CMS Awards $110 Million in Seven Level One Establishment Grants

CMS awarded six states – Idaho, Illinois, Maryland, Massachusetts, Vermont and Washington – and D.C. a total of $110 million in Level One exchange establishment grants. The funding will be used by the states for website development, customer service, Small Business Health Options Program (SHOP) Marketplace functionality and other purposes.

Administration Proposes Rule To Amend Excepted Benefits, Employer-Provided Wraparound Coverage

The Departments of Health and Human Services, Labor, and Treasury issued a proposed rule that would allow low-wage workers to receive health benefits from their employer in addition to premium tax credits to purchase qualified health plan coverage – marking a departure from previous guidance. The proposed rule, which generally applies to employees who cannot afford to participate in their employer’s coverage plan, would define certain wraparound benefits offered by an employer as “excepted benefits.” This would allow employees to enroll in a qualified health plan and receive tax credits. The rule is open to comments until January 22, 2015.

CCIIO Issues Draft Letter to FFM Issuers for 2016 Plan Year

CCIIO released a draft Letter to issuers seeking to offer plans on the FFM or Federally-facilitated Small Business Health Options Program (SHOP) Marketplace with policy and operational requirements for the 2016 plan year. Much of the guidance repeats information CMS released in previous regulations and issuer Letters; however, the draft Letter proposes an April 15 deadline for the 2016 FFM qualified health plan certification applications, potentially requiring premiums to be set before health issuers know the true impact of risk adjustment, transitional reinsurance, and temporary risk corridors for the 2014 plan year. The Letter is open to comments until January 12, 2015.

Enrollment Growth Continues; 2.5 Million Select Marketplace Plans and 9.7 Million More Enroll in Medicaid/CHIP

Between November 15 and December 12, nearly 2.5 million people selected a plan on the Federally-facilitated Marketplace. More than 1 million of the enrollments occurred last week, indicating a growing interest as the open enrollment deadline nears. As with previous weeks, the breakdown of enrollees was roughly split between new (48%) and returning (52%) customers, according to an HHS blog post. CMS also released a Medicaid/CHIP enrollment report, indicating that a total of 68.5 million people have enrolled in Medicaid and CHIP as of October 2014 – with 9.7 million enrolling since October 2013, representing a 17% increase over the average monthly enrollment for July through September of 2013. Enrollment rose by over 24% in states that have implemented Medicaid expansion as compared to 7% in states that have not expanded.

National Center for Health Statistics Shows 2014 Coverage Gains are Largest in Four Decades

On the heels of the Marketplace and Medicaid enrollment announcements from HHS and CMS, the National Center for Health Statistics released new data indicating that the nation’s uninsured rate is the lowest it has been since the 1970s. The uninsured rate dropped from 13.1% in the first quarter of 2014 to 11.3% in the second quarter, both down from the average rate of 14.4% in 2013. The decline in the uninsured rate corresponds with the increase in coverage for individuals who have enrolled in Marketplace and Medicaid/CHIP coverage over the past year.

HHS Announces Over $622 Million in State Innovation Model Test Awards

Eleven states were awarded over $622 million in State Innovation Model Test Awards to design and test innovative healthcare payment and delivery system reforms, according to HHS. The funds are intended to support transformation that improves healthcare quality while lowering costs. The funding for these states -- Colorado, Connecticut, Delaware, Idaho, Iowa, Michigan, New York, Ohio, Rhode Island, Tennessee and Washington – will be used to support testing and implementation of State Health Care Innovation Plans. In addition, 17 states will receive nearly $43 million to design proposals for statewide health system transformation.