February 4, 2014 – February 10, 2014

Notable Updates

  • March coverage deadline is almost here! Consumers must select a plan by February 15 to get covered by March 1.
  • System maintenance will affect applicants February 15-18: Consumers will not be able to get eligibility determinations from 3 p.m. on February 15 to 5 a.m. on February 18 due to the Social Security Administration’s annual systems maintenance work, which affects the Federal Data Services Hub. Consumers who apply after 3 p.m. on February 15 need to call the federal call center on February 18 to complete their enrollment and request a March 1 coverage effective date.
  • Draft guidance for next year’s marketplace plans: The Centers for Medicare and Medicaid Services (CMS) issued a draft letter to insurers proposing new guidelines for next year’s FFM plans, including new standards to strengthen network adequacy and transparency, improve benefit design, patient safety, and oversight of agents and brokers.
  • Employer mandate regulations issued: The Internal Revenue Service (IRS) issued final regulations on the employer responsibility provisions. The regulations simplify reporting requirements for businesses with 100 or more employees starting in 2015 and delay the requirement that businesses with 50-99 employees provide coverage to their full-time employees until 2016.

Top Successes

  • New HealthCare.gov functionality: Two features are now available for consumers applying on HealthCare.gov:
    • Edit application: A new edit feature (via the “report a life change” button) allows consumers to amend any part of their application. For instance, consumers can fix typos, add new people to their plan, or update their income information. Previously, consumers had to report changes directly to insurers.
    • Medicaid question: Applicants are now asked to report if they have already been determined ineligible for Medicaid or CHIP. If the answer is yes, consumers will skip a redetermination for Medicaid/CHIP. This will help applicants who have been stuck in a loop with HealthCare.gov finding them eligible for Medicaid/CHIP but the state finding them ineligible. Last week, CMS also issued a help guide for this question.
  • Colorado’s outreach efforts: Connect for Health Colorado had an RV tour in December, headed to National Western Stock Show in January, and is now teaming up with tax assisters who provide free help to low-income individuals in order to reach the consumers wherever they are!
  • Massachusetts’ plan forward: The Commonwealth released an independent report assessing the Health Connector’s troubles, and the governor announced a plan for fixing the issues identified. The Health Connector will keep their original contract with CGI but will also contract with Optum to facilitate and expedite IT fixes and process the backlog of paper application. The governor also appointed a temporary high-level manager to oversee the project and is working with CMS to extend old coverage programs until the website is fixed.


  • Medicaid applications:
    • FFMs: Some FFM states are not yet able to accept electronic transfers from HealthCare.gov and are struggling to process flat files. For example, Missouri has not processed any of the 25,000 applicants HealthCare.gov assessed as likely-eligible for Medicaid, and Ohio assisters are suggesting consumers apply, or re-apply, directly with the state Medicaid agency.
    • State-based marketplaces: Nevada is struggling to handle the influx of newly eligible Medicaid enrollees and reportedly has a backlog of 50,000 applications to process.
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