Friday, January 22, 2016

CMS Tightens Qualifying Events for Obamacare - But Effort Woefully Inadequate

These were not the most abused qualifying events. The elimination of these six, mostly obscure, special enrollment rationales will make little to no difference. 

From the New York Times on January 19th:
The Obama administration, responding to complaints from insurance companies, announced several steps on Tuesday that will make it harder for consumers to obtain health insurance after the annual open enrollment period.

Insurers say many consumers have belatedly signed up for coverage under the Affordable Care Act when they become sick and need care. Those latecomers drive up costs for people who sign up during the regular open enrollment period, insurers say. Open enrollment ends this year on Jan. 31.

The administration, which had created more than 30 “special enrollment” periods, sent emails to millions of Americans last year urging them to see if they might be eligible to sign up after the annual open enrollment deadline. But, insurers and state officials said, the federal government did little to verify whether late arrivals were eligible. ...

Mr. Counihan said the administration would eliminate six of the special enrollment periods, including two for certain lawfully present noncitizens who experienced “system errors” and “processing delays” when they used ...

Federal officials said nearly 950,000 people used special enrollment periods to get coverage through from late February to the end of June 2015. In some cases, insurers said, consumers dropped coverage soon after receiving costly medical services. ...

Clare Krusing, a spokeswoman for America’s Health Insurance Plans, a trade group, welcomed the administration’s steps but said they did not go far enough. ...

Insurers had, for example, urged the administration to narrow the “exceptional circumstances” in which the federal government could grant a special enrollment period.

In a blog post on Tuesday, Mr. Counihan said, “Our program integrity team will pull samples of consumer records nationally and may request additional information from some consumers or take other steps to validate that consumers properly qualified for these special enrollment periods.” ...
Here are the eliminated QEs from the CMS blog post:
Eliminating Unnecessary Special Enrollment Periods: Last month, we announced that the Tax Season special enrollment period will no longer be offered. Today we are announcing the elimination of six other special enrollment periods that are no longer needed. Just as the Marketplace evolves, so too does consumer behavior. The rules we use to operate the Marketplace need to keep up with these changes. As such, special enrollment periods are no longer available for:
  1. Consumers who enrolled with too much in advance payments of the premium tax credit because of a redundant or duplicate policy
  2. Consumers who were affected by an error in the treatment of Social Security Income for tax dependents
  3. Lawfully present non-citizens that were affected by a system error in determination of their advance payments of the premium tax credit
  4. Lawfully present non-citizens with incomes below 100% FPL who experienced certain processing delays
  5. Consumers who were eligible for or enrolled in COBRA and not sufficiently informed about their coverage options
  6. Consumers who were previously enrolled in the Pre-Existing Condition Health Insurance Program