CMS Offers State Medicaid Agencies Guidance on Coordinating Marketplace and Medicaid Eligibility and Enrollment

CMS released a bulletin reiterating the requirements on state Medicaid agencies to coordinate eligibility and enrollment processes among insurance affordability programs “without undue delay,” and, particularly, the requirement that Medicaid agencies: (1) “determine potential eligibility for coverage through the Marketplace” when the agency deems the applicant ineligible for Medicaid or CHIP, and (2) transfer that individual’s account to HealthCare.gov. CMS highlighted that state Medicaid agencies can treat anyone they determine as ineligible for Medicaid or CHIP as potentially eligible for Marketplace coverage (unless the individual is determined ineligible for procedural reasons). This approach acknowledges that when individuals submit applications directly to a Medicaid agency, the agency does not have sufficient information to assess potential eligibility for tax credits or cost-sharing reductions through the Marketplace. CMS’ clarification is intended to reduce states’ administrative burden while ensuring a timely transfer to the Marketplace.

Minnesota: Survey Finds Uninsurance Rate Cut in Half, Remaining Disparities

The uninsurance rate in Minnesota fell to an unprecedented 4.3% in 2015, down from 8.2% in 2013, according to the State Department of Health’s (DOH) semiannual Health Access Survey. The percentage of individuals insured through public coverage increased more than two percentage points, while group coverage remained steady, ending yearly declines in group coverage since 2011. The most substantial coverage gains were among those who had been uninsured one year or longer. In a presentation to the MNSure board (the State-based Marketplace), DOH noted that there are a number of individuals eligible for premium subsidies who are not receiving them, potentially due to people’s lack of awareness or confusion about their eligibility. DOH noted that as the uninsurance rate falls, those left without insurance can be harder to reach, hence the importance of targeted outreach efforts.

Oregon: Panel of Experts Aims to Transform Behavioral Healthcare Delivery System

Oregon Health Authority (OHA) Director Lynne Saxton assembled a Behavioral Health Collaborative to develop policy proposals that will define the financing and infrastructure needed to update and integrate Oregon's behavioral healthcare system. The collaborative was formed in response to a 2015 report that identified systemic challenges in the State’s behavioral healthcare system, including poor service integration, administrative complexity, access issues, and lack of pediatric services. The Collaborative is expected to meet through December 2016.