August 26, 2014 – September 8, 2014

Pennsylvania Expands Medicaid Program: On August 28, the Centers for Medicare and Medicaid Services (CMS) and Governor Tom Corbett announced an agreement to expand Medicaid to cover all Pennsylvanians with incomes up to 138 percent of the federal poverty level (FPL). Pennsylvania’s expansion, called Healthy PA, calls for the new Medicaid population to be covered through managed care plans coordinated by the Department of Public Welfare, and starting in 2016, consumers above 100 percent FPL may have to pay up to 2 percent of their income in premiums. Pennsylvania residents can apply through the state starting December 1, 2014, and coverage will begin January 1, 2015.

Department of Health and Human Services (HHS) Awards $60 Million in Navigator Grants to 90 Organizations: On September 8, HHS announced $60 million in grant awards to 90 organizations that will serve as Navigators in federally facilitated marketplaces (FFM) and partnership marketplaces for the second open enrollment period (OE2). Sixty-one of the 90 awards went to organizations that served as Navigators during the initial open enrollment period. The full list of federal grant recipients is available online.

CMS Releases Updated Training Materials for In-Person Assisters: On September 4, CMS released an updated and enhanced training curriculum for Navigators and Certified Application Counselors in FFMs and partnership marketplaces for OE2. Like last year, the training is conducted through the Health Insurance Learning Management System. All assisters should contact the organization they are affiliated with to determine when to take the training.

Final Guidance Issued on Renewing Marketplace Coverage and Financial Help for 2015: On September 2, HHS issued a final rule on how to conduct eligibility determinations and renew consumers in marketplace coverage for 2015, as well as final notices and instructions for insurers. The final rule establishes the automatic renewal of coverage and financial assistance for most enrollees in the FFM, as described in earlier guidance released on June 26. To ensure these consumers receive the correct amount of financial help for 2015 and are enrolled in a plan that meets their needs and budget, they should check to see if they qualify for financial help, shop for a plan, and then pick or keep the plan that is right for them during open enrollment. State-based marketplaces have flexibility to follow the FFM’s model or propose an alternative plan.

CEO Hired to Manage Kevin Counihan, who ran Connecticut’s marketplace since 2012, will be the first-ever CEO for the FFM. HHS announced the hire on August 26, having created the CEO position in June as part of a change in leadership structure to strengthen management and accountability for OE2.

HHS Schedules Weekend Maintenance for To help prepare the online enrollment system for OE2, HHS will take portions of offlinefor certain blocks of time over the next few weekends. During these maintenance periods, consumers will not be able to create accounts, log in, apply for coverage, update their personal information, or upload documents. Consumers will still be able to use the website to find information about their new health insurance options.

New Special Enrollment Periods (SEPs) Created for Consumers in FFMs and Several States

    • Enrollees who tried to submit documents before September 5 can obtain retroactive coverage that will begin when their old plan ended.
    • Enrollees who did not submit documents by September 5 are eligible for an SEP due to loss of coverage and have up to 60 days after their marketplace plan ends to submit documentation and pick a plan, which will begin the first day of the next month. Enrollees can apply for this SEP before September 30 to avoid a gap in coverage.
    • Enrollees who are found to be ineligible for marketplace plans will be disenrolled but may be eligible for an SEP (due to loss of coverage) to purchase a plan off the marketplace.
  • Some FFM enrollees living outside their plan service area: Enrollees who live outside the service area of the plan they selected through the marketplace, and who were offered the plan due to marketplace or insurer error, may be eligible for an SEP. To receive this SEP, consumers should reach out to the FFM call center (1-800-318-2596).
  • Oregon: Starting August 31, consumers who were incorrectly enrolled in either the state’s Medicaid program or private coverage are able to switch to the correct plan, but must call the marketplace (1-855-268-3767) by October 30, 2014.
  • Washington State: The Washington Healthplanfinder announced an SEP effective August 27 for consumers who had experienced issues with enrollment, billing, or payment through the state’s marketplace. The SEP will last through November 14 (the day before the beginning of OE2). Consumers interested in this SEP should contact an in-person assister or call the Healthplanfinder consumer hotline (1-800-562-6900) for assistance.
  • Wisconsin: CMS announced a new SEP for consumers in Wisconsin who had lost their coverage when the state changed the eligibility criteria for its Medicaid program, BadgerCare. Effective September 4, consumers who lost BadgerCare coverage have sixty days (until November 2) to enroll in a new plan and receive financial help. To get started, they can call the marketplace call center (1-800-318-2596).

Internal Revenue Service (IRS) Releases Draft Tax Form Instructions: On August 28, the IRS released a number of draft tax form instructions (Forms 1095 A-C, 1094 B-C) for individuals, insurers, employers, and marketplaces to report coverage and determine individuals’ final tax credit amount or the dollar amount of the fine for not having coverage. For instance, if the final premium tax credit for an individual does not match the advanced payments of premium tax credits that a consumer received throughout the year from the marketplace, he/she may either get an additional refund or have to pay back the extra tax credit. The IRS will finalize these forms and instructions among others later this year after reviewing comments from the public.

Minnesota’s Marketplace Awards $4.6 Million for Outreach and Enrollment: On September 2, MNsure announced 28 outreach and enrollment grant awards for OE2, which total $4.6 million and will fund over 80 community organizations.

Final 2015 Health Insurance Rates Approved in Three States

  • Montana: The Montana Commissioner of Securities and Insurance released the state’s 2015 individual market and small group premiums on August 27. Premiums for the individual market, which are sold on, will increase by an average of 1.6 percent. In the previous five years, average premiums had increased 13 to 18 percent in the state’s individual market.
  • New York: On September 4, the New York Department of Financial Services announced 2015 premium rates for marketplace plans. On average, premiums for individual market plans will increase by 4.5 percent, which was reduced from insurers’ requests for an increase of 12.5 percent.
  • Washington State: At an August 28 board meeting, the marketplace board certified final rates for 2015 plans for the Washington Healthplanfinder. Premiums in the individual market will increase by an average of 1.9 percent. Insurers’ initial requests to increase premiums by an average of 8.6 percent were denied by the Office of the Insurance Commissioner.
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