As of the end of February, 4.2 million individuals enrolled in exchange coverage, making it unlikely that exchanges will reach their 6 million target for 2014. Several state-based exchanges (SBEs), including California, Connecticut, Washington, DC and New York, continue to increase outreach to last-minute shoppers, and exchanges are adjusting systems and operations in anticipation of the surge before the close of open enrollment. Experts worry that over the next few weeks, back-end technology issues compounded by high volume could lead to lost applications or confusion among consumers waiting for confirmation of coverage from issuers.
Meanwhile, preparation for the 2015 benefit year is increasing. This month, HHS released the Final Notice of Benefit and Payment Parameters for 2015. The final rule relaxed meaningful difference requirements for plans, raised the 2015 individual maximum out-of-pocket (MOOP) limit to $6,600, and extended the 2015 open enrollment period by one month, beginning Nov. 15 and ending Feb. 15, 2015.
For Medicaid, about 10.8 million individuals were determined eligible between Oct. 1 and March 13; Avalere estimates 2.4 to 3.5 million of these individuals are newly enrolled in Medicaid as a result of the ACA. Meanwhile, Pennsylvania submitted an 1115 waiver request to cover newly-eligible beneficiaries in exchanges via premium assistance beginning in 2015, with an optional work program and scaled-back premium requirements. New Hampshire’s Senate passed a premium assistance bill, which is expected to pass the House, and Arkansas’s premium assistance expansion survived a political challenge as the House passed a bill funding expansion through June 2015. Meanwhile, future expansion in Utah and Virginia is less certain as the states end their legislative sessions.
This article was excerpted from the March issue of State Reform Insights. For access, contact Hillary Bray at HBray@avalere.com.