Resources from the Federal Government

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Program Integrity Final Rule: Exchange, Premium Stabilization Programs, and Market Standards

Oct 2013

This final rule outlines financial integrity and oversight standards with respect to Affordable Insurance Exchanges, qualified health plan (QHP) issuers in Federally-facilitated Marketplaces (FFMs), and States with regard to the operation of risk adjustment and reinsurance programs. It also establishes additional standards for special enrollment periods, survey vendors that may conduct enrollee satisfaction surveys on behalf of QHP issuers, and issuer participation in an FFM, and makes certain amendments to definitions and standards related to the market reform rules.


Shared Responsibility Provision Question and Answer

Oct 2013

This most federal guidance clarifies that individuals have until March 31, 2013 to enroll in coverage through the health insurance marketplaces to avoid being subject to the penalty for not maintaining minimal essential coverage.


Medicaid Enrollment: June 2012 Data Snapshot

Oct 2013

In June 2012, Medicaid enrollment reached 54.1 million as high unemployment and falling incomes led many families to turn to Medicaid for coverage. However, as economic conditions improved, enrollment growth in Medicaid slowed. An additional 1.3 million people enrolled in Medicaid between June 2011 and June 2012 (a growth rate of 2.5 percent) compared to the program’s most recent peak at the height of the recessionary period, where nearly 3.5 million additional people enrolled each period (growth rates of 7.8 and 7.2 percent). The issue brief provides further analysis of enrollment trends across all 50 states and DC as well as within select eligibility groups such as families, the aged and disabled, as well as adult expansions of non-disabled, non-elderly adults.


Health Insurance Marketplace Premiums for 2014

Oct 2013

This report summarizes the health plan choices and premiums that will be available in the Health Insurance Marketplace. It contains new information on qualified health plans in the 36 states in which the Department of Health and Human Services (HHS) will support or fully run the Health Insurance Marketplace in 2014. Plan data is in final stages but is still under review as of September 18 and may be revised in HHS systems before being displayed for consumers, so this information is subject to change. This analysis also includes similar information that is publicly available from 11 states and the District of Columbia that are implementing their own Marketplace. 


Multi-State Plan Program Map

Oct 2013

The Multi-State Plan Program, established under the Affordable Care Act , directs OPM to contract with private health insurers in each State to offer high-quality, affordable health insurance options called Multi-State Plans (MSPs). MSPs are being administered in 30 states and the District of Columbia. This map details the MSP options that are available in the participating states.  


State-Based Marketplace Data Collection Templates

Sep 2013

These templates were released as part of the Paper Work Reduction Act notice, and represent the metrics that the Department of Health and Human services propose state-based marketplaces collect in order to monitor and evaluate their operations.


Income, Poverty, and Health Insurance Coverage in the United States: 2012

Sep 2013
This report presents data on income, poverty, and health insurance coverage in the United States based on information collected in the 2013 and earlier Current Population 
Survey Annual Social and Economic Supplements (CPS ASEC) conducted by the U.S. Census Bureau. It found that the percentage of people without health insurance decreased between 2011 and 2012, while the number of uninsured in 2012 was not statistically different from 2011.

FAQs on Health Insurance Marketplaces and Income Verification

Sep 2013

This set of Frequently Asked Questions (FAQ) provides guidance on how health insurance Marketplaces will verify incomes of applicants that qualify for premium tax credits or cost-sharing reductions. CMS has determined that they will have sufficient resources to request and process additional income documentation such that the sample size is 100 percent. However, state-based Marketplaces are allowed to determine their own sample size percentage for this group, as long as it is statistically significant.


Rate Review Annual Report – September 2013

Sep 2013

This analysis of rate review activities in calendar year 2012 shows that the rate review process saved consumers approximately $1.2 billion on their premiums when compared to the amount initially requested by insurers. In the individual market, the average rate request increase dropped by 12 percent after rate review, saving consumers an estimated $311 million. In addition to the $1.2 billion saved due to rate review, consumers received an additional $500 million in medical loss ratio rebates for 2012, for a total $1.7 billion in savings in 2012. Moreover, insurers were much less likely to submit requests for rate increases of 10 percent or more in 2012 than in previous years, and it is likely that this change in issuer behavior is a result of the Affordable Care Act policy that requires requests for increases of 10 percent or more to be justified and reviewed.

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