultimately indicated more coverage at a reduced cost, attributable to Washington’s already competitive insurance market. The proposed rates must be evaluated by OIC prior to being issued on the Exchange.

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CMS rule requires MA and Medicare Part D to comply with MLR

Posted on May 20, 2013 | No Public Comments

The Centers for Medicare and Medicaid Services (CMS) released a final rule that requires Medicare Advantage (MA) and Medicare Part D issuers to comply with the medical loss ratio (MLR), which states that these issuers must spend 85% of their premium revenues on patient services. The MLR permits only 15% of this revenue to be spent on organization administrative and overhead costs. MA and Part D issuers are required to submit data to CMS that allows consumers to use the sponsor’s MLR as a measure of efficiency. If the plan sponsors do not meet the MLR requirements, they will be subject to financial penalties, enrollment sanctions, and potential contract termination if issuers repeatedly miss the minimum MLR requirement.

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CMS sets PCIP payment at Medicare rates

Posted on May 20, 2013 | No Public Comments

In an Interim Final Rule released Friday, the Centers for Medicare and Medicaid Services (CMS) stated that as of June 15th, payment rates for the federal Pre-Existing Condition Insurance Plan (PCIP) will be set to those of Medicare. Until the passage of the Affordable Care Act (ACA), many Americans with pre-existing conditions were denied insurance coverage or charged exorbitantly high premiums. PCIP, which was created under the ACA, was allocated $5 billion to enable those with pre-existing conditions to obtain insurance prior to 2014. 135,000 otherwise uninsured individuals with pre-existing conditions were granted coverage under PCIP, with claims averaging $32,108 per enrollee. Changes in PCIP payments were authorized in order to ensure program solvency until 2014. One specific example is the provision in which payments to skilled nursing facilities may be reduced by 50% as of June 15, 2013.

Enrollment in federal PCIP programs was capped in February due to funding concerns. Enrollment in the 27 state-operated PCIP programs was suspended several weeks later. As of now, 17 of the state-operated PCIP programs will be administered by the US Department of Health and Human Services (HHS) for the duration of the year.

Enrollment in federal PCIP programs was capped in February due to funding concerns. Enrollment in the 27 state-operated PCIP programs was suspended several weeks later. As of now, 17 of the state-operated PCIP programs will be administered by the US Department of Health and Human Services (HHS) for the duration of the year.

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