States with HIX Woes to Get Enrollment Relief

A move by CMS to tweak the public health insurance exchange rules grants a measure of relief to states where individuals have struggled to enroll because of faulty state exchange websites.

They are still looking at the fine print, but state officials are welcoming a decision by the federal government to ease public exchange enrollment for individuals in states with exchange website woes.

On Feb. 27, the U.S. Centers for Medicare & Medicaid Services issued a bulletin announcing the availability of advance payment of the premium tax credit and cost-sharing reductions for individuals who have had trouble enrolling in states with troubled exchange websites.

The bulletin says the enrollment relief measures are being granted in states that "have had difficulty in providing timely eligibility determinations to applicants and enrolling qualified individuals in Qualified Health Plans through the Marketplace during the initial open enrollment period for the 2014 coverage year."

The open enrollment period ends March 31.

In comments to HealthLeaders Media this week, state officials in Massachusetts, Minnesota, and Oregon, which have all experienced significant problems with their exchange websites, praised both the substance and the spirit of the CMS bulletin.

"Here in Massachusetts, we have put in coverage extensions and transitional coverage that help people who may be having trouble accessing the website, and we are working on identifying how that programming crosses over with the CMS guidance," said a spokesman for Massachusetts Health Connector. "That said, throughout our transition to the Affordable Care Act, we have been working very closely with CMS and the federal government to ensure that we are delivering the choice, benefits, and expanded subsidy opportunities to as many people as possible in Massachusetts."

On Monday night, Minnesota Governor Mark Dayton issued a brief but emphatic statement on the CMS bulletin. "I guarantee that my administration will do everything possible to provide Minnesotans with all the federal tax credits for which they are eligible," the first-term Democrat said.

Officials at MNsure, the public exchange in Minnesota, were cautiously optimistic that the CMS bulletin will help residents in the state who have struggled to enroll online. "There are a number of important decisions for MNsure to make in regards to this bulletin," the Minnesota officials said. "There will be opportunities for Minnesotans to secure retroactive coverage when warranted, which is certainly a positive step for consumers who need affordable health insurance. We are still assessing this situation, and we are working very closely with our health insurance company partners to determine how we will proceed."

A spokeswoman for Cover Oregon also said state exchange officials were working in tandem with insurers to make the most of the flexibility offered in the CMS bulletin. "We will work closely with our carriers to get this policy implemented so that Oregonians get the financial help they are eligible for," she said.

Enrollment has been one of the prime areas for cooperation between CMS and insurers in the rollout process for the public exchanges since they were launched in the fall.

In November, CMS announced a pilot program in Ohio, Florida, and Texas to allow individuals a "direct enrollment" option to buy health insurance. "If consumers choose to directly enroll in a Marketplace plan through an insurance company, they still will be able to compare products, and choose the one that offers them the best value for their dollar," Julie Bataille, CMS director of communications said in an agency blog post on Nov. 22. "Consumers will be informed that they can compare and select other plans on HealthCare.gov, and prior to buying a health plan, [a] consumer's application will be securely routed to HealthCare.gov to assess their eligibly for coverage along with potential discounts on premiums and cost sharing."

In her blog post, Bataille said the direct enrollment pilot program was linked to ongoing efforts to improve the rollout of the public exchanges. "Issuers utilizing direct enrollment in these three states will provide detailed feedback on their experiences to feed into our real-time work to make improvements for both consumers and issuers," she said.