June 29, 2016

ACA News--Youth, Rehabilitation and Habilitation, and Immigration Resources


Plans to Target Enrollment Efforts at Young People

Last week the administration unveiled plans aimed at increasing marketplace enrollment during this year's open enrollment period (Nov. 1, 2016, to Jan. 31, 2017), particularly among young adults. Among other efforts, the Department of Health and Human Services (HHS) plans to send letters about marketplace coverage to uninsured people who paid the individual mandate penalty for not having coverage or claimed an exemption from the insurance mandate. In addition, HHS will encourage insurers to contact young adults before they turn 26 and move off their parents' health plans to tell them about marketplace coverage options. By getting more young, generally healthy, people to enroll in plans, it will help to keep the risk pool healthier, and thus help to keep premiums lower. See this blog post from the Georgetown Center on Health Insurance Reforms, suggesting an additional step to help get young adults covered.


Report and Resource on Rehabilitation and Habilitation Benefits in Qualified Health Plans


The American Occupational Therapy Association (AOTA) released a new report, Analysis of Rehabilitation and Habilitation Benefits in Qualified Health Plans, which reviews the rehabilitation and habilitation benefits available in 724 silver-level Qualified Health Plans (QHPs) offered through the health insurance Marketplaces in Arkansas, Arizona, California, Colorado, Connecticut, Florida, Hawaii, Idaho, Indiana, Kentucky, Louisiana, Massachusetts, Maryland, Michigan, Minnesota, New York, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Vermont, Washington, Wyoming, and the District of Columbia. The report examined information provided in the plans' Summary of Benefits and Coverage (SBCs) with respect to: (1) therapies covered for rehabilitation, (2) therapies covered for habilitation, (3) visit limits for rehabilitation, (4) visit limits for habilitation, and (5) whether the deductible had to be met before the benefit began. Links to all of the 724 plans' SBCs are provided in the report.


The report concluded that consumers still lack adequate and critical information regarding rehabilitation benefits, and to a larger degree, habilitation benefits, in order to make informed decisions while shopping for coverage in the marketplaces. The report also found that many QHPs are not complying with the Essential Health Benefit (EHB) benchmark standards for rehabilitation and habilitation coverage.


Assister Guide for Immigration Section of Marketplace Application

CMS recently released the Assister Guide to the Immigration Section of the Online Marketplace Application, intended to help assisters complete the citizenship and immigration questions of the online Marketplace application. It provides step-by-step instructions and screenshots that illustrate how to verify identity, provide complete and relevant information about citizenship or immigration status; submit supporting documentation (if requested); complete other steps necessary for enrollment in a QHP through the Marketplaces; and be determined or assessed potentially eligible for Medicaid or the Children's Health Insurance Program.