May 13, 2014 – May 19, 2014

Final Rule Released on Exchange and Insurance Market Standards for 2015 and Beyond: On Friday, May 16, the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) finalized recent proposed regulations related to health insurance issuers, marketplaces, and in-person assisters. Enroll America commented on the proposed rules and recommended a number of provisions to strengthen health insurance marketplaces and the essential role of in-person assisters.The final rule reinforces the critical role of in-person assisters by finalizing new standards and guidelines for assister programs, and preventing states from enacting overly restrictive policies that impede navigators and other assisters from carrying out their responsibilities. The final rule also established provisions that will make it easier for consumers experiencing qualifying events to enroll in marketplace coverage outside the open enrollment period.

Indiana Governor Proposes Medicaid Expansion Plan: Governor Pence (R-IN) submitted a waiver to CMS to expand Medicaid by building on the Healthy Indiana Plan (HIP), an existing state limited benefit health care program. The revised HIP (called HIP 2.0) has three parts:

  • HIP Plus pairs a High Deductible Health Plan with required monthly contributions to a Health Savings Accounts (HSA). The HSA is jointly funded by the state and individual, and will pay for consumers’ cost-sharing (including deductible, copays, etc).
  • HIP Basic is only available to consumers under the poverty level and has no monthly contributions. It has fewer benefits than HIP Plus, and requires copays for all prescriptions and health care services, except preventive and pregnancy care.
  • HIP Employer Benefit Link helps pay consumers’ contributions to employer-sponsored coverage that is not affordable.

If CMS approves Pence’s plan, HIP Plus and HIP Basic will go into effect on January 1, 2015, and HIP Employer Benefit Link will go into effect in 2016.

Supporting Documents for Federally Facilitated Marketplace (FFM) Applications Remain Unprocessed: When an applicant’s reported income or immigration status does not match the federal database, the consumer is asked to submit supporting documents to the FFM (online or through the mail). According to the Washington Post, over a million consumers’ documents have not been processed because the automated system to match documents with the appropriate application has not yet been built. CMS is working on a plan to process the documents by hand beginning this summer.

Committee Vote Next Week on Nominee for U.S. Health Human Services (HHS) Secretary: The U.S. Senate Finance Committee is planning a committee vote on the nomination of Sylvia Burwell for HHS secretary on Wednesday, May 21. The Senate Finance Committee held a hearing on the nomination last week and the Senate Health, Education, Labor, and Pensions Committee held its hearing on May 8. Burwell received bipartisan support during both hearings and is expected to be confirmed.

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