In 2018, the number of children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) declined 2.2 percent. It is not known if these children moved to other sources of health coverage, like employer-sponsored insurance, or became uninsured until publication of the US Census Bureau’s American Community Survey this fall. However, last year’s decline is significant because there has not been a drop in child enrollment in Medicaid and CHIP since 2007.
Many states are re-assessing their approaches to Medicaid and CHIP outreach and enrollment and are interested in learning new, promising practices from others. The Centers for Medicare & Medicaid (CMS) recently awarded $48 million in outreach grants to 39 recipients in 25 states, including New Jersey’s Department of Health and Human Services, to enhance and improve enrollment of children in public coverage. Currently, CMS is accepting applications to distribute an additional $6 million in grant funds to states and community-based organizations to increase enrollment of American Indian and Alaska Native children in Medicaid and CHIP.
The federal grants are designed to help states generate effective outreach and enrollment strategies that all states can learn from and adapt for their own programs. The following highlights some of the ways that states are using community and school partnerships, social media, and other targeted outreach initiatives to ensure that families who may have eligible children are aware of these coverage programs.
While many states collaborate with community organizations to help enroll children in Medicaid and CHIP, Wisconsin’s outreach efforts via community partnerships are robust in scope and execution. The state takes a multi-pronged approach by engaging the Community Healthcare Access Program (CHAP), Covering Wisconsin (CWI), and the Milwaukee Enrollment Network (MKEN) to distribute information about health insurance – including CHIP – at local churches, daycare programs, neighborhood community events, and other social functions. CHAP has become an important health care coverage resource for Wisconsin families over the program’s 11-year history by using mobile hot spots, which allow enrollment workers to efficiently set up and manage events while streamlining the process of disseminating information to consumers and enrolling eligible children.
CWI employs focus groups so officials can better understand how to package information in consumer-friendly ways. Based on focus group feedback, CWI has created clear and concise informational materials targeted to specific audiences with easy-to-follow steps for families to sign up for Medicaid and CHIP. CWI also trains employees at local health centers and schools about how to educate residents (including parents) about available health insurance options.
MKEN, a coalition of about 100 organizations operating in Milwaukee County, targets low-income consumers and special populations by conducting outreach at job fairs, schools, pharmacies, and other community-based events. By conducting outreach through multiple organizations, Wisconsin leverages these partnerships to efficiently target multiple populations who may be eligible for Medicaid or CHIP.
School-based Outreach Efforts
Virtually every state has some form of “back-to-school” program at the core of its outreach efforts, and state health officials often coordinate with school administrators and nurses to enroll eligible children in Medicaid and CHIP. Connecticut’s health insurance exchange, Access Health CT, partners with the Department of Social Services and the Department of Education to identify uninsured students in the public school system and conduct targeted outreach to their families. A new state law mandates that each regional education board report every student’s insurance status. As a result of having various departments and agencies work together and mandating insurance status reporting, Connecticut has developed a comprehensive and coordinated approach to reach school-aged children who may qualify for Medicaid or CHIP coverage. Florida’s KidCare builds and maintains partnerships with school nurses and administrators to disseminate information about CHIP to the parents of potentially eligible children.
Medicaid and CHIP programs in many other states, including in North Carolina, Virginia, Arkansas, Massachusetts, and Missouri, partner directly with school nurses. School nurses are often privy to the insurance status of students, which helps them identify children who might be eligible for Medicaid or CHIP so they can provide their parents with information about the coverage. Wyoming has even recruited school counselors and psychologists to assist in monitoring insurance status and conducting CHIP outreach.
Social Media Campaigns
With the rise of social media use, many states have incorporated Facebook, Twitter, and Instagram in their outreach efforts. Social media as a tool for Medicaid and CHIP outreach is a cheap, effective method for engaging with low-income families. The nature of the platform also comes with built-in analytics, allowing states to observe the impact of their efforts, such as how many people were reached and how many interacted with the platform.
In May through July of 2018, Pennsylvania conducted an outreach campaign called “CHIP Strong,” and the social media portion of the initiative ran on Facebook, Instagram, and Twitter. Analytics from the campaign showed promising results. The campaigns generated:
- 16,627,352 impressions and 23,468 link clicks with an overall click through rate of 0.30 percent;
- 1,534 new page fans on Facebook; and
- 34 new Twitter followers and 131 conversations, all of which helps spread information about the coverage programs.
Arkansas also makes use of Twitter and Facebook to advertise its ARKids First program. State officials have found social media outreach to be particularly effective for targeting low-income parents. Florida uses the built-in analytics of social media platforms to assess data about how many people viewed an advertisement, how many people clicked on it, and the zip codes that enrollees live in to help target their efforts.
Targeted Outreach Initiatives
Many states tailor their outreach initiatives to ensure they are connecting with all potentially eligible families. For example, Florida’s KidCare program targets its outreach efforts by analyzing publicly available data from sources, such as the US Census, to identify uninsured or underinsured residents in certain counties for whom outreach and coverage educational materials may have the greatest impact. North Carolina uses a data-driven approach in its Division of Health Benefits’ enrollment dashboard. The real-time data collected through the website is organized by county, and enables comparison between regions, allowing for more precise targeting to populations eligible for Medicaid and CHIP.
Some states with significant Native American populations develop specific outreach partnerships to engage them. Of the 573 federally recognized tribes, 231 are in Alaska, so the state developed partnerships with Tribal Health Organizations to help spread the word about CHIP and Medicaid programs. Alaska initiated Tribal Medicaid Administrative Claiming (TMAC) in 2016 to strengthen the relationship between Alaska’s Department of Health and Social Services, promote access to Medicaid and Denali KidCare to Native Americans, and reimburse Tribal Health Organizations for performing Medicaid and Denali KidCare outreach and linkage activities.
Oklahoma’s Health Care Authority has a Tribal Government Relations Unit, which is responsible for working with tribal governments and their related health systems. Unit staff often attend tribal health fairs and other outreach events to enroll tribal citizens in public coverage and disseminate other health information. North Carolina also invests heavily in outreach to its eight Native American tribes by conducting outreach at various community events, including the Unity Indian Conference.
As this snapshot of programs demonstrates, state Medicaid and CHIP agencies use a wide range of thoughtful, tailored outreach strategies. States are continually working to find new ways to reach eligible children and efficiently target their outreach initiatives. The new federal outreach grants will help support states and community-based organizations to test new strategies to reach and enroll children in Medicaid and CHIP.
State health policymakers are eagerly waiting to see if Congress’ omnibus budget bill released this week will attempt to stabilize Affordable Care Act (ACA) insurance markets by reinstating ACA’s cost-sharing reduction (CSR) payments. An early proposal by US Sen. Lamar Alexander would fund the cost-sharing subsidies, which reduce a family’s out-of-pocket health care costs, retroactively from 2017 through 2021.
While this is a potential solution to how the federal government can subsidize health insurance for some consumers who purchase insurance through ACA markets, data collected by the National Academy for State Health Policy (NASHP) illustrates the complex interplay between marketplace subsidies and consumer decisions that states face.
States and insurers demonstrated incredible dexterity in quickly redesigning insurance plans in response to the Administration’s late-in-the-game decision to end CSR payments in October 2017. The result was that consumers faced new confusion as insurance plans were revamped and repriced in 2018, resulting in major enrollment shifts both off and within health insurance marketplaces. Below, NASHP presents 2018 enrollment data collected by state-based marketplaces (SBMs), which closely manage their own exchanges, highlight how state actions to address the loss of CSR funding influenced market decisions in 2018. Key findings indicate:
- Decreased enrollment in marketplace silver plans, especially among consumers who no longer had access to CSR subsidies and who did not qualify for tax credits;
- Enrollment growth in marketplace bronze plans;
- Mixed enrollment growth or declines in gold plans; and
- Mixed growth, and some declines in the total number of subsidized enrollees in the marketplaces.
The findings do not provide a complete picture of what has occurred in markets nationwide, as the data represent only 10 states and do not include complete information about off-marketplace enrollment patterns or full consideration of other factors that may have influenced enrollment during the 2018 enrollment period, including shortened enrollment periods and other factors influencing premium costs. However, they provide a glimpse into how states’ markets reacted to federal policy shifts and the serious ramifications of CSR changes wrought by Washington on consumer purchasing behaviors.
Under the CSR program, insurers are required by federal law to cover certain out-of-pocket expenses (e.g., deductibles, copayments, coinsurance) for enrollees with incomes below 250 percent of the federal poverty level (FPL). CSRs are only available through silver-level health plans purchased on the state or federal health insurance marketplaces. Typically, silver-level plans have an actuarial value (AV) of 70 percent, meaning that the plan must cover in aggregate at least 70 percent of the health care costs received under the plan. CSRs change the AV of plans by varying amounts depending on the income of the qualifying consumer (see Table 1).
|Table 1. Qualifying for CSRs|
|To qualify for the ACA’s CSR program, consumers must purchase silver-level health plans and have incomes between 100 to 250 percent of FPL, which in 2018 ranged from $16,642 to $30,150 for individuals and from $33,948 to $61,500 for a family of four.|
|CSR-Eligible Plan||Standard Silver||Silver 73||Silver 87||Silver 94|
|Income||Any||200-250% FPL||150-200% FPL||100-150% FPL|
The ACA designed the CSR program so that insurers would be reimbursed for expenditures incurred under the program, and would be paid back whatever costs were charged to ensure that consumers who received services were only paying out-of-pocket expenses in line with the AV of their CSR-eligible health plan.
Questions about the exact language of the CSR law spurred litigation over whether it was legal for the government to issue reimbursements without an explicit appropriation for the program. Pending the outcome of this litigation, the Administration stopped issuing CSR reimbursements.
Response to Elimination of Federal CSR Reimbursements
After the Administration stopped CSR payments last October, most state regulators directed their insurance carriers to adjust their 2018 premium rates to account for CSR losses. Not responding to the issue would have left insurers exposed to the lost federal funding, possibly resulting in insurers opting to not participate in markets. As CSR payments most directly affected silver-level plans sold on the marketplaces, most states and carriers opted to load premium increases onto silver-level plans offered through their insurance marketplaces. The Congressional Budget Office (CBO) estimated that silver plan premiums increased by 10 percent on average in 2018 in response to elimination of CSR funding. Among the states that operate their own marketplaces, only three did not load the increases onto their silver plans. These included:
- Colorado, which advised its insurers to distribute premium increases across all metal levels to mitigate the effect on silver-level plans;
- Vermont, which similarly distributed premium increases across all metal levels due to uncertainty over the effects of the changes on its uniquely-merged individual and small group markets; and
- Washington, D.C., which calculated that elimination of the CSR payments would have minimal effect on its market due to low enrollment of CSR-eligible individuals.
CSR Loading Had Differing Impacts on Subsidized and Non-subsidized Consumers
Silver-loaded premiums shifted the affordability and value of plans offered through marketplaces, distorting costs and participation in the markets. For consumers who were eligible for premium tax credits to subsidize their coverage (82 percent of marketplace consumers in 2017), some coverage options became even more affordable. This is because the tax credit is calculated based on the second-lowest-cost silver plan available to a consumer. As a result, as silver premium costs increased in response to CSR elimination, so did the total amount of tax credit a qualifying consumer could receive. This increase in tax credits — combined with more marginal increases in premiums for bronze- and gold-level plans than for silver plans — meant that both bronze and gold plans became more affordable for these consumers. Availability of these more affordable plans may have attributed to the enrollment increases seen in some states’ marketplaces.
While the silver-loading strategy served the important purpose of insulating lower-income consumers from CSR losses, it resulted in increases costs for consumers who were ineligible for tax credits. The increased premiums escalated affordability concerns and forced many of these consumers to seek cheaper options, either by enrolling in lower-value bronze plans or by disenrolling from marketplace coverage entirely. These changes had important repercussions for both consumers and insurers participating in the markets.
- Distorted market competition and enrollment. CSR payment elimination had disproportionate effects on marketplace insurers as they adjusted premium rates differently based on the proportion of CSR-eligible consumers enrolled in their plans. Insurers with a greater proportion of CSR-eligible individuals increased premiums by a higher amount than those with fewer CSR-eligible enrollees. In California, for example, CSR-induced premium rate increases ranged from 8 percent to as much as 27 percent. This lead to a distortion of premium prices between insurers and generated shifts in market share as consumers switched to insurers whose plans had smaller premium growth.
- Increased consumer susceptibility to out-of-pocket spending. The lower-cost bronze plans, which offer less coverage, enticed more consumers to purchase them. While this lowered consumers’ annual spending on premiums, the lower AV of bronze plans means that these consumers are at greater risk of higher out-of-pocket spending. This is especially true for consumers who were once CSR-eligible but switched from silver to bronze plans without considering the resulting out-of-pocket costs.
- Complete disenrollment from individual market coverage. While the total impact of CSR changes on enrollment cannot be known without additional data about off-marketplace enrollment, it is highly probable that premium increases and confusion over the changes in premium costs spurred some non-subsidized consumers to drop insurance coverage altogether. These drops in coverage led to altered market risk pools and premium increases.
Consumers Shifted Purchasing Patterns in 2018
While it is not possible to determine the absolute effect of CSR elimination on consumers’ behavior, initial data collected by the 10 SBM states indicate that state and insurer decisions to silver-load influenced consumers’ choices in 2018. Key patterns that emerged include:
- Disenrollment in silver-level health plans, especially among unsubsidized consumers: While the majority of consumers from these states continued to select silver-level health plans, there was an almost a universal drop in the proportion of enrollees selecting silver-level plans (exceptions include Colorado and Vermont, which did not silver-load, and Minnesota, whose Basic Health Program for consumers earning up to 200 percent FPL offset the effect of CSR losses.) As expected, shifts away from silver plan selections were more common among individuals who did not receive tax credits.
- Growth in enrollment in bronze plans: There was almost universal growth across all states in the proportion of enrollees who selected bronze plans, with the exception of Minnesota and Vermont, which only saw marginal reduction in bronze plan selections.
- Varied growth or disenrollment in gold plans: Changes in gold selections vary across states, from Colorado where the proportion of gold enrollments dropped by nearly one-third to Maryland where gold enrollments increased nearly four-fold.
Different trends in enrollment among subsidized and unsubsidized consumers in these states indicate that CSR policies did not by themselves drive shifts in enrollment. It is also likely that the total effect of the CSR issue varied greatly across all states, depending on several factors including:
- The proportion of unsubsidized marketplace consumers in the state — especially those enrolled in silver plans who were most susceptible to silver-loaded premiums; and
- Baseline premium prices of bronze or gold alternatives for consumers seeking to shift away from silver plans.
Investments in education and outreach also affected how consumers responded to CSR-loading in various states. The Massachusetts’ Health Connector, for example, was among several states that took extensive steps to urge its unsubsidized silver-plan enrollees to seek more affordable options either on or outside the marketplace. Connector officials reported that they were successful in moving 82 percent of affected enrollees into new coverage plans. This meant that 18 percent of unsubsidized consumers remained in silver plans, despite its aggressive outreach efforts to inform consumers about the availability of more affordable options.
Outlook for States and Markets Pending Federal Action
While this information provides a snapshot of enrollment patterns in 2018 from 10 states, it indicates that responses to the CSR funding elimination had diverse effects on states’ markets and consumers. Similarly, if CSR funding is reinstated, the effect will reverberate differently across states’ markets and consumers. Significant changes could mean another year of disruption for insurers, who will need to adapt products and rates based on shifting federal policy, and consumers, who may need to once again actively shop around and switch plans next year. The CBO estimates that 500,000 to 1 million consumers would become uninsured from 2020 to 2021 if CSR funding was reinstated. These would mostly impact consumers with incomes between 200 to 400 percent FPL who would no longer would benefit from tax credits, which are larger than CSR subsidies.
While states and insurers rapidly responded to the Administration’s decision to end the CSR program in 2017, an absence of clear policies and continuous last-minute changes will spur unrest in markets. Without sustainable policies to stabilize the individual market, consumers will face higher costs, confusion, and anxiety about whether insurance coverage will be available when they need it.
While CSR funding remains a concern to some states, states are also seeking solutions that could bring immediate stability to markets, such as federal reinsurance funding. Whatever policies are implemented this spring, time is of the essence as state regulators are already in active negotiations with their insurers for 2019 offerings, with rate filings expected in some states as early as May. Ideally, future federal policies will grant states sufficient time and flexibility to respond to policy changes in a manner most appropriate for their markets.
Click here to view a chart comparing marketplace enrollment by metal level in California, Colorado, Connecticut, Idaho, Maryland, Massachusetts, Minnesota, Rhode Island, Vermont and Washington State.
On November 1, health insurance marketplaces officially opened to millions of individuals for 2016 enrollment. Early reports indicate a smooth launch of the open enrollment season, partially due to several new tools to ease enrollment and renewal processes for marketplace consumers.
Smarter Plan Comparison Tools
Recent articles have featured the many new shopping tools available on healthcare.gov, the health insurance marketplace used by the 38 states opting to use the federal platform. Similarly, many states operating their own marketplaces are launching a slew of new tools that will enable consumers to make smarter choices across their coverage options. New or enhanced “shop-and-compare” tools in California, Connecticut, Massachusetts, Minnesota, and the District of Columbia will enable consumers to make informed comparisons across their plan choices. Kentucky’s tool allows consumers to enter basic information about health conditions, medications, and frequency of doctors’ visits to generate plan recommendations and costs. Similarly, Connecticut’s tool allows consumers to select from a list of common medical conditions, which they can also rate by severity, to calculate costs. Furthermore, the tool is connected to the state’s all-payer claims database (APCD) to draw in more accurate and real-time data on costs.
Smoother Enrollment and Renewal Experiences
Improved system performance was the focus of several states, including Rhode Island and Vermont, which installed major systems upgrades to fix enrollment glitches from prior years. The District of Columbia has streamlined its online application; reducing the number of screens a consumer will “touch” to complete his or her application from 28 to eight. To ease traffic, which can slow systems, Idaho and Maryland enabled advanced plan browsing, encouraging consumers to educate themselves early about their plan options. California allowed current enrollees to come in as early as October 12 to renew plans, or shop for a new one.
Improved Provider Directories
States are easing consumers’ ability to find information about provider networks through marketplaces plans. The District of Columbia’s new Doctor Directory allows consumers to search for providers by name, location, specialty, and language(s) spoken (English or Spanish). To ensure accuracy of information, the District has also implemented a monthly reporting mechanism to inform both health plans and the marketplace about inconsistencies in Directory information. Massachusetts’ provider search can provide information about which plans include inputted physicians, and acute-care hospitals. In the future, the state is considering adding community health centers, mental health providers, and social workers to the searchable list. Maryland will continue to have its provider search tool managed by the state health information exchange, known as CRISP, which enables real-time information sharing about providers in both commercial and Medicaid coverage.
Enriched Customer Service and Support
Adapting to reach both the remaining uninsured as well as the evolving needs of current consumers, states have revamped their consumer support strategies to serve their target consumers. California is doubling the number of “storefronts” it will open during this enrollment period to provide consumers with in-person support services. Minnesota is tripling the number of enrollment centers it will open to allow consumers to get assistance from certified brokers and navigators as well as piloting a new portal to facilitate the ability of assisters to complete applications on behalf of enrollees. Massachusetts has opened four new walk-in centers, including three at community health centers, to offer expanded face-to-face assistance to applicants. Maryland is launching a pilot that will enable its call center to transfer applicants directly to brokers to complete enrollment—giving consumers access to enrollment experts while reducing the burden on its main call center staff. Washington has updated its online consumer resources including a new enrollment guide and glossary of key terms.
Open enrollment runs from November 1, 2015 through January 31, 2016. Over that time, we will monitor enrollment activity across all marketplaces and share updates about how states are working to bring new consumers to their doors including targeted marketing and use of data and surveys to direct outreach work.
The Affordable Care Act’s (ACA) third annual open enrollment period kicked off November 1st and continues through January 31, 2016. During this time, individuals can enroll or renew coverage in qualified health plans through state and federal exchanges. The ACA’s open enrollment period is a great time to focus on reaching and enrolling children as well as their parents and other eligible adults. Research shows that parents who are enrolled in health coverage are more likely to enroll their children in coverage.
Although, very few children obtain their coverage through exchanges, as they are predominately enrolled in employer sponsored insurance or are eligible for Medicaid and CHIP, the Children’s Health Insurance Program (for which enrollment is open year round), open enrollment is a good time to remind families about the public and publicly subsidized coverage available for their children. By capitalizing on the current increased attention on health coverage, there are steps states can take to make sure children are part of outreach, enrollment and retention efforts.
NASHP recently published an issue brief that shares state strategies for reaching, enrolling, and retaining children in coverage during early implementation of the ACA. The promising practices discussed in the brief were surfaced during work with NASHP’s Children in the Vanguard network which, since 2011, has brought together teams of state Medicaid and CHIP officials with child health advocates to work together to advance child’s coverage. Many of the promising practices included in the paper are the direct result of the strong working relationships established between state officials and advocates.
State teams took creative approaches to maintain a focus on children’s coverage, and their strategies emerged in themes:
- Targeting outreach efforts to specific populations
In Ohio, Medicaid officials engaged underserved minority communities to reduce enrollment barriers.
- Engaging and educating new partners
Rhode Island child health advocates developed a business process plan to engage partners, such as WIC offices, in a new Medicaid and CHIP renewal process.
- Keeping children enrolled in coverage
In Washington, officials created a streamlined renewal form for Medicaid and CHIP, and the state has seen its retention rate for family, children, and pregnancy Medicaid cases increase from 84 percent before 2014 to 91 percent today.
For more examples of ways state officials and advocates are working together to advance children’s coverage, read Promising Practices in Reaching, Enrolling, and Retaining Children in Coverage During Early ACA Implementation.
The Patient Protection and Affordable Care Act (ACA) included new eligibility and enrollment requirements, which have presented states with significant implementation opportunities and challenges. Although states had choices about whether to host a health insurance exchange or expand Medicaid, the ACA required all states to make major changes to Medicaid eligibility policy, including adding mandatory coverage of new groups, implementing streamlined eligibility and renewal , incorporating new eligibility and verification requirements, and coordinating enrollment systems with exchanges.
As a result, states had to create or significantly update existing systems, collaborate and coordinate with other state and federal agencies, and develop new processes to support enrollment. States implemented these changes within a constrained timeframe, with much activity occurring between the Supreme Court ruling in NFIB v. Sebelius in summer 2012 and the first open enrollment period in fall 2013. In addressing the challenges of ACA implementation, many states and federal agencies were highly innovative, developing approaches that set a new standard for promoting effective enrollment in public programs.
Drawing on key informant interviews and ongoing engagement with states between 2013 and 2015, this brief examines states’ early experiences implementing ACA’s eligibility and enrollment requirements; highlights promising practices and lessons learned; provides some context on the state experience; and concludes with possible areas of focus for future enrollment and implementation efforts. With the recent Supreme Court decision in King v. Burwell, there is new momentum for state and federal agencies to learn from early experiences with ACA implementation to further improve enrollment systems in future years. This brief offers reflections to support continued growth and movement.
|Download the Brief|
The states featured in this chart have demonstrated how to quickly build effective retail enrollment centers. As SBMs, the Connecticut, Colorado, and Kentucky exchanges were uniquely situated to reach target populations and try dynamic, innovative outreach methods to increase enrollment. SBMs have more centralized control over multiple aspects of outreach and enrollment processes than other states because the responsibility and authority for outreach is housed within the SBM, allowing the SBM the ability to tailor communications to the unique enrollment and assistance landscape, opportunities and challenges facing that specific state.
NASHP gathered information to create this chart through key informant interviews, email queries to state officials, and research supported by the Robert Wood Johnson Foundation’s Enrollment 2014 project, a one year project in which NASHP interviewed state leaders and stakeholders in 10 states with early success in enrollment and supported engagement of FFM state officials in Medicaid, CHIP, and Insurance/Exchange agencies. Although the information below reflects the step-by-step considerations of building pop-up shops for outreach and enrollment into health coverage programs by SBE agencies, other state agencies may also use this model to develop retail enrollment centers for other programs. Has your state also used a retail enrollment center approach? Please let us know – we welcome information from other states with similar experience.
|State||State Exchange Structure||Number/ Location of Stores; Hours of Operation; Selection Process||Staffing||Operational Costs & Expenses||Physical Plant||Number of People Enrolled at Stores; ROI||Development Timeline|
|CO||State Agency:||Number/ Location:
1 store in Downtown Denver (Years 1 and 2) (1)Operating Hours:
M-F: 10am-6pm Sat: 12pm-6pm Closed Sunday (except on open enrollment deadline)Location Selection:
Note:Usually 4-5 workers at store
$16,000 rental$42,314 operational (furniture, wifi, signage, security, etc.)Additional Expenses:
Night security (amount not provided)
Repurposed staff laptops & work cell phones; no new equipment purchasedRetail Space:
2,000 sq. ft. 4 month lease (Nov. 1-Feb. 28)Process for Establishing:
238 enrolled1,055 assisted (not including individuals who called or were assisted but didn’t want to be tracked)ROI:
(2)$206.06 per enrollee$55 per customer assisted 2Other Benefits:
Work-plan fully developed 3 months prior to launchPhysical Plant:
Scouted physical locations 2 months prior to launch; finalized location 1 month before launchStaffing:
1 month to plan; planning began 3 months prior to launch Identified sign-up tool to fill unique shifts by brokers, navigators, and staff
Connecticut Health Insurance ExchangeExchange Name:
Quasi-public entity established bystate law
2 stores: New Haven & Hartford (Year 1)Operating Hours:
10am-8pm most daysLocation Selection:
$136,000 for both storesOperating Budget (Per Year):
$140,000 (not including staff time)
20 laptops per store (only about 15 in use at a time)Retail Space:
2,200 sq. ft each; 1-year leaseAcquisition:
Real estate agent helped survey properties/select spaceProcess for Establishing:
7,639 enrolled15,191 assistedROI:
(3)$36 per enrollment$18 per individual assistedOther Benefits:
|Planning: **Physical Plant:**Staffing: **|
|KY||State Agency:||Number/ Location:
1 store in Fayette Mall, Lexington, KY (Year 2)Operating Hours:
10am-9am (mall hours)Location Selection:
$60,000 (including reusable materials)Operating Budget (Per Year):
Note:connectors and agents used their own equipment.
1540 sq. ft.; 4 mo. lease (Nov. – Feb.)
Process for Establishing:
Worked with a marketing firm and advertisements; approached the mall about a temporary lease.
Over 5,900 enrolled7,600 visited the storeROI:
$27 per enrollment$21 per assistedOther Benefits:
2 months to plan; planning began 3 months prior to launchPhysical Plant:
1 month to install fixtures and prepare physical plant (after the design/layout was finalized); began 1 month prior to launchStaffing:
2 months of planning prior to launch; ongoing changes during first weeks of operation; by 6 weeks following launch the staffing plan was finalized
(2) ROI determined by dividing overall cost by number of people helped ($58,000/1,055=$55); however, this ROI does not reflect actual cost per person assisted given larger volume of individuals that were helped not tracked in the system.
(3) Estimated based on $276 total annual costs divided by number of individuals enrolled or assisted. Note that this does not take into account the staff time invested in developing and supporting the center.
(4) Added consumer representative role 1 month after launch, upon realizing consumers needed help at the beginning of the process to route them to the right assisters for help.
Advanced Premium Tax Credits (APTC) and plan renewals for consumers already enrolled in a plan through the marketplace, as well as some of the resources states produced to educate consumers about renewal and enrollment options.
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|States||Type of individual marketplace||Will the marketplace conduct auto-renewals for any QHPs?||How are Advanced Premium Tax Credit (APTC) redeterminations being handled?||Consumer renewal resources from states (notices, renewal packets, infographics, etc.)|
|Federally-Facilitated Marketplaces (FFM) & State Partnership Marketplace (SPM) States (AK, AL, AR, AZ, DE, FL, GA, IA, IL, IN, KS, LA, ME, MI, MS, MO, MT, NC, ND, NE, NH, NJ, NM, OH, OK, PA, SC, SD, TN, TX, UT, VA, WA, WV, and WY) ||FFM or SPM||Individuals who did not return to Healthcare.gov had their current plan renewed or were renewed into similar plans effective January 1, 2015 (slides 5, 10-12).||Autorenewed individuals were eligible for their2014 APTC amounts (slides 5, 11). Individuals who returned to shop for new plans on HealthCare.gov received a redetermination for APTC eligibility.|
|CA||State-Based Marketplace (SBM)||Yes, members who did nothing by December 15, 2014 (slide 21) are automatically renewed into the same plan and metal tier for 2015.||Redeterminations are done for Covered California members returning to Covered California to renew and to those who took no action within 30 days of receiving a renewal letter (slide 21) from Covered California. Current enrollees are encouraged to consent to Covered California’s income verification for APTCs to be renewed.|
|CO||SBM||Yes, eligible enrollees who made no changes to their account by December 15, 2014 were automatically renewed into the same plan they had in 2014.||Colorado automatically redetermines APTC eligibility for households that received APTC in 2014 with the necessary income information available through the federal system.||Connect for Health Colorado Renewal Infographic,Connect for Health CO Redeterminations & Renewal FAQ,C4HCO Annual Plan Renewal Customer Walk-Through (slides 8-10), Time to Renew|
|CT||SBM||Yes, qualified individuals who did nothing before December 5, 2014 (slide 34) were renewed into the same or a similar plan (slide 31) as they had in 2014.||Access Health Connecticut is performing 2015 APTC redeterminations with the data they have on file. If a consumer has not updated his or her information, he or she will be reevaluated with existing 2014 data.||Access Health Connecticut Renewal Packet|
|DC||SBM||Yes, if an enrollee does not select a new plan or terminate their plan, DC Health Benefit Exchange (HBX) will automatically re-enroll that consumer into the same or a similar plan they had in 2014and a 60 day special enrollment period will be triggered on the first day of automatically enrolled coverage.||DC HBX does redeterminations with the most recent information they have on file; consumers are encouraged to contact DC HBX with updates to their information.|
|HI||SBM||Yes, Hawai’i Health Connector automatically renews 2014 enrollees who take no action into the same or similar planwhere available for 2015.||Hawai’i bases renewals on the information currently in their system and is encouraging enrollees to update this information online or by phone.|
|ID||SBM||Yes, Your Health Idaho automatically re-enrolled consumers in their same plan for the 2015 plan year if they did not pick a new plan before December 15, 2014.||Your Health Idaho ran redeterminations for 2014 enrollees with APTC and sent out notices in early November 2014.|
|KY||SBM||Yes, if a consumer takes no action, Kentucky automatically re-enrolled eligible consumers in their 2014 plan if available in 2015. Kentucky advised consumers who did not have authorized data checks with the federal hub, that any payment assistance they received in 2014 was terminated effective December 31, 2014. These consumers were enrolled in their 2014 plan at full cost effective January 1, 2015.||Redeterminations were conducted for consumers that have authorized data checks with the federal hub.|
|MD||SBM||Yes, but only in limited circumstances for non-subsidized QHP coverage. Because the state was transitioning to a new exchange system, Maryland required all 2014 enrollees to submit a new application in the new system to renew their coverage in order to receive financial assistance. Consumers who did not reapply by December 18, 2014 were auto-renewed into the same plan for 2015, but at full cost with no financial assistance.||All consumers are being asked to reapply on the marketplace for a 2015 APTC determination.|
|MA||SBM||No, all eligible residents have to reapply through the new Massachusetts Health Connector system in order to be enrolled.||All eligible residents have to fill out new applications for coverage to receive a determination of APTC eligibility and to receive coverage through Health Connector 2015.|
|MN||SBM||Yes, MNSure automatically renewed enrollees into the same plan they had in 2014 at the 2014 APTC levels if the enrollee did nothing by December 15, 2014. Additionally, Minnesota law requires consumers who do nothing be automatically re-enrolled in their 2014 plan. Individuals with plans no longer available on MNSure are automatically renewed by the insurance company with no APTC and at new 2015 premium rates.||2015 APTC determinations are triggered when a consumer takes action during open enrollment. If a consumer does nothing, APTC will be continued at 2014 levels.||MNSure current enrollee notice, MNSure QHP Renewal Overview Reference Guide (for Assisters)|
|NV||Federally-supported SBM||Yes, Nevadans who did not re-enroll, by December 15, 2014, will be auto-renewed into a health insurance plan for 2015 that does not offer any financial assistance.||Nevada only performs determinations and offers APTCs to those who re-apply through Nevada Health Link.||Nevada Health Link 2015 Updates|
|NY||SBM||Yes, enrollees qualified for full administrative renewal are automatically re-enrolled (slide 8) into their 2014 plan for 2015 with enrollment effective January 1, 2015. Enrollees qualified for partial administrative review (slide 11)are not required to fill out a new application (slide 13) but need to actively select a plan to re-enroll.||APTC redeterminations were performed for all 2014 enrollees for whom data was available through federal and state sources.|
|OR||Federally-supported SBM||No, all customers must renew through Healthcare.gov||APTCs are available to qualified individuals through HealthCare.gov. All non-Medicaid/CHIP consumers must apply through Healthcare.gov to receive APTC in 2015.|
|RI||SBM||No, all consumers are required to submit new applications through Health Source Rhode Island. Coverage took effect January 1, 2015 for plans selected by December 23, 2014.||APTC determinations are only available through the 2015 plan year application.||Renewal Packet|
|VT||SBM||Yes, unless additional information is needed, qualified enrollees will have the same plan they had in 2014 renewed for 2015.||Vermont performed redeterminations based on the most recent information they have from consumers and will request more information if needed.|
|WA||SBM||Yes, eligible consumers who did not take action before December 23, 2014 were auto-renewed into the same plan or a cross mapped plan (slide 6).||Annual eligibility redeterminations were automatically performed for the 85% of enrollees who approved access to federal tax information.||Washington HealthPlanFinder Renewal Checklist,Washington HealthPlanFinder Renewal Timeline,Washington HealthPlanFinder Renewal Fact Sheet|
 All federally-facilitated marketplace (FFM) or state-partnership marketplace (SPM) states follow the same procedure for renewals. This row includes information about renewal processes for these states
Beginning in October, 2013, states initiated their first open enrollment period for health coverage under the ACA. While state approaches varied, all states implemented new rules, system interfaces, and data reporting methods required under the ACA. What are states learning so far about what works to enroll eligible individuals and what are their top-line priorities getting ready for the next open enrollment period in November 2014? This webinar provides an opportunity to learn about promising strategies and innovations states are piloting related to enrollment and retention into insurance affordability programs, including through state-based exchanges and coordination with the federally facilitated marketplace (FFM). State panelists from Kentucky, Montana and Washington share experiences and enrollment successes. NASHP also shares new findings from research with 10 states documenting promising strategies, common challenges and trends in state enrollment experience as part of the Enrollment 2014 project.
- Anne Gauthier, Director, State Health Exchange Leadership Network, National Academy for State Health Policy (Moderator)
- Alice Weiss, Director, Enrollment 2014 Project, National Academy for State Health Policy
- Carrie Banahan, Executive Director, Office of Kentucky Health Benefit Exchange (Kynect)
- Christina Goe, General Counsel, Montana Commissioner of Insurance
- Nathan Johnson, Division Director, Health Care Policy, Washington Health Care Authority