Resources from the Federal Government

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Proposed Rule: Annual Eligibility Redeterminations for Exchange Participation and Insurance Affordability Programs

Jul 2014

This proposed rule provides guidance on eligibility redeterminations and renewal of coverage through Health Insurance Marketplaces for plan year 2015. This rule offers Marketplaces two new alternative options for conducting annual redeterminations. It also details the requirements for the content of the renewal or discontinuation notices that health insurance issuers must send to their enrollees before the first day of the open enrollment period.


Premium Affordability, Competition, and Choice in the Health Insurance Marketplace, 2014

Jun 2014

As an initial step to understanding how the Health Insurance Marketplace is working in its first year of operation, this report provides an overview of health insurance plan premiums available in the Marketplace and the important role of the advanced premium tax credit (“tax credit”) in helping families afford coverage. The report analyzes data on the change in the premium cost associated with the tax credit for plans selected through the Federally-facilitated Marketplace during the initial open enrollment period. It also examines over 19,000 Marketplace plans for 2014 within the four metal levels (bronze, silver, gold, and platinum) for each of the 501 rating areas across 50 states and the District of Columbia. The analysis shows how differences in plan and market characteristics are associated with differences in premiums across the nation.


Medicaid & CHIP: April 2014 Monthly Applications, Eligibility Determinations, and Enrollment Report

Jun 2014

This monthly report on state Medicaid and Children’s Health Insurance Program (CHIP) data represents state Medicaid and CHIP agencies’ eligibility activity for the calendar month of April 2014. While the initial open enrollment period for the Health Insurance Marketplace ended on March 31, Medicaid and CHIP enrollment continues year round. CMS reports that Medicaid and CHIP enrollment grew by 1.1 million in April, which brought the total Medicaid and CHIP enrollment to 65 million people by the end of that month.


Narrow Provider Networks in New Health Plans: Balancing Affordability with Access to Quality Care

Jun 2014

Narrow networks contain a smaller number of providers and in-network facilities than traditional provider networks, typically resulting in lower premiums. This paper assesses the benefits and risks of a range of policy and regulatory options available to federal and state policy-makers on these narrow networks. The development, review and oversight of health plan networks involves trade-offs between premium costs and consumers’ access to and choice of providers. This paper makes clear that there is no current regulatory approach that can satisfy all stakeholders, but with the right balance between consumer choice and cost containment, consumers can receive quality care at an affordable price through narrow networks.


2013 National Healthcare Quality Report

May 2014

The Agency for Healthcare Research and Quality (AHRQ) has released its annual report on progress and opportunities for improving health care quality and reducing health care disparities. This report focuses on national trends in the quality of health care provided to the American people and the prevailing disparities in health care delivery as it relates to racial factors and socioeconomic factors. It is important to note that the report provides a snapshot of health care prior to implementation of most of the health insurance expansions and consumer protections included in the ACA and serves as a baseline against which to track progress in upcoming years. This year’s report also provides expanded analyses of people with disabilities, including children with special health care needs and adults with multiple chronic conditions.


Medicaid and CHIP FAQs: The Basic Health Program

May 2014

This set of FAQs released by CMS provides information regarding eligibility, benefits and cost-sharing for Basic Health Program (BHP) enrollees, and additional details about BHP administration, contracting, and financing by state governments. CMS is currently developing a BHP Blueprint template, and will be making it available to states shortly.


Information Reporting for Affordable Insurance Exchanges

May 2014

This document contains final regulations relating to requirements for Affordable Insurance Exchanges (Exchanges) to report information on enrollments in qualified health plans, and it directs exchanges to report to the IRS and to taxpayers certain information necessary to reconcile the premium tax credit with advance credit payments and to administer the premium tax credit generally.


Health Insurance Marketplace: Summary Enrollment Report for the Initial Annual Open Enrollment Period

May 2014

This is the sixth in a series of issue briefs highlighting national and state-level enrollment-related information for the Health Insurance Marketplace (Marketplace). This brief includes data for State-Based Marketplaces (SBMs), Federally-Facilitated Marketplaces (FFMs), and Marketplaces that are run by states in partnership with the federal government. This brief also includes updated data on the characteristics of persons who have selected a Marketplace plan (by gender, age, and financial assistance status) and the plans that they have selected (by metal level), and it includes self-reported race/ethnicity data on persons who have selected a Marketplace plan through the FFM.


February 2014 Monthly Applications, Eligibility Determinations, and Enrollment Report

Apr 2014

This report is the fifth in a series of monthly reports on state Medicaid and Children’s Health Insurance Program (CHIP) data, and represents state Medicaid and CHIP agencies’ eligibility activity for the calendar month of February 2014, which coincides with the fifth month of the initial open enrollment period for the Health Insurance Marketplace. This report includes state data and analysis regarding applications to Medicaid and CHIP agencies and the State Based Marketplaces (SBMs) and eligibility determinations made by the Medicaid and CHIP agencies. New for this month, this report also includes state data on total enrollment in the Medicaid and CHIP programs.


Risk Corridors and Budget Neutrality

Apr 2014

This set of Frequently Asked Questions addresses several questions about the risk corridor provision of the Affordable Care Act (ACA), including what HHS will do in the event that risk corridors collections are insufficient to fund risk corridors payment for a given year and how insufficient risk corridor payments will impact medical loss ratio calculations.

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