Individuals and families rush to sign up for January 1 coverage: Enrollment rates leading up to the deadline for January coverage were much higher than in October and November for both the federally facilitated marketplaces (FFMs) and state-based marketplaces (SBMs). In total, since October 1, more than six million Americans have gone through the application process.
The breakdown: 2.1 million Americans have selected a private plan through the marketplaces and more than four million have been determined eligible for Medicaid or the Children’s Health Insurance Program (CHIP) (including 3.9 million through state agencies or SBMs and 270,000 through HealthCare.gov).
Proactive troubleshooting by CMS: On January 1, the Centers for Medicare and Medicaid Services (CMS) released several new fact sheets for consumers on how to use their new coverage and focused their weekly assister outreach call on how consumers can get help with their application and with coverage issues.
HealthCare.gov handoffs: The consumer-facing side of HealthCare.gov has been functioning relatively smoothly, but backend handoffs to state Medicaid and CHIP agencies and insurance companies are still bumpy.
With Medicaid/CHIP: Automatic data transfers between HealthCare.gov and Medicaid/CHIP agencies are still being worked out after weeks of testing. In the meantime, state and federal agencies are trying a number of different ways to ensure consumers that applied through HealthCare.gov and were assessed eligible for Medicaid/CHIP actually get enrolled. Strategies range from contacting these individuals directly and encouraging them to apply again through the state Medicaid office to manually processing alternative data transfer files that often have incomplete information.
With insurers: Handoffs of applicant information from HealthCare.gov to insurers continue to improve, but these files are also still missing information and require additional follow-up.
FFM hotline issues: The recent initiative to amend how the federal call center is handling complex application issues has improved processes, but additional changes seem necessary, as we continue to hear reports that federal call center representatives are inadequately addressing consumers’ and assisters’ questions and concerns.
Assister confusion: Based on recent questions from assisters, there seems to be continued confusion about tax credit eligibility and misunderstandings about how to determine household composition.