Last week, the Departments of Health and Human Services, Treasury and Labor released a proposed revised template for the Summary of Benefits and Coverage (SBC), giving the public 30 days to comment before these long-coming changes are finalized (comments are due March 28, 2016). The process for implementing changes to the SBC template began in December 2014 but took a…
…coverage through the FFM, continue to face problems that often requires a human touch. Promising action steps to improve the customer experience include: dedicating a specialized unit in the FFM call center to resolving complex cases for immigrant families; providing functionality for the FFM call center to access the application to better manage and resolve complex cases; creating workflows for…
…this change in response to insurer complaints about special enrollment periods and the lack of a process to verify SEP eligibility. And the administration is between a rock and a hard place: it’s trying to appease insurers participating in healthcare.gov while trying to provide as many opportunities as possible for individuals to enroll. But this new approach with special enrollment…
…by the law itself: a waiver must ensure coverage is at least as comprehensive and affordable as the ACA, must cover a comparable number of residents, and can’t add to the federal deficit. In a recent blog post for the Commonwealth Fund, CHIR researchers Kevin Lucia, Justin Giovannelli, Sean Miskell, and Ashley Williams take a closer look at the states…
By Sean Miskell, Georgetown University Center for Children and Families Comparing outcomes across states provides an opportunity to consider how state-specific approaches to administering their health programs provide coverage to their residents and help them stay enrolled. Our readers certainly know that we like our 50-state tables here at Georgetown. The Commonwealth Fund has updated its interactive tool that allows…
…do I apply for an exemption? (FAQ 1.1.6) I live overseas, do I still have to comply? (FAQ 1.1.11) Some consumers may go to a tax preparer to get help with preparing and submitting their taxes. Last year, the I.R.S. received complaints about some preparers telling consumers incorrectly that they had to pay for being uninsured even when they had…
By Tricia Brooks, Georgetown University Center for Children and Families Last week, the 2016 federal poverty levels (FPL) were published in the federal register. How does this impact consumers applying for coverage through the Marketplace, Medicaid or CHIP? Let’s start with eligibility for Marketplace subsidies. For 2016 calendar year coverage, regardless of when someone applies or enrolls, eligibility is based…
…the agency responsible for oversight of the ACA’s market reforms, rightly followed a “good faith compliance” policy for insurers in 2014 and 2015. So long as insurers demonstrated good faith efforts to follow the law, CCIIO did not impose penalties or fines for non-compliance. However, the good faith compliance stance expired in December 2015, so insurers may begin facing actual…
By Tricia Brooks, Georgetown University Center for Children and Families For the most part, the Affordable Care Act aligns the way that Medicaid determines eligibility based on the same Modified Adjusted Gross Income (MAGI) rules used to determine eligibility for financial assistance in the Marketplace. But there are exceptions in Medicaid as I outlined in this blog. The differences can…
…them legitimately. CMS will provide additional information about this review and will use the results of its review to inform future policy. Second, it will review healthcare.gov call center scripts to ensure that they clearly inform consumers about penalties associated with providing false information on enrollment applications. Clarifying the Marketplace Residency Requirement and the “Permanent Move” SEP CMS also published…
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