Reports & Analysis

Analysis of Marketplace enrollment has focused primarily on the initial 2014 open enrollment period. But as the second open enrollment period ends—and as open enrollment periods shorten in future years—special enrollment periods (SEPs) will warrant increasing attention. This paper analyzes the legal framework, limited enrollment data, and first year special enrollment experiences in five State-Based Marketplaces (SBMs) and finds that Marketplace systems and consumer outreach and enrollment efforts did not yet match the significant potential for SEP enrollment. The paper identifies several themes that may help policymakers improve SEP enrollment systems in 2015 and beyond.

How would a Supreme Court ruling for the plaintiff in King v. Burwell affect consumers, insurers, providers, and states? A new series on The Commonwealth Fund Blog looks at the potential real-world impact of the case being argued next week. The series will examine the consequences of a decision that would end subsidies for residents of the 34 states that have federally run health insurance marketplaces. The first post looks at how individual consumers would fare in health insurance markets that would likely function even more poorly than those that existed before the Affordable Care Act was enacted.

Many tax filers who were uninsured for all or part of 2014 are learning for the first time that they must pay a penalty, and have missed the opportunity to enroll in 2015 coverage. These gaps in consumer awareness, combined with the timing of this year’s open enrollment period (OEP), have led to several Marketplaces allowing certain uninsured consumers additional time to enroll in order to avoid paying a penalty next year. The Federal government and nine State-based Marketplaces have already announced plans to establish a Special Enrollment Period (SEP) to permit individuals subject to the tax penalty to enroll in 2015 coverage outside of this year’s OEP, thereby minimizing the penalty they could incur when filing their 2015 taxes. This document, prepared by Manatt Health Solutions, provides a summary of the tax season SEPs being utilized by each of these Marketplaces.

The risk corridor program created by the Affordable Care Act (ACA) has proven to be one of the most controversial aspects of the health care law. Questions have been raised about the source of payments, whether the Department of Health and Human Services (HHS) has the authority to make payments under the program, and whether the program is required to be budget neutral. This brief has been updated to examine the impact of the Consolidated and Further Continuing Appropriations Act of 2015 on the risk corridor program and whether insurers will receive their full 2014 risk corridor payments.

Given the often overwhelming prevalence of social needs facing Medicaid populations, including housing, transportation, and nutrition, aligning social services and supports with health care delivery is critical. Many states recognize the connection between social determinants of health and health care utilization and outcomes, and are building the infrastructure to support social service delivery through accountable care organization (ACO) programs. This brief highlights the initial efforts of seven states — Colorado, Maine, Minnesota, New York, Oregon, Vermont, and Washington — that participated in CHCS’ Medicaid ACO Learning Collaborative, and outlines key themes and considerations from these early adopters to help additional states support collaboration between ACO and social service providers.

In January 2014, the major coverage provisions of the Affordable Care Act (ACA)—including the expansion of Medicaid eligibility and the availability of subsidized coverage through Health Insurance Marketplaces— went into effect. As the first year of new coverage under the ACA comes to a close and the end of the second open enrollment period nears, there is great interest in understanding why some people continue to lack coverage and in reaching out to the eligible uninsured. This report, based on the 2014 Kaiser Survey of Low-Income Americans and the ACA, profiles the nonelderly adult population that remained uninsured as of Fall 2014.

The Affordable Care Act provides financial assistance via cost sharing reductions (CSR) and premium tax credits to help modest income individuals purchase health insurance and reduce the direct costs of their care. This brief estimates the characteristics of the CSR eligible population using the Urban Institute’s Health Insurance Policy Simulation Model. Researchers found that the CSR eligible individuals are most likely to live in the South, to be single adults without children, and to be White, non-Hispanic. Researchers also estimate the average value of a CSR to be $479 in 2016, with the value varying by the eligible person’s income.

New preliminary data from the Medicaid Budget and Expenditure System (MBES) released by the Centers for Medicare and Medicaid Services (CMS) details for the first time the number of adults enrolled in Medicaid under the new Affordable Care Act (ACA) Medicaid expansion category. The data show that as of March 2014, among 48 states reporting data, 4.8 million adults out of the total 54.1 million individuals enrolled in Medicaid were in the ACA Medicaid expansion category. These data provide another element of Medicaid enrollment that differs from other enrollment data released from CMS as part of its Medicaid and CHIP Performance Indicator Project, which provide point-in-time Medicaid and CHIP enrollment data to support program management and oversight. These two data sets are not comparable; they have different purposes and include different populations. This issue brief provides an overview of the new data as well as how it differs from the Performance Indicator data.

This brief provides an overview of the role of Section 1115 waivers in expanding Medicaid coverage since the enactment of the ACA.  The brief also highlights key themes in these waivers including implementing the Medicaid expansion through a premium assistance model, charging premiums, eliminating certain required benefits (most notably non-emergency medical transportation), and using healthy behavior incentives as well as provisions that CMS has not approved.

The Affordable Care Act's drafters envisioned a continuing, significant role for brokers in the reformed nongroup insurance markets, but circumstances limited their active participation in the first year of marketplace enrollment. This analysis delineates the early barriers to brokers' full engagement, highlights the main concerns with their having a more prominent role and offers options for making them more effective in enrolling the uninsured. The information presented in this brief is based upon interviews conducted with stakeholders (e.g., providers, insurers, consumer advocates, navigators, assisters, brokers) in 21 states and the District of Columbia during the first half of 2014.