Tag Archive: FFE

SCOTUS should issue ruling in King v. Burwell ASAP

The U.S. Supreme Court should issue its ruling in King v. Burwell regarding the availability of advance premium tax credits in the nearly three dozen states where the federal government operates state health benefit exchanges as soon as possible. Waiting to issue its decision at or near the expiration of its current term at the end of June will produce months of needless uncertainty adversely impacting the policy planning of the states with federally facilitated exchanges (FFEs), particularly given that many of their legislatures are in session now and considering contingencies including establishing state-based exchanges should the subsidies be ruled illegal in those states.

If the subsidies are found to be contrary to the Patient Protection and Affordable Care Act — even though there’s at least an even chance they will not — states will need sufficient time to authorize and set up their own exchanges and select exchange qualified health plans prior to the start of plan year 2015 open enrollment on November 1. Health plan issuers also need to know if the subsidies will be available in order to make decisions as to what if any plans they will offer in the affected FFE states. Finally, with Congress trapped in partisan gridlock, there is little likelihood of a quick fix from the legislative branch of the federal government if the subsidies are cut off in the FFEs. It’s up the the judiciary to end the uncertainty. A rapid ruling would also be consistent with the high court’s expedited decision to hear the case before a full split could develop among the U.S. circuit courts of appeal.

 


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. 

Utah: Medicaid expansion would save large employer penalties, use SHOP exchange for individual plans

Approval of its proposed Healthy Utah Medicaid expansion program would allow large employers of low wage workers avoid penalties when those workers enroll in subsidized individual health plans though the state’s health benefit exchange, according to a document describing the program. The proposed 3-year pilot program is pending approval of a Section 1115 waiver of Medicaid rules from the U.S Department of Health and Human Services.

Utah is served by a federally facilitated exchange (FFE) in the individual market and operates a state-based exchange (SBE) serving small employers of 1 to 50 employees under the Small Business Health Options Program (SHOP) of the federal Patient Protection and Affordable Care Act. A notable component of Utah’s proposed Medicaid expansion program is those in the expansion population would receive federal Medicaid share funding to purchase commercial plans sold via the state’s small business exchange, Avenue H, and not the FFE, healthcare.gov. Those earning more than 100 percent of federal poverty levels (FPL) are eligible to purchase coverage in the FFE.

“Beginning in 2016, large businesses in Utah will likely face $11 to $17 million less in tax penalties each year if their employees making between 101 percent and 133 percent FPL are enrolled in a state-sponsored program rather than a Health Insurance Marketplace plan with a tax credit,” the document states. Employers of 50 or more full-time employees must offer health insurance to 95 percent of their workforces starting in 2016.

In addition, children who currently receive Medicaid would have the option to enroll in the same commercial plan their parents select through Avenue H. “Medicaid would continue to provide cost sharing and wrap-around coverage for these children to ensure they continue to receive the same level of coverage they do today,” the Healthy Utah plan states. “It is hoped that having a single primary health plan for the family will simplify coverage for the family. The federal government has previously denied Utah’s requests to use Medicaid funding to purchase these private plans. However, through the Healthy Utah negotiations, Utah was able to obtain approval for this type of assistance.”

 


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 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. 

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