Getting enrolled in coverage was a milestone for millions of Americans in 2014. While the importance of this achievement cannot be overstated, these gains are at risk without a solid plan for managing coverage transitions and renewals in future years. In honor of World Cup fever, let’s imagine the coverage process as a soccer match! The first open enrollment period was really just the opening kick down the field in a continuous volley in which consumers report changes, switch plans and renew coverage as they move toward the goal of continuous coverage. Are states, federal agencies, assisters and individuals ready for the big match? Let’s consider some key factors in play.
As Gene Lewit reminds us in a recent report on enrollment experience from the Children’s Health Insurance Program (CHIP), there is a very real risk that individuals eligible for coverage will “churn” off at renewal, due to income changes, affordability issues, or simply being “lost” to coverage programs by not returning a form. Ensuring seamless transitions will be critical to retaining coverage gains.
Federal and state officials are working to create a streamlined renewal process based on electronic verifications that provides a seamless experience for consumers. Yet this first year is likely to be complex and confusing. Here’s why:
- Medicaid and CHIP renewals require states to use available information to complete the renewal process to the greatest extent possible and use a model, prepopulated form when new information is needed. What makes the process complicated this year is that states will not have all the income and household data they will need, both for all of the renewals of those already enrolled in Medicaid and CHIP and for some of those who are newly enrolled due to insufficient electronic data available or changes in circumstances. For some consumers a renewal might feel a bit more like a new application process. For a great backgrounder on Medicaid and CHIP renewal requirements, check out this CCF brief.
- Qualified health plan (QHP) renewals require both marketplaces and health insurance plans to get in the game under proposed guidance recently released by CMS. State-based marketplaces and the federally-facilitated marketplace (FFM) will be sending open enrollment notices in September 2014, letting all enrollees know about the renewal and change-reporting process, as well as timeframes and information on the availability of advanced premium tax credits (APTC). Plans will be responsible for informing enrollees about their options for renewal under the same plan (if it’s being offered) or a different plan and payment, including information about the premium and estimated tax credits (based on 2014 rates). Consumers will need to understand their coverage and subsidy options and act before February 15, when the open enrollment period ends.
These plans for 2015 renewals include more than a few nailbiters for consumers. Medicaid and CHIP agencies will need to locate and get information from consumers, but we know these links are often hard to make. States may need new tools to simplify this process, some of which CMS may be unveiling soon. The QHP process will also require active consumer participation. QHPs will renew consumers who don’t respond, which is good for continuity but could enroll consumers in coverage they do not want. Also, consumers receiving tax credits who have given the FFM permission to check their tax income will get the 2014 credit amount if they don’t ask the FFM for a new determination based on more recent tax data, putting them at risk for either overpaying for coverage or receiving too large of a tax credit. Consumers who didn’t give permission for the marketplace to request updated tax information will be renewed without a tax credit. Clearly, it pays to make sure tax credits are based on accurate information, so consumers will need to make a move. Finally, the plan’s renewal notice may come just before open enrollment begins, leaving consumers with little time to research options and make a decision given the holiday rush in November and December.
Consumers will need information and assistance to stay in the game. The good news is the key players have time to limber up before the big match. State and federal agencies can start by creating public media campaigns informing consumers about the renewal process and what it means to them. Assisters and agents can also play a critical role in educating consumers about renewal options and requirements. A recent Enroll America report found that one in five Americans needed direct personal assistance with enrollment—it’s safe to assume a similar proportion, if not more, will need help with renewals. With support, information, and engagement by all the players, we can win the coverage match and over the long term retain coverage for millions of newly enrolled individuals.
Want to hear more about fancy renewal footwork from Kentucky, Montana and Washington? Register for State Refor(u)m’s webinar on July 22 here, which will feature promising state enrollment and retention strategies.
What is your state planning for renewals? Join the conversation in our renewal discussion or let us know in a comment below.