July 28 – August 10, 2015

New Gallup Poll Shows State-by-State Decline in the Uninsured Rate: From 2013 to the first half of 2015, the uninsured rate has fallen across the country, according to a new state-by-state survey from Gallup. The uninsured rate has fallen by double digits in five states, and 25 states now have uninsured rates under 10 percent.

Medicaid and Children’s Health Insurance Program (CHIP) Enrollment Continues to Climb: Three new reports from the Centers for Medicare and Medicaid Services (CMS) show that more Americans have gained health coverage through Medicaid and CHIP since the fall of 2013. CMS’ monthly Medicaid and CHIP enrollment report found that 12.8 million more Americans were covered by Medicaid/CHIP as of May 2015, with a 29 percent increase in enrollment for states that have expanded Medicaid and a 10 percent increase for non-expansion states.  In addition, HHS released two new editions of a quarterly report with state-by-state counts of enrollees in Medicaid expansion programs for October 2014 through March 2015.

Having More Choices in the Health Insurance Marketplace Has Led to Reduced Premiums, According to New Report: On July 30, the Department of Health and Human Services (HHS) released a report detailing changes in the number of issuers and level of premiums in the federally facilitated marketplace (FFM) from 2014 to 2015. HHS found that the number of issuers offering plans increased in most counties, and that competition played a significant role in limiting increases in premiums. In 2015, 86 percent of eligible individuals in the FFM had at least three issuers to choose from, an increase from 70 percent in 2014.

Kaiser Family Foundation Surveys Assister Programs: More than 5.9 million people received in-person application assistance during the second open enrollment period, according to a new Kaiser Family Foundation survey of assisters. Over 4,600 assister programs employed around 30,400 staff and volunteers around the country, with Certified Application Counselors (CACs) making up 61 percent of the total number programs. Eighty-two percent of assister programs said that most or nearly al consumers needed help understanding their plan choices. The survey included Navigators, In-Person Assisters, CACs, and, unlike last year’s survey, agents and brokers.

New Guidance for How State-Based Marketplaces Can Make Eligibility Determinations for Exemptions: On July 28, CMS released guidance that allows state-based marketplaces (SBM) to continue to delegate eligibility determinations for exemptions from the fine for not having health coverage to HHS, and plans to propose regulations to make this option available on a permanent basis.

Updates on Special Enrollment Periods (SEPs) in the Federally Facilitated Marketplace:

  • Losing Medicaid/CHIP Coverage: Because of a recent systems issue in the FFM, individuals who lost Medicaid/CHIP, and who are now eligible for marketplace coverage, were incorrectly denied a SEP. The FFM is fixing the underlying issue that prevented consumers from accessing SEPs and is making automated calls to reach these individuals so they can enroll.
  • Incorrect Eligibility Determinations: People who previously received incorrect eligibility determinations because the FFM incorrectly counted their dependents’ Social Security benefits as income can now access an SEP.

SBM Updates:

  • California:
    • A new survey from the Kaiser Family Foundation found that 68 percent of Californians who were uninsured in the summer of 2013 now have health coverage.
    • Ninety-two percent of California’s marketplace and 82 percent of Medicaid/CHIP enrollees who were eligible to renew coverage for OE2 did so, according to a report from Covered California and the state’s Department of Health Care Services.
  • New York:
    • On July 31, the state Department of Financial Services announced approved 2016 premium rates for New York State of Health, the state’s marketplace. On average, premiums for marketplace coverage will increase by 7.1 percent.  In addition, starting in 2016, consumers will be able to enroll in a Basic Health Program option called the Essential Plan. Under the Essential Plan, New Yorkers with incomes at or below 150 percent of the Federal Poverty Level (FPL) will not have to pay any premiums, and premiums will be capped at $20 for consumers at or below 200 percent FPL.
    • As of February, 89 percent of marketplace enrollees had been previously uninsured, and 86 percent of marketplace enrollees from OE1 had renewed for 0E2.
  • Washington State: Effective August 31, the CEO of the Washington Health Benefit Exchange will step down, and the marketplace’s chief of staff will become interim CEO.
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