CMS Announces New Special Enrollment Period for Failure to Reconcile 2014 Tax Credits

CMS created a new special enrollment period (SEP) for individuals who did not enroll in 2016 Marketplace coverage because they were determined ineligible for federal premium tax subsidies by HealthCare.gov for failure to file 2014 tax returns. To be eligible for the new SEP, individuals must file a 2014 tax return, reconcile any advanced premium tax credits received for that year, and attest to doing so on HealthCare.gov. Eligible individuals must not currently be enrolled in HealthCare.gov coverage but they must have previously attempted to enroll for 2016. The SEP runs from February 1 to March 31. CMS recently eliminated six SEPs in response to insurers' concerns over SEP enrollees' eligibility and selection.

12.7 Million Individuals Enrolled in 2016 Marketplace Coverage

Approximately 12.7 million individuals selected a plan for 2016 coverage through the State and Federal Marketplaces before the close of open enrollment on January 31, 2016, according to the Department of Health and Human Services (HHS). Of those 12.7 million, approximately 9.6 million enrolled through HealthCare.gov, while 3.1 million enrolled through a State-based Marketplace. An additional 400,000 individuals signed up for New York's Basic Health Program (BHP) and 33,000 signed up for Minnesota's. (BHPs provide coverage to low income individuals who would otherwise be eligible to purchase qualified health plans on the Marketplaces.) Four million of the HealthCare.gov enrollees are new, and of the 5.6 million who re-enrolled, nearly 70% (3.9 million) selected a new plan and 30% (1.7 million) were automatically reenrolled. While total enrollment numbers have been revised downwards in previous years, coverage cancellations were tracked in real-time for the first time this year, making downward revisions less likely.

Kentucky: CMS Details Requirements for Transition to HealthCare.gov

CMS sent Governor Matt Bevin (R) a letter detailing the immediate stepshis administration must take in order to shut down kynect, the State-based Marketplace, and transition its approximate 81,000 customers to HealthCare.gov. The State must facilitate conversations with kynect's insurers to assure they understand the transition process and the requirements for selling on HealthCare.gov, including the 3.5% issuer fee. The State must also produce a detailed plan for how kynect will continue to meet its legal and regulatory obligations through the end of 2016, including how it will maintain the ability to process enrollees' changes in circumstances or special enrollment period sign-ups. Kentucky must also build a new system that will send and accept application transfers between the State's Medicaid/CHIP system and HealthCare.gov, and must ensure individuals can apply for Medicaid directly to the State. Kentucky may not use its remaining $57.5 million in CMS establishment grant funding to finance the transition.

Oregon and Alaska: Moda Health Returns to the Marketplace Two Weeks After Exit

Moda Health Plan (MHP) will resume selling and renewing policies in Oregon and Alaska after the Oregon Department of Consumer and Business Services (DCBS) and Alaska's Division of Insurance (DOI) lifted their January 27 supervision orders. MHP must take specific steps to raise capital and stabilize its financial position, including: set aside $15 million to protect Alaska policyholders if MHP were to fail (no measure is required in Oregon because the State has the ability to seize MHP assets if needed); sell a portion of money owed to MHP by the federal government; sell assets, including those owned by its parent company Moda, Inc.; and borrow money by issuing surplus notes. DCBS approval will also be required for increases to executive compensation. Enrollees' premiums, cost-sharing, and benefits will remain the same and DOI will ask the federal government for a special 10-day open enrollment period for Alaskans affected by MHP's suspension. Alaska's individual Marketplace would have had only one insurer issuing new policies if MHP's supervision order had been maintained, and MHP is the third largest insurer in Oregon.