New Opportunities to Get Covered through a Special Enrollment Period (SEP): On August 4, the Centers for Medicare and Medicaid Services (CMS) issued new guidance about two additional SEPs available for people living in Federally Facilitated Marketplace states. The first scenario applies to consumers who previously applied through the marketplace or their state Medicaid agency, were denied Medicaid because their state chose not to expand coverage, and later experienced an increase in income so that they now expect to earn at least 100 percent of the federal poverty level during 2014 ($11,490 for an individual and $23,550 for a family of four). The second scenario applies to consumers who had their application transferred to the state Medicaid agency, but were ultimately found ineligible for Medicaid (and so should be eligible for marketplace coverage with financial help, after all). Consumers must contact the call center and explain their circumstances to qualify for one of these SEPs.
Clarification Regarding Timing of Assister Certification Expiration: This year, allmarketplace assisters must complete the certification process again in order to offer in-person help during the second open enrollment period and beyond. According to an update this week from CMS, mid-September is the earliest possible date that Certified Application Counselors’ (CAC) certification will expire, even if the CAC organization or CAC received their training certificates prior to September.
Medicaid Enrollment Continued to Grow in June: On August 8, CMS released the June enrollment report for Medicaid and the Children’s Health Insurance Program (CHIP). From May to June, enrollment increased by around 600,000 people. Since the start of the first open enrollment period in October 2013, enrollment in Medicaid and CHIP has increased by 7.2 million people, or 12.4 percent, compared to average monthly enrollment just before open enrollment began. In states that expanded Medicaid, enrollment increased by 18.5 percent on average, and non-expansion states saw an average increase of around 4 percent.
New Hampshire Medicaid Expansion Going Into Effect: This Friday, August 15, coverage will begin for individuals who have enrolled in New Hampshire’s expanded Medicaid program. Enrollment began on July 1 for New Hampshire residents with income up to 138 percent of the FPL. Residents can apply through the state’s application or HealthCare.gov.
Massachusetts Will Remain a State-Based Marketplace: Instead of transitioning to use the federally facilitated marketplace (FFM) for enrollment, Massachusetts state officials announced on August 8 that they will use a new software system and continue to run their own enrollment portal. CMS approved the decision, following successful tests of the new system, including being able to integrate federal premium tax credits with Massachusetts’ additional financial help.