SEPs

Back in March, the Health & Human Services (HHS) Dept. and the Centers for Medicare & Medicaid Services (CMS) proposed a so-called "Marketplace Integrity & Affordability Rule" which would include sweeping changes to how the ACA exchanges (both the federal one (HealthCare.Gov) and the 20-odd state-based ones (Covered California, MNsure, etc) operate, as well as who is or isn't eligible to enroll in ACA exchange coverage, restrictions on subsidy eligibility and so forth.

Many of these changes are simply repeals/reversals of improvements put into place during the Biden Administration; others are completely new ones being put into place by the Trump Regime under RFK Jr. & Dr. Oz.

However, until today, these were still technically only proposed changes. Now they're official. The final version isn't quite as bad as it could have been, and there's one or two items on the list which I'm not that upset about, but overall...yeah, it's pretty ugly.

This was actually announced a few weeks ago, but I was knee-deep in my Congressional District-level Enrollment Breakout Pie Chart project so I didn't get around to posting about it until now.

Via the Musk/Trump Admin's Centers for Medicare & Medicaid Services (CMS):

Today, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule to address the troubling amount of improper enrollments impacting Affordable Care Act (ACA) Health Insurance Marketplaces across the country. CMS’ 2025 Marketplace Integrity and Affordability Proposed Rule includes proposals that take critical and necessary steps to protect people from being enrolled in Marketplace coverage without their knowledge or consent, promote stable and affordable health insurance markets, and ensure taxpayer dollars fund financial assistance only for the people the ACA set out to support.

Last spring, I noted that total enrollment in healthcare policies either specifically created by or expanded to more people by the Affordable Care Act had broken 40 million Americans:

Across these 19 states alone, ACA Medicaid expansion enrollment is up 788,245 people since last March, or 6.7% overall. If you remove Missouri and Oklahoma, it's still up 4.28% since then, and again, this is still as much as 8 months out of date depending on the state. Assuming Illinois is wrong, removing it as well puts expansion enrollment up 5.4% since last March.

Assuming these states are representative, it's safe to assume that Medicaid expansion is up at least 4.3% nationally since March 2022, or around an additional 960,000 people. If you go with the higher end estimate (+5.4%), it would be up over 1.2 million nationally.

That puts the grand total at somewhere between 39.9 - 40.1 million people with ACA-enabled healthcare covered nationally.

The Affordable Care Act includes a long list of codified instructions about what's required under the law. However, like any major piece of legislation, many of the specific details are left up to the agency responsible for implementing the law.

While the PPACA is itself a lengthy document, it would have to be several times longer yet in order to cover every conceivable detail involved in operating the ACA exchanges, Medicaid expansion and so forth. The major provisions of the ACA fall under the Department of Health & Human Services (HHS), and within that, the Centers for Medicare & Medicaid (CMS)

Every year, CMS issues a long, wonky document called the Notice of Benefit & Payment Parameters (NBPP) for the Affordable Care Act. This is basically a list of proposed tweaks to some of the specifics of how the ACA is actually implemented for the following year (actually, it's the year after the following year, since the final rule is generally released in mid-December).

(Note: This was actually announced the day before CMS posted the December Medicaid Unwinding transition data.)

Via the Centers for Medicare & Medicaid Services (CMS):

HHS Extends Special Enrollment Period to Help People Transition to the Marketplaces, Issues New Resources for Partners, and Publishes Guidance Reinforcing Key Federal Requirements

Yesterday I noted that Idaho, which was the one of the first states to start "redetermining" Medicaid/CHIP enrollees the moment the Medicaid Unwinding process began last spring, has at least completed doing so; in the end, over 121,000 - 145,000 Idahoans got the boot, of which somewhere between 51,000 - 106,000 may still actually be eligible for Medicaid/CHIP coverage due to having their coverage terminated for purely procedural reasons.

Today, there's a consolation prize of sorts; via Your Health idaho:

Special Enrollment Period for the Loss of Medicaid Extended

Idahoans who have lost Medicaid coverage have until Nov 30, 2023, to enroll in health insurance through Your Health Idaho

via Connect for Health Colorado:

There Are Just a Few Days Left for Friday Health Plans Customers to Avoid a Gap in Coverage 

08/29/2023

  • Customers must enroll in a plan by this Thursday to have coverage that starts Sept. 1

DENVER— Friday Health Plans customers have less than three days to choose a new health insurance plan before their current health insurance coverage ends. Last month, the Colorado Division of Insurance announced that it had asked the courts to move Friday Health Plans into liquidation, ending coverage for all Friday Health Plans customers on August 31, 2023. Connect for Health Colorado, the state’s official health insurance marketplace, continues to urge Friday Health Plans customers to sign up for a new plan on or before this Thursday, August 31, to avoid a gap in coverage.

via Connect for Health Colorado:

08/14/2023

  • So far, about 46 percent of these customers have picked a new plan*

DENVER— Friday Health Plans customers have about two and half weeks* to choose a new health insurance plan before their current health insurance coverage ends. Connect for Health Colorado, the state’s official health insurance marketplace, is urging Friday Health Plans customers to sign up for a new plan before the end of the month to avoid a gap in coverage.

*Note that this press release was issued 9 days ago, so CO Friday enrollees actually only have 8 days left.

I thought I had finally posted the last entry regarding the Friday Health Plans debacle, but there's still some mopping up left to do in a few states.

via Connect for Health Colorado:

Friday Health Plans Coverage Ending August 31

DENVER— Today, the Colorado Division of Insurance (DOI) announced that they have asked the courts to move Friday Health Plans of Colorado into liquidation, which will end coverage for Friday Health Plans customers on August 31, 2023. 

Chief Executive Officer of Connect for Health Colorado, Kevin Patterson, released the following statement: 

October 2022:

...Well, just one day after the Bright Healthcare bombshell news broke, Texas-based health insurance broker Jenny Chumbley Hogue sounded the alarm on another large carrier bailing on Texas next year:

TX Marketplace Rumor Mill: Friday Health Plans is OUT for 2023. @LouiseNorris @charles_gaba @bjdickmayhew

— Jenny Chumbley Hogue (@kgmom219) October 12, 2022

And its confirmed. Email received from Friday. Buckle up folks! Individual OEP in Texas is going to be a bumpy ride! https://t.co/AMNJ4rPyr3

— Jenny Chumbley Hogue (@kgmom219) October 12, 2022

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