CMS May Expand the Circumstances Under Which It Fully Funds Services for Medicaid-Eligible American Indians and Alaska Natives

CMS requested comments on a proposed policy change related to federal funding for services furnished to Medicaid-eligible American Indians and Alaska Natives by Indian Health Service (IHS) or Tribal facilities. Federal law requires the federal government to assume 100% of the amounts paid for services “received through” these facilities. CMS has established four conditions under which services are assumed to be “received through” these facilities, but states and Tribes have expressed concern that these conditions are overly restrictive. CMS is proposing to liberalize three of these four conditions, thereby making it easier for IHS and Tribal facilities to obtain the 100% federal match. The agency's announcement comes as it negotiates with Alaska and South Dakota—both states with large Tribal populations—to determine how best to pay for Medicaid expansion. CMS is requesting written comments by November 17, 2015.

2016 Marketplace Open Enrollment Successfully Launches

The open enrollment period (OEP) for HealthCare.gov and State-based Marketplaces successfully launched on November 1, 2015 at 7:00 am EST. OEP appears to be off to a relatively quiet start, with few reports of technical glitches preventing enrollment, and approximately 250,000 applications submitted through HealthCare.gov during the first two days of OEP, according to Politico. December 15, 2015 is the last day for consumers to enroll in or change plans for coverage beginning January 1, 2016. OEP ends on January 31, 2016.

Nearly One-Quarter of HealthCare.gov Enrollees Switched Plans During 2015 Open Enrollment

A newly released HHS report found that 23% of all people with 2014 Marketplace plans switched to a new plan for 2015, a much higher rate than is traditionally seen in employer-sponsored insurance (2.8% in 2010), the Federal Employee Health Benefits Program (12% in 2001), and Medicare Drug Plans (13% across four enrollment periods). Enrollees were more likely to switch issuers than metal levels; those who elected to switch plans within the same metal level saved almost $400 annually relative to what they would have paid if they remained in the same 2014 plan. Not surprisingly, consumers were highly sensitive to costs. Of silver plan enrollees who re-enrolled through the Marketplace in 2015, the vast majority (91%) remained in a silver plan, the only metal tier through which individuals with incomes under 250% of the federal poverty level can receive cost-sharing reductions.

Access to Specialty Care Limited in 2015 Marketplace Plans

A review of qualified health plan physician networks available through HealthCare.gov for 2015 found that 14% of plans do not provide access to at least one common specialty, according to researchers at Harvard's T.H. Chan School of Public Health. The study searched for specialists in a 50 and 100 mile radius of the most populated city where each plan was offered. Using the broader search criteria, the percentage of specialist deficient plans only decreased to 13.3%. The most common specialties lacking in-network access include psychiatry, rheumatology, and endocrinology.

Children’s Uninsured Rate at Record Low Following ACA Implementation

The uninsured rate among children dropped from 7.1% in 2013 to 6.0% in 2014 following implementation of the Affordable Care Act, according to a report by the Georgetown University Health Policy Institute. Nationally, 25 states showed statistically significant decreases while no states showed statistically significant increases, and states that expanded Medicaid coverage for adults had a decline of uninsured children almost double that of non-expansion states. The authors credit the decrease in uninsured rates to the launch of the Marketplaces, which covered nearly 500,000 children in 2014, and the “welcome mat” effect for children who were already eligible for Medicaid and CHIP. Nevada had the largest decrease in the rate of uninsured children—5.3 percentage points between 2013 and 2014—while Colorado, West Virginia, Mississippi, and Rhode Island also saw large declines ranging from 2.1 to 2.6 percentage points. Half of the remaining 4.4 million uninsured children live in six states: Texas, California, Florida, Georgia, Arizona, and Pennsylvania.