April 6, 2018
2018 Open Enrollment: CMS Released its Open Enrollment report chock full of interesting stats: A few things to note.
- While overall enrollment dipped 3%, there was a big difference depending on if the Exchange was run by a state or the Federal Government. Among the heathcare.gov states, enrollment dipped more than 5% while the State-based Marketplaces (SBMs) saw flat enrollment.
- Bloomberg has an excellent map on how enrollment shifted between 2017 and 2018 at a county level. Please note the enrollment decreases in Louisiana are likely due to the Medicaid expansion.
- Metal level shifting was a real thing. Due to the CSR defunding and the resulting Silver loading on premiums, overall enrollment in Silver decreased to 63%. State context is extremely important as a ton of variation exists in the distribution of metal level enrollment. For example, In Mahoning County, Ohio, Gold enrollment was less than 5% but right across the border in Lawrence, Pennsylvania, Gold enrollment was in excess of 30%. You can see the distribution of enrollment by metal level and county here.
- The share of younger adults (18 to 34) decreased relative to 2017, to 26%.
CSR Reconciliation Manual was Released
The long awaited 2017 (and final) CSR reconciliation Manual was released. A few key points are below. For more information, Aree Bly, FSA, MAAA is an expert on the topic
- Reconciliation files must be submitted during the April 2, 2018 through June 1, 2018 window. There is no test period for submitting files this year, so early file submissions can serve as a test run.
- CSR reconciliation of 2017 benefit year claims must utilize the standard methodology. The full year of 2017 claims can be included in the analysis, and will be compared to the advance payments that were paid through September 2017.
- The guidance notes that the reconciliation is “for the purpose of identifying overpayments.”
Non-ACA plans coming to Iowa maybe Idaho
- Iowa officially passed a bill that would allow the Farm Bureau, in conjunction with Wellmark, to offer non-ACA coverage. Iowa was able to skirt the ACA laws as the Farm Bureau plans are not considered insurance and therefore the ACA does not apply.
- Politico was reporting that Idaho is continuing to work on a plan to have non-ACA coverage but still be considered insurance.
Billing Complexity and Administrative Costs
New research at Health Affairs was released about the dramatic variation in claim denial rates between different types of coverage. Fee for service Medicaid was the most challenging, although interestingly Medicaid managed care was higher (about 6 percentage points higher) than fee-for-service-Medicare. You can read about it and the larger implications here.