September 22 – September 28, 2015

17.6 Million Americans Gained Health Coverage Since the Affordable Care Act Went Into Effect: On September 22, the Department of Health and Human Services (HHS) published a report reaffirming gains in health coverage under the Affordable Care Act (ACA). More than 15 million adults gained coverage from October 2013, when the health insurance marketplaces launched and Medicaid expansion began, through September 2015. In addition, 2.3 million 19-to-25-year-olds gained coverage from 2010 through October 2013, as the ACA began allowing young adults to stay on parents’ plans until age 26.

13.2 Million More Americans Enrolled in Medicaid and CHIP Since October 2013: On September 28, HHS released its July 2015 enrollment report for Medicaid and the Children’s Health Insurance Program (CHIP). The report found that from the start of the first Affordable Care Act open enrollment period (OE1) in October 2013 through July 2015, an additional 13.2 million Americans enrolled in Medicaid and CHIP. This is a 23 percent increase compared to average enrollment for the three months prior to OE1 and brings total enrollment in Medicaid/CHIP to 72 million Americans.

HHS Notifies Consumers Enrolled Concurrently in Marketplace and Medicaid/CHIP: On September 28, HHS sent notices to consumers who may be concurrently enrolled in both marketplace coverage with financial help (either tax credits or cost-sharing reductions) and Medicaid/CHIP. The notices alerted these consumers to cancel their marketplace financial help either online or via the call center if they are concurrently enrolled. These individuals will likely have to pay back tax credits for the months they are enrolled in both marketplace coverage with financial help and Medicaid/CHIP. HHS periodically matches enrollment data from the marketplace and state Medicaid/CHIP agencies to identify and notify consumers who are concurrently enrolled.

Previewing the Upcoming Open Enrollment Period: HHS Says 10 Million Uninsured Americans Qualify for Marketplace Coverage: In a speech on September 22, Secretary Sylvia Burwell outlined HHS’ plans for the upcoming open enrollment period (OE3), based on the geographic and demographic distribution of the 10.5 million uninsured Americans who are eligible for marketplace coverage. HHS’s top priority areas are Dallas, Houston, northern New Jersey, Chicago, and Miami, which are where the highest numbers of eligible uninsured Americans live. Of the eligible uninsured population, half are young adults (18-34 years old), 40 percent have incomes between 139 and 250 percent of the federal poverty level, and one-third are people of color.

State Updates:

  • Hawaii: As part of the state’s transition to using the federal enrollment platform, the state has awarded a contract for a firm to connect its Medicaid eligibility system to
  • New Mexico: On September 23, the state’s partnership marketplace issued a Request for Proposals to fund organizations to conduct outreach and education on health coverage. Proposals are due October 7, with an estimated award date of October 14.
  • New York:
    • As part of a series of reports on the performance of state-based marketplaces (SBMs), the HHS Office of the Inspector General issued an audit of New York State of Health (NYSOH) on September 23. The audit found flaws in some of the marketplace’s system for verifying enrollees’ eligibility and made recommendations to resolve the issues.
    • The New York issuer Health Republic, created under the ACA’s CO-OP program, was ordered to wind down its individual market business by state and federal regulators due to concerns over its financial stability. Current individual market plans will end at the end of December, and the issuer is not permitted to sell new plans. The issuer currently has over 100,000 enrollees in the individual market who will be given the opportunity to choose a new plan for the 2016 plan year during OE3.
  • Oregon: The state is switching its Medicaid eligibility system to a new system purchased from Kentucky. The new system will transfer applicants between Medicaid and the marketplace more smoothly and give enrollees the option of choosing a Coordinated Care Organization. The transition is expected to be finished on December 15.
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