Pre-existing Condition Insurance Plan (PCIP) Ending: The PCIP program, which has covered individuals with pre-existing conditions since 2010, will end on April 30. The program was originally set to sunset on December 31, 2013, but was extended to ensure continuous coverage for high-risk individuals during the rollout of the health insurance marketplaces. Consumers currently enrolled in PCIP will receive a 60-day Special Enrollment Period (SEP) to find coverage through the marketplaces and can get coverage retroactive to May 1.
Extended Enrollment Deadline for Certain Individuals Ending April 30: All individuals in Oregon, consumers who had difficulty enrolling in Washington, D.C., and those who submitted paper applications to the federally facilitated marketplaces (FFMs) during open enrollment must finish the enrollment process by April 30. Consumers may be able to enroll outside of open enrollment if they are eligible for Medicaid, the Children’s Health Insurance Program, or an SEP.
Oregon’s Marketplace Will Transition to HealthCare.gov: On April 25, Cover Oregon’s board voted to forgo its current website, which was not fully operational during the initial open enrollment period, and switch to HealthCare.gov for the next open enrollment period. State and federal officials are still determining details of the transition. Federal officials are also looking at Maryland and Massachusetts, two other state-based marketplaces that have struggled with their technology as well. Several weeks ago, Maryland’s marketplace decided to purchase technology from Connecticut and use it to revamp their website. Massachusetts is still assessing its path forward.
New Tools for the Small Business Health Options Program (SHOP) Marketplace: The Centers for Medicare and Medicaid Services (CMS) released a small business tax credit estimator and a full-time equivalent employee calculator to aid small businesses in assessing their options to provide employee health coverage.
Update on Account Transfers between Medicaid Agencies and FFMs: CMS reports that the majority of state Medicaid agencies can handle inbound and outbound consumer account transfers with the FFMs. These transfers between Medicaid and marketplace entities ensure a no-wrong-door application experience for consumers, who may not know which coverage option they are eligible for before applying. At this stage, most transfers are made weekly (not in real time). Five states that are not accepting account transfers from HealthCare.gov are scheduled to begin this week. Six states that are not transferring accounts to the FFMs, and those states with backlogged transfers, are working with CMS to improve their processes.