CMS Extends Paper-Based Eligibility Appeals for Marketplaces

CMS released sub-regulatory guidance that allows the Federally Facilitated Marketplace and State-based Marketplaces to use a paper-based eligibility appeals process through December 31, 2015. The extension applies to individual eligibility appeals, employer appeals, and Small Business Health Options Program (SHOP) Marketplace appeals. CMS noted in the issued guidance that this flexibility protects the rights of appellants while allowing states to complete systems development and processes needed to implement online appeals systems.

CMS Intends to Extend Funding and Authority for Medicaid Eligibility and Enrollment System Modernization and Integration

CMS announced its intent to issue new regulations to permanently extend the federal funding match provided to states for Medicaid eligibility and enrollment system modernization. The 90% match was introduced in 2011, increasing the level of federal support for eligibility and enrollment systems builds from 50%, alongside detailed standards that states must meet in order to receive the funds. The new regulations will codify the 90% match and propose updated standards to ensure states have continued support to implement high-functioning and streamlined systems.

In addition, CMS announced it will provide a three-year extension to the Office of Management and Budget Circular A87 cost allocation waiver that supports states' efforts to integrate eligibility and enrollment systems across health and human service programs, such as Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF). The waiver extension will be formalized in forthcoming guidance and will provide funds to states through December 2018.

Insurers Announce Expectation of Enrollment Increase during 2015 Open Enrollment Period

Six private and not-for-profit insurers interviewed by Reuters announced expectations for enrollment growth during the 2015 Open Enrollment year, basing predicted growth on consumer interest reported through call centers, sales forces, and brokers. Some insurers predicted increases of at least 20% in Marketplaces while some indicated they expect enrollment to double in specific states. Among the insurers interviewed were Florida-based Health First Health Plans, Pennsylvania- based Blue Cross and Houston-based Community Health Choice.

Early Testing of SHOP Marketplace Reveals Need for Improvements

One week after testing the federal Small Business Health Options Program (SHOP) Marketplace began in five states, small business owners, employers, insurance agents and brokers revealed several concerns with site functionality. Testers identified incompatibility with certain web browsers, inaccurate premium information and inconsistencies regarding which plans were approved for online sale and which appeared on the site. Federal officials responded to the concerns, stating that many of the issues will likely be resolved by November 15, the site’s official launch date at the start of Open Enrollment.