Colorado, D.C. and Illinois Submit 2017 Benchmark Plans to CMS

As permitted in the HHS Notice of Benefit and Payment Parameters for 2016, states have begun selecting new essential health benefit (EHB) base benchmark plans for 2017 from among those that were offered in 2014. States that do not select a new benchmark plan for 2017 will default to the largest plan in the small group market. Three states announced their selections: Colorado selected a new plan that offers obesity, chiropractor, and some infertility coverage, which were not included in the previous benchmark plan. D.C. selected the largest small-group plan, which it says is consistent with its previous benchmark; and, Illinois selected a small group plan from the same carrier as last year, which it says will “preserve the benefits offered in the current EHB benchmark without reducing coverage in any of the 10 EHB categories.”

Nevada: Marketplace Assists Enrollees File for Exemption from Penalty for Uninsurance

According to Nevada Health Link Executive Director Bruce Gilbert, the IRS has confirmed that Marketplace enrollees who experienced difficulty enrolling in coverage due to a Marketplace technical failure will be eligible for an exemption from the Affordable Care Act’s penalty payment for uninsurance.” In order to receive this exemption, consumers must submit the IRS tax-exemption document, Form 8965, and specifically indicate exemption type “G.” The Las Vegas Review Journal reports that some consumers in Nevada filed for the exemption under “general hardship,” which does not cover technological failures and requires CMS to grant an individual-specific exemption code. Nevada Health Link has posted instructions on its website for its enrollees to resubmit Form 8965.

New York: Governor Announces Savings and New Funding for Medicaid for Delivery System Reform

New York Governor Andrew Cuomo (D) announced that per person Medicaid spending dropped to $8,223 in 2014, the lowest per capita spending rate since 2003. Despite enrollment growth from 4.3 million to 6.3 million during this time, the rate of overall growth in Medicaid spending also decreased. New York’s Medicaid spending has grown 1.4% annually from 2011 to 2014, down from a 4.3% annual growth rate between 2003 and 2010. The Governor attributed the reduced per person spending and growth rates to initiatives implemented under the Medicaid Redesign Team (MRT). In tandem with the announcement, the Governor also detailed new funding allocations for provider networks developed under the MRT Delivery System Reform Incentive Payment program, totaling $7.3 billion to be invested over the next five years.

Ohio: Budget Requires State to Seek New Medicaid Cost-Sharing

The 2016-2017 state budget, signed into law by Governor John Kasich (R) last week, requires the Ohio Department of Medicaid to request a federal waiver to enact Health Savings Accounts (HSAs) for all non-disabled Medicaid recipients regardless of income. Beneficiaries would be required to contribute 2% of household income, up to $99 annually, to their HSA, into which the Ohio Medicaid program would also contribute $1,000 each year. Until the account is depleted, beneficiaries would be subject to copayments and health plans would not be allowed to pay for any services. Currently, no other state has federal permission to condition Medicaid eligibility on premium payments or account contributions for enrollees with income below 100% of the poverty line.