Reports & Analysis

Low enrollment levels in the health insurance marketplaces in the first year may also mean disproportionate enrollment of high cost individuals. This could lead to higher premiums and destabilization of the non-group market, but this is unlikely. First, policies put in place in the law, specifically risk corridors and risk adjustment, will provide insurers with some significant financial protection. Second, low enrollment does not necessarily mean adverse selection – there are strong incentives for young adults to enroll. Third, insurers cannot necessarily recoup any 2014 losses by raising 2015 premiums. Insurers will need to set premiums for 2015 based on the expected enrollment in 2015, not based on any losses that may occur in 2014.

Recently, HHS and CMS have reported new eligibility and enrollment data for the marketplaces created by the ACA, as well as for Medicaid and CHIP, providing some of the timeliest data on Medicaid enrollment that has ever been captured along with preliminary information on how early ACA implementation is impacting Medicaid enrollment. However, currently, there is no single data source that provides comprehensive information on Medicaid enrollment. As such, to gain a full picture of enrollment in Medicaid, it is important to look across the different enrollment paths connecting people to the program today. This brief provides an overview of these different enrollment paths and national level data available to date on enrollment through these avenues.

Since 2009, the eight states participating in the Maximizing Enrollment program have worked to increase enrollment and retention of eligible children into Medicaid and the Children’s Health Insurance Program (CHIP) and to establish and promote best practices in streamlining eligibility and enrollment systems, policies and procedures to share with other states. This report, the second in a series of reports highlighting lessons learned from Maximizing Enrollment, examines how states brought a set of strategies together into a tapestry of change management that supported the states’ overall health coverage vision and goals for streamlining systems, policies and procedures.

The ACA will make health insurance more accessible to millions of Americans. However, it is estimated that as many as one in four uninsured individuals eligible for Advance Premium Tax Credits (APTCs) do not have a checking account, presenting a basic signup challenge as timely payment must be made to both initiate and maintain coverage on a monthly basis. This brief, prepared by Wakely Consulting Group, offers some insights on this sizable population and explores various solutions that Marketplaces and issuers might consider in early 2014 to address the payment challenges presented by unbanked and underbanked individuals.

Implementation of the health insurance marketplaces has been an ongoing challenge across the country in the initial months of open enrollment. While state marketplaces are still evolving, and some are experiencing their own implementation challenges, they are largely working. This brief, prepared by the team at Manatt Health Solutions, looks at five state marketplaces to assess early lessons that might help to explain early enrollment trends. Based on interviews with state leadership and review of publicly available documents, the report explores the early implementation experience in Kentucky, New York, Minnesota, Rhode Island, and Washington.

The Affordable Care Act requires health insurers to justify rate increases of 10 percent or more for non-grandfathered plans in the individual and small-group markets. Analyzing these filings for rates taking effect from mid-2012 through mid-2013, insurers attributed the great bulk—three-quarters or more—of these larger rate increases to routine factors such as trends in medical costs. Insurers attributed only a very small portion of these medical cost trends to factors related to the Affordable Care Act.

Part of states' roles in administering the new health insurance marketplaces is to certify the health plans available for purchase. This analysis focuses on how state-based and state partnership marketplaces are using their flexibility in setting certification standards to shape plan design in the individual market. It focuses on three aspects of certification: provider networks; inclusion of essential community providers; and benefit substitution, which allows plans to offer benefits that differ from a state’s benchmark plan.

This brief examines the sources of high costs in the United States, the obstacles to getting them under control, and the promising public and private efforts under way to uncover the secret to high-value health care.

States with Partnership or Federally Facilitated Marketplaces (FFM) are coordinating closely with the federal government on Medicaid eligibility and enrollment. Each state Medicaid agency has chosen whether the Marketplace will only assess, or whether it will also determine Medicaid eligibility for individuals who apply through the Marketplace. This brief outlines the responsibilities of the FFM in assessing or determining Medicaid eligibility, explains the differences between these two models, and examines the rationales behind two states’ choices.

Due to the ACA’s new eligibility verification rules, states have developed plans outlining Medicaid and CHIP eligibility verification procedures. This chart highlights key elements from states’ verification plans, such as which eligibility factors are verified through electronic data and the specific data sources states are using, as well as whether self-attestation is accepted for some eligibility factors. The chart also contains information about how states will determine reasonable compatibility, which is how they will resolve issues if there are discrepancies between electronic data sources and information provided by applicants.