Search Results for: no wrong door

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Medicaid enrollment glitch in federally operated state exchanges impairs “no wrong door” policy, initial enrollment for QHP issuers offering Medicaid plans

Today’s New York Times follows on a previous report by The Washington Post on a glitch involving the eligibility and enrollment process in state exchange marketplaces operated by the federal government. According to The Times, the federal website HealthCare.gov that serves as the online enrollment portal in those states is currently unable to electronically transfer applications to state Medicaid offices for individual plan applicants whose incomes qualify them for Medicaid under the guidelines established by their states.

That’s a serious issue for a couple of reasons. The exchanges are intended to operate as a single, integrated marketplace for both subsidized commercial insurance plans (referred to as Qualified Health Plans or QHPs) and Medicaid. The idea is affording people a single source for coverage regardless of household income makes it easier to enroll, thereby reducing the number of medically uninsured individuals. However The Times story notes under the current circumstance, those determined eligible for Medicaid will have to make a separate application though their state Medicaid offices, adding another step that could discourage enrollment.

Second, the glitch is problematic for QHPs that offer both commercial health plans as well as Medicaid managed care plans since it could deter initial enrollment of Medicaid eligibles in these plans. According to an issue brief (.pdf) by the Association for Community Affiliated Plans (ACAP), QHP issuers in 33 states and the District of Columbia have both commercial and Medicaid managed care plans, with 39 percent operating Medicaid plans in the same state. Having both commercial and Medicaid plans in the same state exchange marketplace could help reduce administrative costs and coverage gaps when enrollees’ incomes fluctuate across income guidelines for commercial and Medicaid plans, the ACAP brief notes.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

New Kentucky state benefit enrollment portal to include Medicaid E&E

Kentucky: State Launches New Website for Medicaid and Public Assistance Programs. The Cabinet for Health and Family Services launched Benefind, a new web portal through which residents can enroll in Medicaid, Supplemental Nutrition Assistance Program and the State’s cash assistance program. Program enrollees can also use Benefind to renew benefits, check benefit amounts, report changes, upload verification documents, check claim status, make claim payments and receive electronic notices. The rollout of Benefind comes shortly after Governor Matt Bevin (R) announced plans to dismantle kynect, Kentucky’s State-based Marketplace, and transition to HealthCare.gov by the end of the year.

Source: Manatt on Health Reform: Weekly Highlights – March 2016 | Manatt, Phelps & Phillips, LLP – JDSupra

This latest development in Kentucky comes as the state shifts from a state-based health benefit exchange (kynect) to a federally supported state-based exchange. Benefind allows Kentucky residents to enroll online in Medicaid as well as the state’s supplemental nutrition assistance and cash assistance to families with children programs.

Benefind appears at odds with the Patient Protection and Affordable Care Act’s “no wrong door” policy that requires a single application to determine eligibility for subsidized individual plans sold on all state health benefit exchanges as well as for state subsidy programs such as Medicaid and CHIP. It’s contained at ACA Section 1413, titled Streamlining Of Procedures For Enrollment Through An Exchange And State Medicaid, Chip, And Health Subsidy Programs.

With its own portal for Medicaid eligibility as well as for individual plans offered on the exchange, the Bluegrass State won’t have a single application door but rather two: one offered though the state health benefit exchange and another through its Benefind web portal. The Benefind portal will also refer applicants to the exchange portal if it determines their household income potentially qualifies them for enrollment in an exchange plan, Vickie Yates Brown Glisson, Kentucky’s health and family services secretary, told state lawmakers.

While perhaps not compliant with the ACA’s single, no wrong door policy, Kentucky’s model may address problems in some state exchanges getting Medicaid-eligibles quickly qualified and enrolled in coverage due to difficulty interfacing with state Medicaid computer systems.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Medicaid drove NY State of Health exchange enrollment to double in 2015 – Business – The Buffalo News

Enrollment in New York’s health insurance exchange more than doubled between 2014 and 2015, across the state and in Western New York, driven by soaring enrollment in Medicaid, the state Health Department reported Wednesday.

About 2.1 million New Yorkers were enrolled in coverage through the NY State of Health marketplace at the end of February, a sharp increase from the 961,000 enrolled at the end of the 2014 period, with 80 percent of them enrolled in Medicaid or Child Health Plus, according to the department’s first detailed breakdown of exchange enrollment through the end of the 2015 sign-up period. In the eight counties of Western New York, enrollment more than doubled from 55,844 to 117,330 between last year and this year.

Source: Medicaid drove NY State of Health exchange enrollment to double in 2015 – Business – The Buffalo News

This item comes as state health benefit exchange officials convene with their federal government partners this week in McLean, Virginia to discuss meeting the challenge of keeping the exchanges financially self sustaining. As I discussed in a recent post, states like New York that established their own exchanges and expanded Medicaid eligibility criteria are finding Medicaid enrollment far outpacing that of commercial qualified health plans (QHPs) offered on the exchanges. That’s a big financial sustainability issue for the exchanges since they obtain no ongoing income for Medicaid eligibility and enrollment processing but are required to perform that function under the Affordable Care Act’s “no wrong door” provision mandating a single integrated application process for both QHPs and Medicaid.

Now that the federal Department of Health and Human Services has issued a proposed rulemaking that would subject Medicaid managed care plans to regulatory requirements like those for commercial QHPs, I expect allowing health benefit exchanges to assess fees on Medicaid managed care plans will be one of the financial sustainability ideas discussed at the McLean meeting.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Growing Medicaid enrollment poses potential fiscal threat to state health benefit exchanges

The biggest threat to the future financial sustainability of the state health benefit exchange marketplace may be declining economic prosperity and the resulting polarization of household income strata, particularly in the states that have elected to expand Medicaid eligibility to households earning up to 138 percent of federal poverty and to single adults.

The reason? Low income households that qualify for Medicaid generally cannot purchase qualified health plans (QHPs) offered on state health benefit exchanges. If the growing Medicaid eligible population isn’t able to purchase QHPs, the exchanges don’t derive fees assessed on health plan issuers – their main source of revenue as federal establishment grant funds dwindle — that are based on a percentage of premium or set amount for each “effectuated” enrollee. (In states that have opted not to expand Medicaid eligibility, households earning at least 100 percent of federal poverty are eligible to purchase exchange QHPs.)

A Rand Corporation analysis of 2013-15 health coverage enrollment trends issued in June 2015 reported 6.5 million newly enrolled in Medicaid as of February 2015, outpacing by 58 percent the 4.1 million that enrolled in exchange QHPs. According to federal data, 71.1 million Americans were enrolled in Medicaid and the Children’s Health Insurance Program as of April 2015, 12.3 million more than the average for July to September 2013.

While exchanges realize no revenue from Medicaid enrollments, they do incur expense in handling them. Under the Patient Protection and Affordable Care Act’s “no wrong door” policy, exchanges are required to process eligibility and enrollment for both state insurance programs like Medicaid as well as QHPs. It’s also easier to enroll in Medicaid coverage. Unlike exchange QHPs that limit enrollment to part of the year during open enrollment periods, those eligible for Medicaid can enroll at any time of the year.

In California, an expansion state with the nation’s largest Medicaid program serving 12.2 million or about 1 in 3 Californians, enrollment grew by 41.4 percent between December 2013 and January 2015, according to the state’s Medicaid administrator, the Department of Health Care Services. Before that, a severe economic downturn added about 1 million new eligibles to the Golden State’s Medicaid rolls between 2007 and 2010.

Enrollment in California’s Medicaid program – known as Medi-Cal – far outstrips that of QHPs sold through the state’s health benefit exchange, Covered California. According to the federal Department of Health and Human Services, there were 1.4 million enrolled in Covered California plans as of February 2015 — about the same number for plan year 2014. To put that in perspective, there are roughly 61 Medi-Cal enrollees for every 7 enrolled in a Covered California QHP.

Colorado, a Medicaid expansion state that operates a state-based exchange, has seen burgeoning Medicaid enrollment tax the finances of its exchange. The state enrolled 1.2 million in Medicaid — an increase of 433,172 or 55 percent — between late 2013 and February 2015. For 2015, the state’s exchange, Connect for Health, enrolled 27,465 people in Medicaid or CHIP. That’s nearly twice the 15,566 enrolled in commercial plans, blowing a $7 million hole in its budget for increased call center costs handling complex Medicaid enrollments and prompting the exchange to seek reimbursement from the federal government, according to The Denver Post.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Exclusive: States quietly consider ObamaCare exchange mergers | TheHill

A number of states are quietly considering merging their healthcare exchanges under ObamaCare amid big questions about their cost and viability. Many of the 13 state-run ObamaCare exchanges are worried about how they’ll survive once federal dollars supporting them run dry next year. Others are contemplating creating multi-state exchanges as a contingency plan for a looming Supreme Court ruling expected next month that could prevent people from getting subsidies to buy ObamaCare on the federal exchange. The idea is still only in the infancy stage. It’s unclear whether a California-Oregon or New York-Connecticut health exchange is on the horizon.But a shared marketplace — an option buried in a little-known clause of the Affordable Care Act — has become an increasingly attractive option for states desperate to slash costs. If state exchanges are not financially self-sufficient by 2016, they will be forced to join the federal system, HealthCare.gov.

Source: Exclusive: States quietly consider ObamaCare exchange mergers | TheHill

The Patient Protection and Affordable Care Act provision referenced in this story is at Section 1311(f), which allows state exchanges to combine into “regional or other interstate exchanges,” subject to approval by the participating states and HHS. Another provision, Section 1333(a), would facilitate interstate exchanges by providing a mechanism for health plan issuers to pool risk and sell across state lines via “health care choice compacts” starting in January, 2016. Two or more states could enter into an agreement under which health plans could be offered in state individual markets, subject to regulation by the state in which the plan was written or issued, provided plans comply with the other states’ rules regarding market conduct, unfair trade practices, network adequacy, and consumer protection standards including standards relating to rating and handling of disputed claims.

While complex in and of itself, this might be easier to accomplish if state health benefit exchanges conducted eligibility and enrollment solely for commercial individual plans. A major complicating factor is Section 1413(c)(1) of the Affordable Care Act requiring each state to “develop for all applicable State health subsidy programs a secure, electronic interface allowing an exchange of data …that allows a determination of eligibility for all such programs based on a single application.”

This “no wrong door” policy requires the exchanges to screen households applying for coverage for income and household size eligibility criteria for both commercial Qualified Health Plans or QHPs) as well as state insurance programs such as Medicaid and the Children’s Health Insurance Program (CHIP). States have separate eligibility guidelines for these programs that won’t easily translate across state lines, especially considering a lack of uniformity among states on the Affordable Care Act’s expanded Medicaid eligibility. In addition, state operated exchanges as well as the federal marketplace have had difficulty integrating their IT systems to perform eligibility and enrollment functions fulfilling the Affordable Care Act’s “no wrong door” requirement.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Higher than expected Medicaid enrollment strains IT infrastructure, finances of Colorado health benefit exchange

Medicaid patients enrolling through the state health insurance exchange are taking too much of its resources, exchange board members said Monday, but state officials propose an even tighter partnership with a single technology vendor.

The federal policy of “no wrong door” was meant to be a single online portal for the uninsured that would seamlessly determine their eligibility for either Medicaid or private insurance with tax subsidies they purchased on the exchange.

But system and user errors have created problems for thousands of Colorado customers seeking financial assistance under the Affordable Care Act.

via Colorado health insurance exchange officials clash over Medicaid role – The Denver Post.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Achieving single, integrated marketplace for individual, Medicaid health plans faces initial difficulties

Section 1413(c)(1) of the Patient Protection and Affordable Care Act requires each state to “develop for all applicable State health subsidy programs a secure, electronic interface allowing an exchange of data …that allows a determination of eligibility for all such programs based on a single application.” That means state health benefit exchanges must operate as integrated marketplaces offering both commercial insurance plans (referred to as Qualified Health Plans or QHPs) as well as Medicaid coverage for those whose household incomes meet their state’s Medicaid eligibility guidelines. The policy rationale – known as “no wrong door” and “one touch and you’re done” – is to reduce the ranks of the medically uninsured by simplifying the process of getting health coverage and removing roadblocks to enrollment.

Implementing that Affordable Care Act mandate, however, has been challenging from IT integration standpoint given the variety of legacy state computer systems that manage their Medicaid programs and state rules governing them, including those of the three dozen states using the federal marketplace, healthcare.gov.

That’s also been the case in California, where enrollment elegance has proven elusive. “I think we’ve oversold simplicity,” said Frank J. Mecca, executive director of the County Welfare Directors Association of California. Mecca made that observation today at a California Healthcare Foundation (CHCF) briefing in Sacramento on early consumer experiences with enrollment in the Golden State’s exchange, Covered California.

Mecca described the IT interface between the California Healthcare Eligibility, Enrollment and Retention System (CALHEERS) and the IT system that manages Medicaid eligibility and enrollment, the Statewide Automated Welfare System (SAWS) as a “clogged highway.” Consequently, Mecca noted, a large backlog of potential Medicaid enrollees remain stuck in the system. Mecca credited Covered California and the California Department of Health Care Services (DHCS), the state’s Medicaid administrator, for their efforts to remedy the backlog and improve the interface between the two IT systems. “It’s not an easy thing to fix,” Mecca added. “Things have improved tremendously, but we still have a long way to go.”

Both Mecca and another panelist at the briefing, Sonya Vasquez, policy director of the community-based health advocacy and policy organization, Community Health, said greater emphasis should be placed on marketing both Covered California QHPs as well as Medi-Cal, the state’s Medicaid program, particularly given Medi-Cal does not have set enrollment periods. They also said more effort should be made to make consumers aware in-person assistance is available for those seeking to enroll in coverage, including welfare department staff who can sign up applicants for either Covered California QHPs or Medi-Cal. (California is among those states have expanded Medicaid eligibility to 138 percent of federal poverty guidelines).

Consumers participating in focus groups conducted in early 2014 by PerryUndem Research/Communication were mostly uninsured and had substantial knowledge gaps for both Medi-Cal and QHP coverage and advance tax credit subsidies for the latter for households with incomes between 138 and 400 percent of federal poverty. (Click here for the full report on the findings presented at today’s CHCF briefing.)

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Streamlined enrollment in state health subsidy programs hobbled by federal exchange web portal problems

One of the goals of the Patient Protection and Affordable Care Act (ACA) is to integrate eligibility and enrollment for applicants for both commercial health plans sold in the state health benefit exchange marketplace as well as state subsidy programs for poor and low income households including Medicaid and the Children’s Health Insurance Program (CHIP). The idea is to reduce the ranks of the medically uninsured by making it easier for people to get covered with a single, streamlined application process referred to as “no wrong door.” Applicants are more likely to sign up for coverage if they don’t have to contact multiple entities to get it.

The requirement is set forth in Section 1413 of the ACA. Section 1413(c)(1) requires each state to “develop for all applicable State health subsidy programs a secure, electronic interface allowing an exchange of data (including information contained in the application forms described in subsection (b)) that allows a determination of eligibility for all such programs based on a single application.”

In the three dozen states where the federal government is operating the state exchange marketplace, online eligibility and enrollment is being handled by the federal web portal. Problem is according to today’s Washington Post, the portal isn’t yet able to integrate with the state subsidy programs:

But in a phone call Tuesday with the nation’s state Medicaid directors, Marilyn Tavenner, director of the Centers for Medicare and Medicaid Services (CMS), the agency overseeing the exchange, said that this part was still not working and did not predict when it would be ready, said Matt Salo, executive director of the National Association of Medicaid Directors. In the meantime, the Web site simply tells low-income Americans whether they appear to be eligible and then advises them to contact their state’s Medicaid agencies, where they must start applications from scratch.

The Post story details the implications of this glitch:

The Web site’s Medicaid problems matter because, under the health-care law, about half of the 32 million Americans who stand to gain insurance are expected to be covered through the state-federal health program for the poor and the disabled. The Web site is designed to tell people, depending on their income, whether they are likely to qualify for Medicaid or new federal tax credits to help them pay for private insurance. The site steers consumers in one direction or another after they enter information, including their family size and income. That part works.

Here’s the snag: If the Web site determines that a consumer probably qualifies for Medicaid, it cannot communicate with a state Medicaid program for quick enrollment. Instead, the site gives the person a message to contact the state’s Medicaid program. Then the person has to “start all over again,” said Salo of the Medicaid directors association. He added that the malfunction is “a frustration…It can turn [consumers] off and make them angry about how government works.”

Likely complicating enrollment for those eligible for state subsidy programs is a crazy quilt patchwork of Medicaid eligibility standards, dependent upon whether the state has opted to expand Medicaid eligibility as authorized by the ACA as well as varying income eligibility levels in states that have opted out of the Medicaid expansion as detailed in Table 1 of this recent Kaiser Family Foundation report (.pdf)

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

California could opt to offer Medicaid “bridge plans” on exchange rather than expand Medicaid eligibility

Despite the assumption that California would opt to expand Medicaid eligibility to households with incomes between 100 and 133 percent of federal poverty guidelines as permitted under the Patient Protection and Affordable Care Act, the policy question remains open in the Golden State.  A number of sticking points remain as detailed in this story in today’s Los Angeles Times. Chief among them is Gov. Jerry Brown’s expectation that since counties would benefit from the expansion through a reduced burden of caring for indigents not currently eligible for Medi-Cal as it’s called in California, they should help Sacramento shoulder the state’s future federal Medicaid cost share.

According to The Times, the Brown administration is also concerned that allowing people to enroll in Medi-Cal online could encourage fraud.  California is rushing to ready an online enrollment system, the California Eligibility, Enrollment and Retention System (CALHEERS), to implement the Affordable Care Act’s mandate that individuals and families be offered enrollment for both government insurance programs like Medi-Cal and private coverage offered through its health benefit exchange thorough a single, streamlined application process.  The unresolved policy question of whether to expand Medi-Cal eligibility poses significant potential to complicate an already complex process to prepare the online system and to provide enrollees what state officials expect to be a customer-friendly “no wrong door” experience.  Problems integrating the state’s legacy Medi-Cal eligibility computer software with CALHEERs have already delayed plans to have it functional by the October 1 pre-enrollment date for 2014 coverage until January 1, 2014.

While the Brown administration’s concerns over expanding eligibility for Medi-Cal have stalled legislation that would do so, the administration is sponsoring pending legislation, SBX1-3, that would authorize commercial Medicaid managed care “bridge plans” per federal guidance issued in December, 2012 for those earning up to 200 percent of federal poverty.  The plans would be available through the state’s exchange marketplace, Covered California.

Since the Affordable Care Act deems households with incomes of at least 100 percent of federal poverty eligible to buy coverage through the exchange marketplace, the bridge plan option provides policymakers an alternative to expanding Medi-Cal eligibility to 133 percent of federal poverty.  Some states that have declined to expand Medicaid eligibility including Tennessee, Arkansas and Oklahoma are negotiating with the federal Center for Medicare and Medicaid Services to obtain waivers to allow their Medicaid eligibles to purchase commercial coverage on their exchanges. Absent a near term political agreement to expand Medi-Cal eligibility, California could soon be among them.

If the trend continues, it could lead to a bifurcated Medicaid system: basic, legacy Medicaid for those households with incomes below 100 percent of federal poverty guidelines and a “super Medicaid” system of federally subsidized coverage for households with incomes above the poverty line that wouldn’t otherwise qualify for Medicaid.  It would also have fiscal implications for the states electing to “expand” Medicaid eligibility via Medicaid bridge plans sold on their health benefit exchange marketplaces since it would reduce their future federal Medicaid cost share burden, shifting subsidization fully to the federal government in the form of advance income tax credits.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

New transitional policy to mitigate IT delay affecting Medicaid, CHIP enrollment in federal exchange marketplace

The Obama administration this week announced a new transitional policy for the three dozen states where the federal government is operating state health benefit exchange markets to mitigate an IT glitch affecting enrollees eligible for state assistance programs. The U.S. Department of Health and Human Services issued guidance (.pdf) on the transitional policy November 29. It allows these states to submit abbreviated enrollee data files in order to allow eligibles to enroll for 2014 coverage.

This new, transitional opportunity for states to enroll individuals assessed or determined eligible by the FFM, using the information provided through the AT flat files, will ensure that enrollment can be completed in a timely way without regard to temporary file transfer system issues at either the federal or state level. It will also help states pace their workloads with respect to enrollment of residents who have applied through the FFM.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

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