CMS Allows States to Use Other Benefit Programs’ Income for Medicaid Eligibility Determinations

CMS announced in a letter to State Health Officials that it will allow states to use gross income information from the Supplemental Nutrition Assistance Program (SNAP) or other means-tested benefit programs, such as Temporary Assistance for Needy Families (TANF), to support Medicaid income eligibility determinations without obtaining waiver approval. States may receive approval for a state plan amendment to do so at application and renewal for those “who are certain to be income-eligible under Modified Adjusted Gross Income (MAGI)-based methodologies,” the criteria for which is further defined in the SHO letter. CMS notes that states may not automatically enroll this individual in Medicaid but must check if he/she is already enrolled in Medicaid and explain how it will obtain the minimum requirements for an application for Medicaid, verify his/her citizenship status, provide all rights associated with a Medicaid eligibility determination, explain how it will obtain additional necessary information, and affirm its ability to comply with Medicaid reporting requirements.

CMS Posts 2017 Benchmark Plans for Public Comment

CMS has posted states’ proposed selections for their essential health benefits (EHB) benchmark plans for 2017, the majority of which are based on a plan sold in the small group market in 2014. The posting includes the summary of benefits and coverage and supporting plan documents providing detail on plan coverage, limits and exclusions for each state benchmark plan for 2017. Comments are due on September 30th, 2015.

CMS Announces 2016 Reenrollment Processes for FFM Issuers

CMS released guidance for health insurance issuers in the Federally-facilitated Marketplaces (FFMs) on the 2016 redetermination and re-enrollment process. Consistent with previous guidance, health insurance issuers are encouraged to conduct outreach to enrollees who will have advance payments of the premium tax credit or cost sharing reductions discontinued during the re-enrollment process because they have: not reconciled their taxes, not provided the Marketplace authorization to access tax return information, or have updated tax return information with a household income above 500% FPL. Specifically, issuers are provided talking points for helping consumers who have not yet reconciled their previous year’s tax credits with the IRS to file the appropriate tax forms to do so.

72 Million Individuals Enrolled in Medicaid and CHIP

According to CMS’s monthly Medicaid/CHIP eligibility and enrollment report, 72 million individuals were enrolled in Medicaid and CHIP in June 2015, an increase of 292,000 individuals since May 2015. Since October 2013, nearly 13.1 million additional individuals have enrolled in Medicaid and CHIP, an increase of almost 23% over the average monthly enrollment for July through September of 2013. Compared to this 2013 timeframe, Medicaid expansion states have seen an average increase in enrollment of 29.7%, while states that have not expanded reported an average increase of 9.8%.

New Report Finds "Cadillac Tax" Estimated to Impact a Quarter of Employers

In 2018, an estimated 26% of employers who offer health insurance to employees will be subject to the Affordable Care Act's high cost plan tax (HCPT), also known as the Cadillac Tax, according to a new report by the Kaiser Family Foundation. However, if employers stopped offering a Flexible Savings Account before that time, only 16% of employers would be impacted. If employers make no changes to their plan over the following decade, the percentage of employers impacted is expected to rise to 42% due to the cost of health care expenditures outpacing inflation. The authors conclude that the Cadillac Tax may cause employers to modify their health benefit offerings and reduce employee choice.