Here’s another HealthCare.gov problem – and a workaround – that haven’t gotten much attention.
People can apply for Medicaid (traditional or expanded) via the federal HealthCare.gov website. But the applications still have to get transferred to the states which have to process them to finalize enrollment in the actual state program. And it’s supposed to be done by Jan. 1.
Guess what? That was a problem. With all the website woes, the feds weren’t able to process that information and had pushed back deadlines. Then, quietly, on the Friday of Thanksgiving weekend, CMS offered a transitional “administrative” fix through this federal policy guidance.
The states are allowed to use the minimal information on the so-called “flat files” to finalize the Medicaid status. The flat files had been pretty bare bones but CMS says expanded files will “include data elements such as: date of birth, Social Security number, eligibility category used for assessment or determination, and verification inconsistencies. The file will identify individuals who have been assessed or determined eligible for Medicaid and CHIP on the basis of modified adjusted gross income (MAGI).”
It would be good to check in with your state’s Medicaid director. Is this enough? Too little, too late? Will people be correctly enrolled in Medicaid by Jan. 1 – or will some be left uncovered, even if they did their part of the application process correctly?
Here’s a list of state Medicaid directors from the National Association of Medicaid Directors.
Photo: Carla K. Johnson
Dan Lustig, C. Scott Litch and Dr. John Rutkausas (left to right) spoke on a panel in Chicago about the Affordable Care Act.
Plenty of good story ideas await journalists willing to explore the nooks and crannies of the nation’s health care law. The Chicago chapter of AHCJ delved into some of these story ideas at a recent meeting titled “Fresh Stories Ahead for the Affordable Care Act.”
For instance, dental coverage for children is an essential health benefit under the law. Consumers in Illinois are able to buy pediatric dental coverage as a stand-alone plan, bundled with a medical plan or “embedded” into a medical plan. Panelist Dr. John R. Rutkausas, chief executive officer of the Chicago-based American Academy of Pediatric Dentistry, predicts consumers will be disappointed if they buy an embedded plan with a high deductible. It may be a rude surprise to learn they may have to pay all their children’s dental care out of pocket because they haven’t yet met their deductible. Continue reading
Three reports – all on various aspects of health care costs – caught my eye today:
The State of the Art of Price Transparency Tools and Solutions
A report released today by Catalyst for Payment Reform examines the price transparency tools and solutions. A summary can be found in the Health Affairs blog. An AHCJ webcast on Dec. 12 will feature CPR’s executive director and Katherine Hempstead of the Robert Wood Johnson Foundation for a discussion about transparency in health care costs. Continue reading
You have all probably gotten some emails about this website or that app that can give costs of various health plans in the new insurance exchanges. I’ve seen some that list plans county by county. People may be tempted by these easy tools because, on the surface, they look like a way around that pesky HealthCare.gov or some of the balkier state exchanges.
But there’s a problem. (There’s also a solution that I’ll get to, but keep reading.) The information on most of these plans is very general. And it’s “sticker” prices. Some don’t take into account the subsidies or other particular family circumstances. And that sticker price may produce enough “sticker shock” that people are scared off and don’t find out what they would actually pay, particularly if they are eligible for subsidies. Some of the calculators don’t include age, either, and that does affect what people will pay.
Nor do the calculators always produce the same estimated cost. I tried two different ones using the same information about a family I had spoken to in California. I got very different results – thousands of dollars different. Neither was close to what the family found when they did get on the California exchange. (In this case, the family’s costs did go up.)
The Arizona Republic did a consumer-focused story about the calculators in which they urged consumers to get on the real sites (which are – slowly – improving) and find out what the precise costs are for their unique family circumstances. Continue reading
Michael Hiltzik (@hiltzikm) of the Los Angeles Times has done some fine reporting about the bottom line on the health insurance cancellations.
In this piece, he reminds us that, until this wave of headlines about people losing their beloved individual health policies, people hated their individual health policies. Prices rose every year, benefits were skimpier than employer-sponsored coverage, there were lots of out-of-pocket costs, people got dropped from plans – and people who had pre-existing conditions couldn’t get plans.
“It’s time to retire the threadbare meme that the cancellation notices are depriving people of something they love, as though their health plans are as much as part of the family as the dog,” he wrote in what may be my single favorite sentence in a health care story of the past few weeks. Continue reading
Here’s a sign that paying more for better care and paying less for inadequate care is taking hold in a significant way. The federal Centers for Medicare & Medicaid Services (CMS) reported this week that 1,231 hospitals will get a performance bonus in fiscal 2014 under its Hospital Value-Based Purchasing program and 1,451 hospitals will receive an overall decrease in Medicare payment. Fiscal 2014 is the second year of the VBP program.
“We think this second anniversary deserves recognition – it’s a sign that value-based purchasing in Medicare is becoming routine,” wrote Patrick Conway, MD, in a blog post on the CMS site. Conway is CMS’ chief medical officer and director of the Centers for Clinical Standards and Quality.
“The Affordable Care Act gave CMS many new tools to convert Medicare from a program that paid for decades on automatic pilot into one that deliberately pays to promote better health,” Conway added. “Now, thanks to one of these tools, the Hospital Value-Based Purchasing program, Medicare is no longer a program that just pays the bills. Acute-care hospitals across the country not only are paid more for higher quality care, they also have skin in the game.” Continue reading
The federal government plans to release exchange enrollment figures once a month (here’s the first report), and they’re expected to give more demographic information (i.e. age, metal tier) in future updates. States have different timetables for releasing their statistics. To keep track of it all, the Kaiser Family Foundation has a new tool: the State Marketplace Statistics.
It has both the enrollment numbers as well as some other key stats to watch (when available):
- Completed applications
- Eligibility determinations, including how many people can enroll in a marketplace plan with financial assistance and how many qualify for Medicaid/CHIP
- How many have selected a plan
A few weeks into the cancellation crisis – some of which could be mitigated by the delay President Obama just announced – here’s what we know and what we don’t. In an upcoming post, I’ll highlight two very good stories exploring aspects of this.
The estimates on how many people are affected by plan cancellations vary widely. We’ve seen anything from “hundreds of thousands,” which is too low, to “up to 14 million,” which is too high. Continue reading
The U.S. Department of Health and Human Services has released the much-anticipated numbers for the first month of enrollment in the ACA’s insurance marketplaces.
A quick breakdown from the press release:
- 975,407 customers have gone through the process but have not yet selected a plan
- 106,185 Americans selected health plans
- 396,261 assessed or determined eligible for Medicaid or CHIP
The 28-page issue brief (PDF) from HHS has plenty of other numbers, including those for individual states and draws comparisons between the healthcare.gov rollout and the launch of other programs, including the Federal Employees Health Benefits Program, Medicare Part D, Massachusetts’ Commonwealth Care, and the Children’s Health Insurance Program.
Canceled health insurance policies are in the news for good reason. When health plans cancel policies, consumers immediately believe they will need to pay more for a different policy. And, it’s often true that new policies cost more. So, that’s a story.
And President Obama is on record as having said “If you like your doctor, you can keep your doctor, and if you like your health insurance, you can keep your health insurance.” Turns out those words were inaccurate and Americans are upset about that. That’s a story too.
But there’s a story behind these stories: Many of the health insurance policies being canceled now do not meet the minimum requirements all policies must meet under the Affordable Care Act. Plans need to offer essential benefits in 10 broad categories and those benefits are set in each state. Also, all plans need to protect consumers against big health insurance bills. Continue reading