States and the Department of Health and Human Services (HHS) are testing exchange eligibility and enrollment systems and websites and executing final plan contracts with October 1 just a few weeks away. HHS executed contracts with plans in federally-facilitated exchanges (FFEs) on September 11; however, final information on plan participation and premium rates will not be released until October 1. Forty-two states have released some information on participating plans for 2014, with plans and states continuing to make adjustments this month. For example, in Washington, the exchange approved revised QHPs from Kaiser Permanente and Washington Community Health Plan after rejecting their initial bids. Nationally, regional plans comprise one-third of participating carriers and are expected to have strong exchange market share. However, the lack of national payer participation in many states could lead to less competition than originally anticipated.
With HHS’ announcement that the federal data hub is ready, exchanges face one fewer hurdle to launch on time. However, questions remain on whether eligible individuals will enroll in coverage and how. As a result, marketing and outreach activity continued to be a priority this month. California launched an $80 million marketing effort, and HHS purchased $12 million of TV ad time in 13 FFE states. States continued to make progress on consumer assisters programs, although these entities are not without controversy. For instance, while Connecticut and Kentucky awarded contracts to community organizations to serve as consumer assisters, Florida decided to not allow Navigators on the grounds of county health departments.
A few states are looking beyond 2014 to other requirements and consumer needs. Washington will collect quality data in 2014 for display during open enrollment in October 2015. Covered California continues to try to make plan quality information available to consumers and is considering using existing data to publish quality scores for all QHPs that have networks that are at least 80% similar to the network of an existing commercial plan offered by the same carrier.
Meanwhile, Medicaid expansion activity is picking up as state legislatures come back into session. States and HHS are working on numerous waivers to find flexible ways to expand as many Medicaid programs as possible. Michigan’s Gov. Snyder (R) signed a Medicaid expansion plan into law, though it will require waiver approval from CMS. Iowa submitted two waivers to CMS for a hybrid premium assistance and traditional Medicaid expansion approach. CMS approved one-year waiver extensions for Indiana and Oklahoma with the understanding that the states are reconsidering the Medicaid expansion as current coverage continues. Last, California submitted a three-year waiver request to test Medicaid bridge plans that aim to mitigate the effects of churning between Medicaid and exchanges.
This article was excerpted from the September issue of State Reform Insights, which highlights the impact of state ACA implementation activity on life sciences, providers and plans in one comprehensive monthly source. For access, contact Caroline Pearson.