Tag Archive: plan participation fees

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. 

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