Tag: insurance

CMS Issues Final Marketplace Stabilization Rule

Last week, The Centers for Medicare and Medicaid Services issued the final Marketplace Stabilization rule to “help lower premiums and stabilize individual and small group markets and increase choices for Americans.” While the rule is designed to help lower premiums and increase the choices consumers will have, some of the policy changes in the rule may potentially impact consumers in a negative way. Below are the key components of the final rule:

2018 Open Enrollment Period: The final rule shortens the annual open enrollment period to November 1, 2017, until December 15, 2017. This is half the duration of open enrollment periods in the past. This shortened window to enroll will result in many consumers potentially missing the opportunity to enroll in coverage and will overwhelm the already limited capacity of organizations providing in-person enrollment assistance. During the 2016 Open Enrollment period for the New York State of Health Marketplace (November 1, 2015 – January 31, 2016), about 74% of consumers enrolled or renewed their coverage with the help of an assistor. Consumers that do not enroll during the open enrollment period will only be able to enroll if they are eligible for a Special Enrollment Period (those eligible for Medicaid, Child Health Plus or the Essential Plan can enroll at any time during the year.)

Special Enrollment Period: Individuals applying outside of open enrollment will be required to provide proof of eligibility for a special enrollment period by submitting supporting documents. This rule aims to reduce fraud and abuse by ensuring that only those who are eligible are able to enroll. Consumers are not currently required to submit proof and this additional documentation burden could result in consumers experiencing delays in their coverage.

Continuous Coverage: The final rule allows insurers to require individuals to pay back past due premiums before enrolling in a plan with the same insurer the following year. Consumers who fell behind in premium payments will have to pay the balance due or they will not be able to enroll in the same coverage, forcing consumers to choose between overcoming a financial burden or being locked out of coverage for the entire year.

Ensuring Additional Choices for Consumers: the final rule allows insurers additional flexibility with the actuarial value of plans so they can offer more plan choices with lower premium options. While at first glance it does seem beneficial to offer greater consumer choice, actuarial value flexibility will allow insurers to offer cheaper plans by removing benefits or increasing out of pocket costs. Consumers may not realize what benefits are not being offered with their plan or what out-of-pocket costs they will be responsible for.

While overall these policy changes may be aimed at increasing choices and lowering costs, a robust education and outreach component should also be included to ensure that consumers understand how these changes may impact their coverage.

State-run marketplaces, like the New York State of Health, do often have more flexibility in establishing some of these policies so it is not entirely clear at this time how this final rule will impact consumers currently enrolled or enrolling in coverage through the New York State of Health Marketplace. HWCLI will continue to follow these changes and provide further updates when additional information is provided by the state.

HWCLI’s #Forthe24 Twitter Chat

On October 13, Newsday published an article titled, “LI’s Shrinking Middle Class”, here is an overview:

According to a recent study, 17.8% or 165,758 Long Island households are making more than $184,657 annually.  This is a 60% increase since 1990.
While this seems like wonderful news, the study also states an increase in the number of Long Island households earning less than $46,165 a year from 179,879 (21% of all households)  in 1990 to 227,914 (24.4% of all households) in 2014. 
What this article re-enforces, is the message we, as a collective having been saying for years. Long Islanders are struggling! It takes almost 2x that amount to survive.
The survival budget standard for a family of 4 is approx.$85,000
Almost 25% of all Long Island households are experiencing significant daily challenges in meeting the basic human needs of our families- housing, food, clothing, transportation, and health care.
Since  the release of this article brought greater visibility to the issue, we were prompted to create a plan of action. A plan of action that continues to bring visibility to the needs of Long Islanders. A plan of action that must include all of Long Island’s elected officials.
Join us in HWCLI’s Twitter Chat on November 4th at 1 PM as we ask ourselves and our elected officials what we can do to support the 24%. 
Simply use the #Forthe24 to join the conversation.


How to join:

  • Log on to Twitter
  • Make sure you are following @HWCLI
  • Use the #Forthe24 along with your tweet

Making a difference starts with a conversation!

Census Data Shows Drop in Uninsured

According to a new federal survey released this week by the U.S. Census Bureau, number of uninsured Americans declined from 13.3 percent of the population in 2013 to 9.1 percent in 2015. Uninsured rates declined across all age groups with adults ages 19-25 experiencing the biggest one-year drop. The uninsured rate among adults ages 19-25 dropped by 2.6 percentage points in 2015. Young adults ages 19 and 26 have a higher uninsured rate than other ages in the group likely due to Child Health Plus ending at age 19 and children losing coverage through their parents at 26. Among racial/ethnic groups, Latinos experienced the largest coverage gains although they continue to be the most likely to lack insurance.

Data from the American Community Survey shows higher uninsured rates in states that have not expanded Medicaid. In 2013, 19 states had uninsured rates of more than 14 percent. In 2015, only Alaska and Texas have uninsured rates that high and at the time data was collected neither had expanded Medicaid (Alaska’s Medicaid expansion went into effect September 2015).

Despite tremendous gains in the number of people covered by insurance, 29 millions Americans remain uninsured. States that have not expanded Medicaid should accept the federal dollars available to them to expand coverage for low-income residents of their states. For more details check out this report from the Commonwealth Fund.

Report Proposes VBP model for Children in Medicaid

The Schuyler Center, together with United Hospital Fund, recently released a new report: Value-Based Payment Models for Medicaid Child Health Services, that proposes a new, child-centered approach to value-based payment in Medicaid. The researchers conclude that because of the significant differences in children’s health care utilization compared to adults, a payment model should be used that promotes—and pays for—screening and effective interventions to address psycho-social risks that are not currently widespread in primary care. The report notes that, “Given the increased recognition of how profoundly social determinants of health (including Adverse Childhood Experiences) affect childhood development and adulthood health and social productivity, payment models need to consider how to motivate and support attention in this area.”

Click here for the full report

Bill Would Expand Insurance Coverage for NYers

Thanks to the Affordable Care Act (ACA) and the opening of the New York State of Health Marketplace, 2.8 million New Yorkers have enrolled into quality, affordable health coverage. Among the provisions of the ACA is the basic health program, which allows states to provide low-cost coverage to eligible individuals who have incomes up to 200 percent of the federal poverty level (roughly $23,700 for a single person).

Since the Essential Plan became available in 2015, nearly 400,000 New Yorkers have enrolled. They now have access to quality healthcare with no deductible and premiums of $20 or less.

Yet New York residents who are Permanently Residing under the Color of Law (PRUCOL) are not eligible for the Essential Plan. Many of those affected are young adults who grew up in the U.S. and are beneficiaries of the Deferred Action for Childhood Arrivals (DACA) policy. Ironically, these individuals are already covered by Medicaid if their income is below the threshold. Once their incomes increase and they are no longer eligible for Medicaid, they face a “coverage cliff” and often must choose between work and access to health insurance.

The New York State Assembly is working to expand Essential Plan eligibility to include immigrants who are PRUCOL. The Assembly included $10.3 million in its 2016-17 budget to provide this coverage.  Unfortunately, the funding was ultimately cut during budget negotiations. Assembly members Richard Gottfried and Marcos Crespo have since introduced legislation that would expand Essential Plan eligibility to include immigrants who are PRUCOL. Bill A10054 was successfully voted out of the Assembly Health Committee on May 17 and is now awaiting a vote by the Ways and Means Committee.

Health Care for All New York has drafted a Letter of Support for A10054. Please feel free to adapt this letter for your organization. Submit completed letters to Assembly Member Gottfried (gottfried@assembly.state.ny.us)

TAKE ACTION: Community Health Advocates’ Funding At Risk!

Community Health Advocates (CHA) is the Consumer Voice for health care access – and it needs your help. 

CHA will have to cut services by 25% without an additional $1.5 million in funding from the Legislature.


   Send a message to your legislators now!
CHA helps New Yorkers:

  • Understand how to use their health insurance;
  • Resolve billing issues and coverage denials with their health plans;
  • Maximize their coverage (get prior authorizations, access specialists and obtain out-of-network services when needed);
  • Access affordable health care services and hospital financial assistance programs; and
  • Understand how small business owners can offer health insurance and get health insurance tax credits.

Since 2010 the CHA helpline and network of community based organizations has completed over 239,000 cases for New Yorkers across the state.  CHA has saved New Yorkers close to $15 million in health care and health insurance costs. 

CHA has an annual budget of $4 million.  Governor Cuomo included $2.5 million for CHA in the state budget this year, leaving a $1.5 million gap to keep CHA services at their current level.  You can help make sure your legislators provide and support funding for this critical program!