Updated April 12, 2021
This chart describes the regular and special enrollment periods when individuals may sign up for health insurance coverage through either the federal marketplace (healthcare.gov, which 36 states use) or state-operated marketplaces (used by 14 states and Washington, DC).
This chart describes the regular and special enrollment periods when individuals may sign up for health insurance coverage through either the federal marketplace (healthcare.gov, which 36 states use) or state-operated marketplaces (used by 14 states and Washington, DC).
|Marketplace||Original 2021 Open Enrollment Period||2021 Extended Special Enrollment Period|
|Federally facilitated marketplace (36 states)||Nov. 1 – Dec. 15, 2020||Feb. 15 – Aug. 15, 2021*|
|California||Nov. 1, 2020 – Jan. 31, 2021||Feb. 1 – May 15, 2021 and April 12 – Dec. 31, 2021**|
|Colorado||Nov. 1, 2020 – Jan. 15, 2021||Feb. 8 – Aug. 15, 2021|
|Connecticut||Nov. 1, 2020 – Jan. 15, 2021||Feb. 15 – April 15, 2021 and May 1 – Aug 15, 2021|
|DC||Nov. 1, 2020 – Jan. 31, 2021||Jan. 1 – May 20, 2021***|
|Idaho||Nov. 1 – Dec. 31, 2020||March 1 – April 30, 2021|
|Maryland||Nov. 1 – Dec. 15, 2020||Jan. 1 – Aug. 15, 2021|
|Massachusetts||Nov. 1, 2020 – July 23, 2021|
|Minnesota||Nov. 1 – Dec. 22, 2020||Feb. 16 – July 16, 2021|
|Nevada||Nov. 1, 2020 – Jan. 15, 2021||Feb. 15 – Aug. 15, 2021|
|New Jersey||Nov. 1, 2020 – Jan. 31, 2021||Feb. 1 – Nov. 30, 2021|
|New York||Nov. 1, 2020 – May 15, 2021|
|Pennsylvania||Nov. 1, 2020 – Jan. 15, 2021||Feb. 15 – Aug. 15, 2021|
|Rhode Island||Nov. 1, 2020 – Jan. 23, 2021||Feb. 1 – Aug. 15, 2021|
|Vermont||Nov. 1, 2020 – Dec. 15, 2020||Feb. 16 – May 14, 2021|
|Washington State||Nov. 1, 2020 – Jan. 15, 2021||Feb. 15 – Aug. 15, 2021|
*Heathcare.gov opened a special enrollment period as a result of President Biden’s Jan. 28, 2021 executive order designed to strengthen Medicaid and the Affordable Care Act enrollment.
**California will close its COVID-19 SEP on May 15, 2021 and will reopen a new, separate SEP in response to the American Rescue Plan Act on April 12, 2021.
***Washington, DC will extend its COVID-19 SEP for the duration of its Public Health Emergency.
As the Supreme Court hears oral arguments today about the fate of the Affordable Care Act (ACA) in the case of California vs. Texas, state-based health insurance marketplaces (SBMs) are actively connecting consumers to health insurance coverage during the annual open enrollment period that launched Nov. 1.
While the court case casts a shadow of uncertainty over the ACA, COVID-19 and the ensuing economic crisis have increased the need for affordable coverage and forced SBMs to alter their consumer engagement strategies. Using lessons learned from their recent special enrollment periods (SEPs) to meet consumers’ coverage needs, SBMs are adapting outreach and enrollment efforts in recognition of social distancing standards.
Targeted Messaging to Promote Affordability and Accessibility
Recognizing the severe economic challenges many Americans face because of the pandemic, SBMs are carefully framing messages showcasing the affordability and accessibility of qualified health plan (QHP) coverage. As job and income losses make more individuals eligible for premium subsidies available through marketplaces, SBMs have adopted simple, straightforward messaging.
- California’s open enrollment slogan, “This way to health insurance” conveys the exchange is available to provide a path to coverage for all consumers.
- Minnesota’s promotion acknowledges the confusion that consumers may experience as they move from employer-sponsored insurance (ESI) and into the individual market with this targeted message: “UNsure about health insurance options? BEsure. MNsure.org.”
SBMs leaders recognize that access to high-quality, comprehensive health coverage is crucial to maintaining the health of individuals and communities, especially as thousands continue to be affected by COVID-19. SBMs are employing the following strategies to remind consumers that health coverage can provide peace of mind and critical care in the midst of the pandemic.
- Washington, DC has distributed masks printed with the message, “Get Covered, Stay Covered” to existing customers, contact tracers, and community leaders to emphasize that both forms of “coverage” — masks and health insurance – are necessary to maintain health during a pandemic. DC Health Link branding will also be incorporated into social distancing signs across the district.
- Massachusetts is highlighting that COVID-19 testing and treatment is covered by most marketplace plans and is promoting the “security” that comes when individuals know they and their families have coverage in the event of an emergency.
In addition to targeting messages to the uninsured, SBMs leaders recognize their existing customers may be vulnerable to losing coverage, especially because of changes in income or life circumstance that may change the amount of subsidies they are eligible for. This includes extreme fluxuations due to changes in employment status and changes in unemployment insurance (UI) payments. To ensure that customers remain enrolled in a comprehensive health plan, SBMs have utilized targeted email blasts, social media advertisements, and text messages to encourage consumers to update any change in their income or employment status — which could result in increased financial assistance or eligibility for Medicaid. SBMs are also encouraging consumers to remain in contact with their marketplaces as their circumstances change to ensure that the enrollees remain properly enrolled in coverage.
- Idaho has shifted its advertising budget slightly to allocate more funds to digital media, which generates more website traffic than traditional media. However, Idaho will still invest significant resources into traditional media sources to reach consumers in rural areas who have limited access to internet services.
- Washington State has collaborated with local newspapers to create customized and regionally relevant content. These media partners will feature articles, dedicate newsletter content, and display advertisements to draw attention to open enrollment.
Adjusting In-Person Outreach for a Socially Distanced World
To adhere to social distancing restrictions, SBMs have transitioned most of their outreach efforts to virtual platforms and now offer very limited in-person events and consumer assistance. SBMs will offer virtual outreach events through Zoom, Facebook Live, and YouTube to help familiarize consumers with the coverage options and financial assistance available through the marketplace. To focus attention to these events, SBMs have leveraged partnerships with government agencies, faith-based groups, schools, and community organizations that have served as direct community touch points throughout the pandemic.
To maximize their outreach efforts, several states have elected to use consumer data to identify and reach consumer groups that would most likely benefit from marketplace coverage.
- Washington State has partnered with its Department of Financial Management to develop a map identifying communities with high rates of uninsurance to help inform the exchange about where outreach is needed.
- In Minnesota, demographic data is utilized to target social media advertisements and website banners to reach individuals who are most likely to be uninsured.
- Maryland’s Easy Enrollment program, which allows consumers to use the marketplace to estimate eligibility for coverage, has produced a list of over 40,000 consumers who have indicated that they are interested in learning more about coverage through the marketplace.
SBMs have also worked closely with their navigators and community partners to develop strategies to provide secure virtual enrollment assistance. Direct consumer assistance has been proven to significantly increase the likelihood that an individual will complete the enrollment process — particularly among low-income individuals and people of color. SBMs have adopted the following strategies to provide personalized enrollment assistance in a COVID-19 environment.
- Connecticut is hosting several virtual enrollment fairs during October and November. During these events, a representative helps consumers walk through the enrollment process with a screen-share feature so both can view enrollment forms together.
- Massachusetts has allocated additional funds to enable navigators to offer limited in-person assistance in place of walk-in centers. While navigators are not able to accept and process documents and payments, they can help customers with the application process.
- Nevada is scheduled to host a series of Facebook Live events with staff available to answer consumer questions and provide real-time enrollment assistance.
- In anticipation of their first open enrollment period as SBMs, New Jersey and Pennsylvania tripled their navigator programs to ensure that consumers would have the accessible support they need to navigate the new platform.
Strategies to Connect with the Recently Unemployed
With millions of Americans losing employment due to the pandemic, SBMs have taken steps to connect with individuals who have lost employer-sponsored insurance (ESI) coverage. A recent Commonwealth Fund study found that as of June 2020, 7.7 million Americans lost jobs with ESI as a result of the pandemic. Experts expect that unemployment and uninsurance will continue to rise as job losses become permanent and temporary policies, like grace periods granted to those unable to pay their monthly insurance premiums, expire. The SBMs officials acknowledge that many consumers who have lost ESI may be exploring coverage options on the individual market for the first time. To ease confusion and stress, SBMs have utilized the following strategies to connect the recently unemployed to coverage.
- New Jersey’s SBM has coordinated with the Department of Labor (DOL) to include a link to the SBM website within DOL’s consumer portal so individuals are reminded of their health coverage options when they check the status of their unemployment claims.
- Colorado has purchased targeted advertisements to reach those who search for Consolidated Omnibus Budget Reconciliation Act (COBRA) so consumers can compare cost and coverage options across programs.
- The Washington Health Benefit Exchange is telling consumers, “Filing for unemployment benefits? Visit the exchange to stay covered” to remind them to seek a new form of coverage after losing their ESI.
- Nevada includes informational pamphlets about open enrollment in direct mailers sent to individuals who have filed for unemployment. In addition, the state’s Department of Unemployment will share open enrollment information on its social media and web pages.
In addition to coordinating with their states’ labor and employment departments, several SBMs have bolstered strategies to connect with consumers who have recently been terminated by their employer. By monitoring Worker Adjustment and Retraining Notices, which require certain employers to give advance notice of mass layoffs, SBMs are able to identify employers that are about to conduct large-scale lay-offs and then work with their human resource departments to tailor an outreach strategy about marketplace coverage options. In many cases, consumers may access lower-cost coverage through the marketplace than through the COBRA coverage that employers are required to offer.
The open enrollment season for most states runs through Dec. 15, 2020, but several SBMs have extended their deadlines. Explore NASHP’s chart and interactive map, Where States Stand on Exchanges, for more information and links to SBM websites.
COVID-19 has affected nearly every aspect of American life, including access to health insurance coverage, which is critical during a pandemic. Job losses and reductions in hours have resulted in millions losing employer coverage or the income needed to pay premiums, forcing them to join the already sizeable ranks of the uninsured. State marketplaces have stepped in to make sure previously uninsured individuals and those losing coverage have a source of coverage.
On June 5, 2020, executive directors from 14 state-based insurance marketplaces (SBM) sent a letter to Congressional leaders voicing support for federal efforts to reinforce insurance markets during the COVID-19 pandemic.
The Department of Health and Human Services (HHS) has issued the final Notice of Benefit and Payment Parameters (NBPP) for 2021 — the annual rule governing health insurance plans and health insurance marketplaces. While the final rule contains several changes, it does not significantly alter automatic re-enrollment for individuals who purchase through the health insurance marketplaces, which the federal government had proposed earlier this year.
The annual NBPP is of particular importance to insurers, insurance regulators, and marketplace officials who rely on the rule and its regulations to set the playbook by which health plans will be required to operate in the following year. The rule also sets requirements for system changes that marketplaces may have to implement as soon as the upcoming enrollment season.
The annual rule was issued May 7, 2020, the latest date that this annual rule has ever been released. As a result, the final regulations come very close to – or for some states after – the filing deadlines by which health insurers must submit their planned offerings for 2021. The delay caused health insurers to develop plans while operating under a level of uncertainty of what might be included in the final rule. Once released, insurers had little, if any, time to adjust their proposed filings in accordance with the changes finalized by the regulation.
Acknowledging the tight timeframe for implementing changes before the 2021 plan year, HHS delayed implementation of several of the requirements imposed under this rule until 2022 – including new requirements for medical loss ratio (MLR) calculations and changes to policies related to special enrollment periods (SEPs).
Delayed implementation of changes and deadlines required of insurers and insurance marketplaces is especially pertinent as markets face ongoing uncertainty resulting from the COVID-19 pandemic. As the country works to curb the spread of the disease, many questions remain about the pandemic’s long-term effects on insurance markets.
- How will consumers who lose employer-sponsored coverage and transition to individual plans affect the commercial insurance market?
- What will be the financial impacts of COVID-19 related treatments, including a possible vaccine?
- What will be the cost of consumers’ delaying or foregoing care?
- How will greater utilization of telehealth services impact costs?
Meanwhile, the health insurance marketplaces are operating in a new environment with increased enrollment of new consumers, all while modifying their operations, which include marketing and outreach strategies that comply with enhanced social distancing standards.
Major changes included in the rule are summarized below.
Annual reporting of state-mandated benefits. Federal law requires that health insurance plans sold in the individual and small group markets cover essential health benefits (EHB) and 10 broad health benefit categories, including hospitalizations, emergency services, and prescription drugs. States may impose benefits requirements in addition to the federal EHB requirement. Typically, benefit mandates lead to increased costs for health insurance. To insulate the federal government from increased expenditures on health insurance subsidies, which are calculated based on the cost of insurance premiums, states must defray the cost of any state-mandated benefits issued after Dec. 31, 2011, either by issuing payments to enrollees or insurers to cover the cost of these mandates. State-mandated benefits are also not allowed to be considered as part of federal advance premium tax credit (APTC) calculations or as part of cost-sharing limitations imposed on qualified health plans (QHPs).
Citing concerns that states may not be defraying the costs of state-requirement benefits, beginning in July 2021, states will be required to submit an annual report on state-mandated benefits outside of EHB. In the first year, states are required to include a comprehensive list of all state benefit requirements for QHPs sold in in their individual and small group markets. This will set a baseline – going forward states will only be required to submit an update to the report to include any new, amended, or repealed benefits. If no changes are made during a given year, a state may submit the same report. The report must accurately report information available within 60 days prior to the annual submission deadline. The rule also clarifies that insurers may refer to states to produce any cost analysis associated with additional benefits, rather than perform the calculations themselves.
The new requirement comes despite a majority of comments opposed to increased reporting, noting a lack of evidence that states were not in compliance with defrayal requirements and that such a requirement would be onerous and duplicative of processes already in place to assess the effects of state-mandated benefits. HHS asserts the reporting requirement should be complimentary to work already being conducted by states to assess these benefits and will help promote a uniform approach to assuring compliance with federal requirements across all states. The rule also stipulates that HHS will be providing additional technical assistance to states to address concerns over the lack of clarity about defrayal processes and identification of state-benefits that fall outside of EHBs.
Consideration of pharmacy price concessions and wellness incentives in medical loss ratio (MLR) calculations. Beginning in 2022, insurers will be required to deduct prescription drug price concessions from incurred claims considered as part of MLR calculations. Such concessions may include drug rebates or incentive payments given directly to insurers as well as those secured and retained by entities providing pharmacy benefit management (PBM) services or PBM-like entities. This is a change from previous requirements that only mandated inclusion of concessions received directly by an insurer and aligns with MLR policies already in place under Medicare and Medicaid. The change intends to even the playing field between insurers with PBM contracts and promote a uniform standard for what factors are considered when performing MLR calculations. HHS is considering additional rulemaking to provide precise definitions for prescription drug rebates and price concessions in advance of implementation of the new requirement.
HHS has also finalized changes that individual market insurers may include the cost of certain wellness incentives as quality improvement activities (QIA), which are considered medical care for the purposes of MLR calculations. Wellness incentives include rebates, discounts, waivers of cost-sharing, or other incentives provided as part of participation in a wellness program. This change conforms with how MLR calculations are assessed in the group market.
Inclusion of drug rebates into cost-sharing calculations. The rule permits, but does not require, insurers to count direct support offered by drug manufacturers (e.g., drug rebates, coupons) toward calculation of an enrollee’s cost-sharing responsibility. The rule clarifies that neither HHS nor the departments of Labor or Treasury will take enforcement action against insurers who exclude the value of direct support from cost sharing, even in cases where supports may incentivize take-up of brand-name drugs when generic alternatives area available.
HHS notes advantages to policies that include rebates as part of calculations (e.g., cost protections for consumers who use/need brand-name drugs) as well as policies that mandate exclusion of rebates (e.g., to incentivize use of generics where available). Application of the rule ultimately defers to state law and any restrictions states may impose on how direct supports are included in cost-sharing calculations. Insurers must apply their policies on direct support uniformly across all QHPs. HHS expects that issuers “prominently include” information on websites and other educational collateral explaining how drug manufacturer rebates are included in cost-sharing calculations.
Greater flexibility on plan selection available during a special enrollment period (SEP). Current rules maintain tight restrictions on the types of plans enrollees may select if enrolling during a SEP; usually requiring that consumers enroll in a plan at the same metal tier (of the same value) as previously held coverage. This is to ensure that consumers do not take advantage of SEPs to enroll in more generous plans because of an emerging health care need, as well as to provide greater consistency for insurers operating in the market. However, in a case where a SEP is triggered by an increase in income, the income change may render a consumer ineligible for cost-sharing reductions (CSRs), an additional subsidy given to individuals earning between 100nto 250 percent of the federal poverty level to cover out-of-pocket costs of care.
Loss of CSR eligibility may significantly alter affordability of certain health plans for a consumer. To account for this change, beginning with plan year 2022, consumers who lose CSR eligibility may enroll in a plan at a different metal level. The rule also allows consumers who are newly eligible for coverage to enroll in the same QHP as any dependents who are currently enrolled in QHP coverage through a health insurance marketplace.
Expedited effective dates for coverage obtained during a SEP. Current enrollment policies can lead to significant delays in effectuation of health insurance coverage. For instance, enrollees who enroll in coverage from the day 16 through 31 of any given month typically would not start coverage until the first of the month subsequent to the month that immediately follows their enrollment (e.g., if a person enrolled on June 16, coverage would not begin until Aug. 1).
Recognizing advancements in the time it takes issuers to process enrollments, in plan year 2022 insurers participating in the federally-facilitated marketplace (FFM) will be effectuating coverage on the first of the month following enrollment, regardless of the date the individual enrolled. State that operate their own marketplaces (SBMs) have flexibility to impose their own guidelines on effectuation dates – several have already accelerated the timeline for their issuers.
Limited flexibility for consumers eligible for retroactive coverage. A consumer may be incorrectly determined ineligible for coverage, in which case they can appeal the coverage decision. In some of these cases, the person may ultimately be eligible for coverage retroactive to a certain point before a determination of the eligibility was finalized.
Earlier rules had given consumers some flexibility over the start date at which consumers could retroactively elect coverage – which gave consumers some options in case they were in need of retroactive coverage, yet had concerns about paying premiums owed to cover all the months of retroactive coverage. The new rule eliminates this flexibility, and requires consumers to either begin their coverage retroactive to the entire period for which they should have been eligible for coverage or to begin coverage prospectively. The change is expected to have minimal effect as less than .05 percent of consumers with verification issues opted for retroactive coverage in 2018 and 2019.
SEP timeframe for Qualified Small Employer Health Reimbursement Arrangements (QSEHRAs). Current rules allow that consumers may qualify for an SEP upon becoming newly eligible for a QSEHRA, a type of health reimbursement arrangement (HRA) whereby employees can use the funds in the HRA to purchase health coverage sold through the health insurance marketplaces (for more information on QSEHRAs, read New Federal Health Reimbursement Proposal Adds New Variables to State Health Insurance Markets). The rule clarifies that the SEP applies even in cases where the QSEHRA’s plan year does follow the calendar year, the typical standard for the coverage year.
Maintains FFM user fee. Health insurers will be assessed at a rate of 3 percent to participate on the FFM, also known as healthcare.gov. For states that use a hybrid marketplace model, known as state-based marketplaces on the federal platform (SBM-FPs), HHS will retain 2.5 percent with 0.5 percent available to states to perform functions related to outreach, marketing, and plan management. Thirty-two states used the FFM in 2020, while six were SBM-FPs. (For more on health insurance marketplace models read Where States Stand on Exchanges.)
Eases process for coverage terminations and verifications. Consumers who are eligible for Minimum Essential Coverage (MEC), including most employer-sponsored coverage, Medicare, and Medicaid – are not eligible to receive federal subsidies to purchase coverage through the health insurance marketplaces. In the case where a marketplace determined that a person was dually enrolled in an exchange plan and MEC, a marketplace was required to redetermine the enrollee’s eligibility for subsidies before terminating that person’s coverage. This rule eliminates the requirement that marketplaces re-determine eligibility before termination, so long as the enrollee has opted in to be automatically terminated from coverage in this circumstance.
The rule clarifies that coverage terminations will be processed retroactive to the date of death in the case of an enrollee who has expired. The rule also clarifies that termination initiated by an enrollee will be effective retroactive to the date that the enrollee first attempted to end coverage, though SBMs are granted flexibility in how to apply this policy.
Finally, currently marketplaces must verify whether consumers are eligible for qualifying employer-coverage as part of determining whether consumers are eligible for marketplace subsidies. In some cases, insufficient data is available to perform this function, in which case marketplaces may use random sampling to verify eligibility. Due to limitations in sampling processes, including availability of adequate data, HHS is continuing its current policy to not enforce action against states that do not conduct random sampling.
Customization of QHP Quality Rating System (QRS) Display. Health insurance marketplaces are required to display quality ratings for insurance plans on their websites. The quality ratings are determined based on the federal QRS, which sets universal standards for the quality of health plans sold across all states. While the rule maintains federal governance over the QRS, it does grant SBM states flexibility in how they choose to display quality data. For example, SBMs may opt to include state-specific information related to quality in addition to QRS data.
Encouraging value-based insurance design. The rule does not explicitly mandate or incentivize adoption of value-based strategies, but does encourage insurer adoption of value-based insurance design principles consistent with policies supported by the University of Michigan Center for Value-Based Insurance Design, including benefit models that offer high-value services to consumers with little to no cost-sharing.
Adjusts factors used for risk adjustment calculations. Under the federal risk adjustment program, the federal government redistributes funds between health insurers that take on lower-risk enrollees, to those with a higher risk mix. Calculations are based on a complicated formula that computes risk based on various disease categories known as Hierarchical Condition Categories (HCCs). The rule updates the HCCs to conform with updated codes used to categorize diseases (a shift from ICD-9 to ICD-10 codes for disease classification). Other changes include a recalibration of how hepatitis C treatments factor into risk calculations and inclusion of pre-exposure prophylaxis (PReP), an HIV-prevention drug, as a preventative service. Collectively, these changes intend to ensure that risk adjustment calculations more accurately reflect current medical diagnoses and practices to ensure better assessment of risk taken on by insurers. The impact of these changes will vary by insurer and enrollee population.
Updated June 8, 2020
State Health Insurance Marketplace Directors Recommend Federal Efforts to Improve Coverage Affordability and Stability in Light of COVID-19
As the state-based marketplaces (SBMs) take steps to improve access to coverage during the COVID-19 pandemic, affordability of coverage and stability of insurance markets remain significant barriers to health insurance.
On June 1, 2020, SBM directors representing 12 state-based health insurance marketplaces sent a letter to Congressional leaders recommending actions that could help ease access to affordable coverage, including reinsurance, enhanced subsidies, and leniency on penalties for individuals whose income and employment fluctuations may lead to incorrect eligibility determinations.
The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) includes a Pandemic Unemployment Compensation benefit of $600 a week, which supplements traditional unemployment insurance (UI) benefits and provides an important source of additional financial support for individuals who qualify for these payments.
However, as highlighted in NASHP’s April 6, 2020 blog, Federal Guidance Needed to Clarify CARES Act Health Coverage Provisions, because these supplemental payments are counted as income for determining eligibility for marketplace subsidies – but not counted when determining eligibility for Medicaid and the Children’s Health Insurance Program (CHIP) – there could be challenges for both individuals and states.
States are required to use streamlined applications across their health coverage programs and several states (CT, DC, CO, MA, MD, MN, RI, VT, and WA) have developed fully integrated eligibility systems shared by their Medicaid and state marketplaces. States must closely coordinate across these agencies as any changes to application instructions or questions could have ramifications for eligibility determinations between the programs.
The Centers for Medicare & Medicaid Services (CMS) recently released guidance that provides information on ways that states can identify the $600 weekly payments that are to be disregarded when determining Medicaid and CHIP eligibility. While the guidance gives states implementation flexibility, the options offered could be burdensome for both state Medicaid and CHIP agencies and individuals. Some of the issues include:
- Complications in coordinating with state unemployment offices: The guidance suggests that state Medicaid and CHIP agencies can work directly with their state unemployment agencies to determine which individuals will qualify for the additional payments. Yet, implementing a plan to identify these individuals in close coordination with unemployment agencies that are already significantly stressed with handling increased consumer demand is expected to be challenging for states.
- Challenges in implementing system changes: CMS notes that state unemployment agencies have the option to include the supplemental payments within their regular UI payments, or make the supplemental payments separately, which could help identify the $600 supplement for health coverage purposes. Separating the supplemental $600 payment from an individual’s regular UI may create additional work for the unemployment agency at a time when they are least able to accommodate additional work, but it could help both Medicaid and CHIP agencies (and although not referenced in the guidance, the marketplaces) to account for those separated funds in eligibility calculations.
CMS suggests that if state Medicaid and CHIP agencies can identify and document that all UI recipients will receive the additional payments, they will be able to program their eligibility systems to automatically reduce all UI income by $600 per week until the additional payments end on July 31, 2020. While the guidance indicates that states can potentially receive a higher federal match rate for making these system changes, quickly implementing them on a temporary basis will be administratively difficult for states – and it also assumes that states will have the ability to determine that all UI recipients are eligible for the additional payments.
- Relying on individuals to correctly report income could create eligibility determination complications: CMS indicates that states can choose to provide instructions in application forms or in their call center scripts to direct individuals to not report the $600 per week additional payments in their income for Medicaid and CHIP eligibility determinations. States can also ask that individuals self-attest about whether or not their UI income includes the $600 per week of additional payments. But some individuals may still mistakenly report the supplemental payments or not provide the correct information about whether their UI income includes the additional payments, which could negatively affect their Medicaid or CHIP eligibility. It could also hamper the ability of states to make accurate eligibility decisions and could result in state eligibility determination workers having to conduct extensive outreach to clarify applicants’ income information.
An important, remaining issue is that the CMS guidance does not address how states should align Medicaid and CHIP eligibility determinations with the fact the CARES Act requires the $600 supplemental payments to be counted as income when assessing eligibility for marketplace subsidies. This is particularly concerning for low-income consumers who are deemed ineligible for Medicaid and then are deemed eligible for low or zero marketplace subsidies because the inclusion of the supplemental payments has pushed them into an even higher income threshold. Concerns also remain about whether consumers might face penalties for inaccurately reporting income because of confusion caused by the different reporting requirements.
Additional federal guidance from the Center for Consumer Information and Insurance Oversight is needed to ensure that states can make accurate and timely eligibility determinations and that individuals are efficiently enrolled in health coverage.
Update: March 2, 2020
State Insurance Marketplace Directors Express Concerns Over Potential Changes to Automatic Re-enrollment
Directors representing 15 state-based marketplaces submitted a joint comment to the US Department of Health and Human Services responding to its latest proposed rule governing health insurance markets. Their comments expressed concerns over future changes to automatic re-enrollment policies that may cause considerable consumer confusion and disrupt insurance markets. Their comments are available here.