June 24, 2014 – June 30, 2014

New Guidance on Renewing Marketplace Coverage and Financial Help for 2015: On June 26, the Department of Health and Human Services (HHS) issued a proposed rule and accompanying guidance on eligibility redeterminations and the renewal process for 2015 marketplace coverage, as well as draft notices and instructions for insurers. The proposed rule would establish the automatic renewal of coverage and financial assistance for most consumers in the federally facilitated marketplaces (FFM). To ensure these individuals receive the correct amount of financial help for 2015 and are enrolled in a plan that meets their needs and budget, they will need to update their information and review their coverage options during open enrollment (November 15, 2014-February 15, 2015, and prior to December 15 for January 1 coverage). State-based marketplaces (SBMs) have flexibility to follow the FFM’s model or propose an alternative plan. Comments on the proposed rule are due July 28 and comments on the draft notices are due July 17.

Supreme Court Issued Decision in Burwell v. Hobby Lobby Case: On June 30, the Court found, in a 5-4 decision, that closely held for-profit corporations are not required to pay for birth control coverage if it is counter to the employer’s religious beliefs. The ruling exempts these corporations from following the Affordable Care Act’s requirement that health insurance plans include contraceptive coverage as a preventive service within their covered benefits. Previous administration rules did exempt religious non-profit institutions from the birth control requirement and instead have insurers provide the coverage directly to women. The Hobby Lobby ruling applies only to birth control coverage in employer-sponsored plans, and does not apply any of the other required benefits or marketplace plans.

States Moving Forward with Hospital Presumptive Eligibility: Implementation of hospital presumptive eligibility for Medicaid continues to move forward. CMS has approved 13 State Plan Amendments (SPAs) (for Connecticut, Idaho, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Ohio, Oregon, Utah, and West Virginia), and is in the process of reviewing the remaining SPAs. All states were required to submit SPAs outlining their presumptive eligibility policies by March 31. Enroll America’s presumptive eligibility toolkit provides a regularly updated summary of each state’s progress in implementing of hospital presumptive eligibility.

Medicaid Expansion Updates:

  • Michigan: In the first few months of expanded Medicaid eligibility, 300,000 Michiganders enrolled. Interested residents should apply through the state’s Medicaid agency.

Updates from SBMs:

  • California: Covered California’s board approved plans for 2014-2015 including a Navigator program with a new model of integrated outreach, education, and enrollment, and an updated $443 million operating budget.
  • New York: New York State of Health released its most comprehensive report on enrollment, providing additional information on enrollees’ county location, financial assistance, plan choice, demographic information, and application method.
  • Washington, DC: The Department of Insurance, Securities, and Banking released the proposed rates for 2015 DC Health Link Plans. The proposed changes range from a decrease of 18 percent to an increase of 24 percent. These rates are not final and will be reviewed in the coming months.
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