We have examined what the PPACA (Patient Protection and Affordable Health Care Act) aka Obamacare is? That was followed up with an examination as to how California is working towards putting in place the funding & mechanisms to meet MOE (Maintenance of Effort) & MCE (Medicaid Coverage Eligibility Expansion) implementation requirements of PPACA via the California Section 1115 Medicaid Demonstration Waiver. Now let us delve into "The HIX" (Health Insurance eXchange). It is the centerpiece of PPACA (Patient Protection and Affordable Health Care Act) aka Obamacare which will be coming in to play by the year 2014.
Prior to that time a great deal of work and organization will be required to "The HIX" (Health Insurance eXchange) (i) up & running efficiently. "The HIX" (Health Insurance eXchange) will be made available to individuals and businesses with fewer than 100 employees, however the California will have the option to extend the exchange to larger firms beginning in 2017.
Enter The "California Health Benefit Exchange". The "California Health Benefit Exchange" will be the primary marketplace for individual health insurance and small business health benefits in California in 2014. Only people participating in the exchange who do not have access to qualifying employer coverage will be eligible for the premium subsidies. The Act also reforms insurance markets by assuring guaranteed issue of coverage, limiting premium variation by age and prohibiting premium variation by health status.The diagram below displays the current "system" (black lines) and proposed future"system" (green lines) under PPACA (Patient Protection and Affordable Health Care Act) HIX" (Health Insurance eXchange).
The overall timeline encompasses a core set of the major developmental tasks that states will need to address in order to launch their exchanges in compliance with PPACA by 2014.
(HIX-Ups) Health Insurance eXchange - Ca. Health Benefit Exchange
Health Insurance eXchange HIX-Ups #01 - Penalty
PPACA (Patient Protection and Affordable Health Care Act) Potential Tax Penalties in 2014 on Large Employers
by January 2014
Large Employers (defined as having “at least 50 full-time employees during the preceding calendar year) NOT Offering Coverage will be subject to a penalty if any of its full-time employees receives a premium credit toward their HIX (Health Insurance eXchangeexchange) plan. In 2014, the monthly penalty assessed to employers who do not offer coverage will be equal to the number of full-time employees minus 30 multiplied by 1/12 of $2,000 for any applicable month.
After 2014, the penalty payment amount would be indexed by a premium adjustment percentage for the calendar year (The law gives the employer a pass on the first 30 employees from the fine). Employers that do not offer coverage must also file a return stating that they do not offer coverage, the number of full-time employees, and other information required by the Secretary.They must provide notice to employees about the existence of the exchange, including a description of the services provided by the HIX (Health Insurance eXchangeexchange).
Health Insurance eXchange HIX-Ups #02 - Penalty
PPACA (Patient Protection and Affordable Health Care Act) Potential Tax Penalties in 2014 on Large Employers
by January 2014
Large Employers who DO offer health coverage will not be treated as meeting the employer requirements if at least one full-time employee obtains a premium credit in an HIX (Health Insurance eXchangeexchange) plan. The total penalty (iii) for an employer would be limited to the total number of the firm’s full-time employees minus 30 multiplied by 1/12 of $2,000 for any applicable month (The law gives the employer a pass on the first 30 employees from the fine).
After 2014, the penalty amounts would be indexed by a premium adjustment percentage for the calendar year. The employer must file a return providing the name of each individual for whom they provide the opportunity to enroll in coverage, the length of any waiting period, the number of months that coverage was available, the monthly premium for the lowest cost option, the plan’s share of covered health care expenses paid for, the number of full-time employees, the number of months employees were covered, if any, and any other information required by the Secretary. As before the employer must provide notice to employees about the existence of the exchange, including a description of the services provided by the HIX (Health Insurance eXchangeexchange).
Health Insurance eXchange HIX-Ups #03 - Penalty
PPACA (Patient Protection and Affordable Health Care Act) Potential Tax Penalties in 2014 on Large Employers
by January 2014
Finally, those firms with more than 200 full-time employees that offer coverage must automatically enroll new full-time employees in a plan (and continue enrollment of current employees). Automatic enrollment programs will be required to include adequate notice and the opportunity for an employee to opt out.
White Castle recently said that The PPACA (Patient Protection and Affordable Health Care Act) would be very costly on their business, eating into much of their profit. Health Reform says that employees must NOT be subject to spend more than 9.5 percent of their income on Health Insurance and anything in excess of this percentage would be deemed "un-affordable". However, due to the income level of the employees at the hamburger chain this percentage would be hard to meet for White Castle to still generate a reasonable profit. It would be more cost effective for White Castle to take the penalty of not offering insurance than to comply with Health Reform. We can see that other Employers will follow suit on this approach. This will drive their employees (and employees of other employers like this) to the Exchange.
The PPACA (Patient Protection and Affordable Health Care Act) MLR (Medical Loss Ratio) provision requires that Health Insurers spend at least 80-85% of premium dollars on medical cost. This is a huge concern for Health Insurers right now because there are services that go into keeping patients healthly that are not categorized today in the "medical cost" umbrella. It may be hard to keep in-line with the MLR target, depending on what is classified under medical cost and MLR. An effect of this is that Insurers have already started to scale back the commissions that it pays to Brokers for bringing Individuals and Employer Groups to buy Insurance. With lower commissions, Broker exit the market and the Individuals and Employer Groups will move to "The HIX" (Health Insurance eXchange).
PPACA (Patient Protection and Affordable Health Care Act) puts into law an "Individual Mandate" where every citizen MUST have Health Insurance or else a "fee" / "penalty" is assessed. Therefore, Individuals without the option to purchase affordable health insurance through their Employer will now come through the Exchange to purchase their insurance. In addition, Members of Congress and Congressional Staff must also elect their insurance through the Exchange.
PPACA (Patient Protection and Affordable Health Care Act) creates SHOP (Small Business Health Options Program) Exchanges where small businesses can go to offer Health Insurance products to their employees. In the Commonwealth of Massachusetts (iv) , where an Exchange is already established, the Individual and Small Business functions operate together in one Exchange, called the Health Connector. Most, if not all, States will probably follow this same model to consolidate both functions into one Exchange for simplification.
PPACA (Patient Protection and Affordable Health Care Act) will enable and support states' creation of "American Health Benefit Exchanges." An exchange cannot be an insurer, yet will provide eligible individuals and small businesses with access to insurers' plans in a comparable way. The exchange will consist of a selection of private plans as well as "multi-state qualified health plans," administered by the Office of Personnel Management (v) .
Health Insurance eXchange HIX-Ups #10 - Exchange Establishment
PPACA States Exchange Compliance
By Jan. 01, 2014
PPACA (Patient Protection and Affordable Health Care Act) requires each state to establish an exchange that facilitates the purchase of qualified health plans by eligible individuals and employers with up to 100 employees. Exchanges must provide four basic benefit categories, along with a catastrophic plan (vi) .
Health Insurance eXchange HIX-Ups #11 - Summaries of AB 1602 (vii) (Perez) and SB 900 (vii) (Alquist & Steinberg)
PPACA States Exchange Compliance
By Jan. 01, 2014
Individuals with incomes between 133% and 400% of the Federal Poverty Level (FPL) will receive refundable tax credits such that Individual Health Insurance may be acquired. These individual will be subject to an "affordable" premium based upon a sliding-sclae which will be capped at 2% - 9.5% of income.
Because of the scope & importance of the California Health Benefit Exchange, the California legislature has generated to key pieces of legislation geared toward initiating the exchange this year (2011). The governance and structure of the exchange are set forth in SB 900 (vii) (Alquist & Steinberg). Each bill is contingent upon the other
The California Health Benefit Exchange will be an independent public entity NOT affiliated with any one agnecy nor department. The exchange is to be financed 'almost' entirely via fees which are to be imposed upon participating health plans which in turn will be free from the requirement of an annual budget appropriation
Health Insurance eXchange HIX-Ups #13 - Summaries of AB 1602 (Perez) and SB 900 (Alquist & Steinberg)
The California Health Benefit Exchange will be governed by a five (5) member board of directors. This board will be made up of the Secretary of California HHS (xiii) (Health and Human Services) or his / her designee, two (2) members as appointed by the Governor, one 91) member as appointed by the Senate Rules Committee and finally one (1) member appointed by the Speaker of the Assembly.
Members of the California Health Benefit Exchange governing board must be California residents and shall serve for a four (4) year term. These members must have demonstrated expertise in at least two of the following areas:
The California Health Benefit Exchange will be headed by an Executive Director and run by staff whom will NOT be subject to civil service requirements. The Executive Directoe in coordination with the California insurance Commissioner will review the "Internet Portal" developed by the U. S. Secretary of HHS (Human & Health Services) to determine whether it provides sufficient data regarding all health benfit groups offered by plans & insurers in the individual and small employer markets.
Reduce number of Uninsured Californians by creating an affordable and quality health care coverage marketplace
Strengthen the health care delivery system
Guarantee availablity and renewability of coverage for both individuals and small businesses
Requires plans and insurers to compete on the basis of PRICE, QUALITY and SERVICE as oppossed to being based upon RISK SELECTION
Health Insurance eXchange HIX-Ups #17 - Summaries of AB 1602 (Perez) and SB 900 (Alquist & Steinberg)
Participation Requirements AB 1602 (Perez)
In the 'Works' Now
The California Health Benefit Exchange Board will determine the minimum requirements a health plan must meet to be deemed as a QHP (Quaified Health Plan) and shall likewise implement procedures of the certification / decertification of QHP's (Qualified Health Plan).
In order to support the development, operations and management of the California Health Benefit Exchange the board will assess a 'reasonable' charge on QHP's (Qualified Health Plan).
Health Insurance eXchange HIX-Ups #18 - Summaries of AB 1602 (Perez) and SB 900 (Alquist & Steinberg)
Participation Requirements AB 1602 (Perez)
In the 'Works' Now
The California Health Benefit Exchange board shall require QHP's (Qualified Health Plan) to:
Submit justification for premium increases prior to implementation of the increase.
Make available claims payment policies, periodic fiancial dislosures, enrollment data, denied claims data, rating practices, COS (Cost of Sharing) data, OON (Out of Network) coverage and information on enrollee and participant rights;
IMMEDIATELY notification when an individual is or will be enrolled in or disenrolled from any QHP (Qualified Health Plan) offered by the carrier
Offer at LEAST one (1) product at each level of the five (5) tiers of coverage (PLATINUM, GOLD, SILVER, BRONZE, CATASTROPHIC)
Offer all product inside & outside of the 'exchange'
Health Insurance eXchange HIX-Ups #19 - Summaries of AB 1602 (Perez) and SB 900 (Alquist & Steinberg)
Participation Requirements AB 1602 (Perez)
In the 'Works' Now
The California Health Benefit Exchange will establish uniform billing and payment policies for QHP's (Qualified Health Plan) as a means of ensuring consistent enrollment and disenrollment policy for individuals enrolled in the 'exchange'.
Health Insurance eXchange HIX-Ups #20 - Summaries of AB 1602 (Perez) and SB 900 (Alquist & Steinberg)
Participation Requirements AB 1602 (Perez)
In the 'Works' Now
The California Health Benefit Exchange will assign a rating to each QHP (Qualified Health Plan). the 'exchange' will inform individuals of eligibility requirements for Medi Cal, Healthy Families or any applicable state or local public program. If the California Health Benefit Exchange determines an individual to be eligible for any such program shall enroll the individual.
Health Insurance eXchange HIX-Ups #21 - Summaries of AB 1602 (Perez) and SB 900 (Alquist & Steinberg)
Technology AB 1602 (Perez)
In the 'Works' Now
The California Health Benefit Exchange shall maintain a website for enrollees and prospective enrollees to obtain standardized and comparative data about health plans. An electronic calculator to determine actual cost of coverage shall be developed.
Health Insurance eXchange HIX-Ups #22 - Summaries of AB 1602 (Perez) and SB 900 (Alquist & Steinberg)
"Navigator Program"
In the 'Works' Now
The California Health Benefit Exchange shall establish a "Navigator Program" which will ensure sufficient public outreach and education. 'Navigators' will likewise be granted the charge of facilitating enrollment and providing referrals in ways which are culturally and linguistically literate.
An individual may be eligible for a Premium Credit (viii) via "The HIX" (Health Insurance eXchange) either because the employer does not offer coverage or the employer offers coverage that is either not “affordable” or does not provide “minimum value.”
Health Insurance eXchange HIX-Ups #24 - Free Choice Vouchers
Health Insurance options
beginning in 2014
An employer who offers 'minimum essential coverage' and pays any portion of the premium must provide free choice vouchers to each qualified employee. A qualified employee is defined as an employee whose required contribution to the employer plan, for self-only coverage, exceeds 8% and is less than 9.8% of the employee’s household income for the taxable year, whose household income is not greater than 400% of the FPL for the relevant family size, and who does not participate in the plan offered by the employer.
An individual receiving a Free Choice Voucher will NOT be eligible for the exchange premium credits or cost-sharing subsidies. No penalty will be imposed on an employer with respect to any employee who is provided with a Free Choice Voucher.
Health Insurance eXchange HIX-Ups #25 - Premium Assistance Credits
Premium Credit Description(s)
beginning in 2014
PPACA (Patient Protection and Affordable Health Care Act) amongst other things is designed to provide “premium assistance credits” to assist certain individuals pay for health insurance.
These 'credits' are only for the purchase of coverage within an exchange, advanceable, refundable premium assistance
credits will be available to limit the amount of money some individuals would pay for premiums.
Health Insurance eXchange HIX-Ups #26 - Premium Assistance Credits
Premium Credit Spec(s)
beginning in 2014
Under PPACA (Patient Protection and Affordable Health Care Act), state-established “American Health Benefit Exchanges” will have to be developed in every state by January 1, 2014. Exchanges will not be insurers, instead they are will be designed to provide qualified individuals and small businesses with access to insurers’ qualified health plans in a comparable way.
Health Insurance eXchange HIX-Ups #27 - Premium Assistance Credits
Enrolled in an Exchange
beginning in 2014
Premium credits will only be available to individuals enrolled in a plan offered through an
exchange.6 Individuals may enroll in a plan through their state’s exchange if they are:
not incarcerated, except individuals in custody pending
the disposition of charges; and
Lawful residents
Only lawful residents may obtain exchange coverage. Undocumented (“illegal”) aliens will be prohibited from obtaining coverage through an exchange, even if they could pay the entire premium without any subsidy. Because PPACA (Patient Protection and Affordable Health Care Act) prohibits undocumented aliens from obtaining
exchange coverage, they will therefore NOT be eligible for premium credits.
Health Insurance eXchange HIX-Ups #28 - Premium Assistance Credits
Eligible for Credits
beginning in 2014
To be eligible for credits, an individual cannot be eligible for other acceptable coverage—that is, “minimum essential coverage,” defined as Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), coverage related to military service, an employer-sponsored plan, a grandfathered plan,8 and other coverage recognized by the Secretary.
Health Insurance eXchange HIX-Ups #29 - Premium Assistance Credits
FPL Threshhold(s)
beginning in 2014
To be eligible for a premium credit, individuals must have “household income” of less than 400% FPL (Federal Poverty Level). PPACA (Patient Protection and Affordable Health Care Act) says premium credits are available to those whose income “exceeds 100 percent FPL (Federal Poverty Level) but does not exceed 400 percent FPL (Federal Poverty Level)….” PPACA (Patient Protection and Affordable Health Care Act) then provides for lawfully present noncitizens who are at or below 100% FPL (Federal Poverty Level) and who are not eligible for Medicaid to obtain premium credits. Non-aged citizens and legal permanent residents at or below 133% FPL (Federal Poverty Level) will be eligible for Medicaid and therefore ineligible for premium credits.
Health Insurance eXchange HIX-Ups #30 - Premium Assistance Credits
Affordability Defined
beginning in 2014
PPACA (Patient Protection and Affordable Health Care Act) includes provisions to study affordability issues. It requires the GAO U. S. Government Accountability Office to conduct a survey of the cost and affordability of health care insurance provided under the exchanges for owners and employees of small business concerns, including data on enrollees in exchanges and individuals purchasing health insurance coverage outside of
exchanges.
GAO U. S. Government Accountability Office is also required to conduct a study on the affordability of health insurance coverage (including the impact of credits for individuals and small businesses), the availability of affordable health benefits plans (including a study of whether the percentage of household income used for credit purposes is appropriate for determining whether employer-provided coverage is affordable and whether such level may be lowered without significantly increasing the costs to the federal government and reducing employer-provided coverage), and the ability of individuals to maintain essential health benefits coverage.
Health Insurance eXchange HIX-Ups #31 - Current Benefit Standards
Five (5) tiers of coverage (PLATINUM, GOLD, SILVER, BRONZE, CATASTROPHIC)
beginning in 2014
The Ca. Health Benefit Exchange will group health insurance plans into four (4) categories by actuarial value to make it easier for consumers to compare options. In addition, The Ca. Health Benefit Exchange web site and brochures will make plan comparison documents available that highlight differences in key plan features such as deductibles, co-pays, and benefit limits.
Return to the Top
Five (5) tiers of coverage (PLATINUM, GOLD, SILVER, BRONZE, CATASTROPHIC)
Platinum -- Covers 90 percent of average medical costs with consumer cost-sharing of 10 percent.
Gold -- Covers 80 percent of average medical costs with consumer cost-sharing of 20 percent.
Silver -- Covers 70 percent of average medical costs with consumer cost-sharing of 30 percent.
Bronze -- Covers 60 percent of average medical costs with consumer cost-sharing of 40 percent.
Catastrophic -- Additionally, a catastrophic plan will be available to individuals under the age of 30 or those who otherwise qualify for a unaffordable exemption. It would have a deductible equal to the out-of-pocket maximum established under federal law for HSA qualified high deductible plans. For 2011, that amount is $6,150 for a family and will be slightly higher in 2014
Health Insurance eXchange HIX-Ups #32 - Enrollment IT Standards
National Coordinator for Health Information Technology
beginning in 2014
The Secretary of HHS (Health and Human Services) recently adopted a series of Enrollment IT Standards for use by the states and federal agencies implementing PPACA (Patient Protection and Affordable Health Care Act). The standards were mandated by Section 1561 of the health reform legislation, developed by a workgroup of stakeholders co-chaired by U.S. Chief Technology Officer Aneesh Chopra and California Healthcare Foundation Vice President Sam Karp, and are now posted on the web site of the National Coordinator for Health Information Technology (ix) . At a high level, the standards support the following vision:
All people have the opportunity to make informed choices about their health coverage and other benefits.
Consumers apply online, renew coverage online, and learn about final determination online.
Systems talk to each other and share and store information so consumers don't have to provide the same information over and over again.
Data provided for one program is used to support consumers through their permission and direction in applying for other programs for which they may be eligible.
Consumers will be able to see data provided by federal verification systems and provide appropriate updates or information to validate their current situation.
Consumers will be able to download and re-use the information they provide for program eligibility for other purposes, similar to the Veteran's Administration "Blue Button" approach.
The process is transparent and enables consumer participation, thereby reducing burden on everyone -- including states and counties.
Health Insurance eXchange HIX-Ups #33 - The Role of the Employer
California Health Benefit Exchange a Shift
beginning in 2014
The California Health Benefit Exchange will likely shift the role of the small employer from a selector and provider of benefit packages to a partial funder of employee benefits. Employees will use the California Health Benefit Exchange (x) to make personal, customized selections, using the online calculator to display the actual remaining employee responsibility by plan.
Health Insurance eXchange HIX-Ups #34 - Standardized Health Benefit Summaries and Coverage
California Health Benefit Exchange Standardization
by March 23, 2011
The PPACA (Patient Protection and Affordable Health Care Act) requires the Secretary of HHS (Health and Human Services) to work with the NAIC (National Association of Insurance) to develop standards for benefit summaries and coverage explanations for individual and group insurance products offered within the federal / states HIX (Health Insurance eXchange) . The Secretary of HHS is required to finalize the standards (xi) by March 23, 2011 and carriers must provide the forms to consumers beginning March 23, 2012.
Health Insurance eXchange HIX-Ups #35 - Standardized Health Benefit Terminology
California Health Benefit Exchange Standardization
by March 23, 2011
The draft NAIC standardized benefit summary is a clearly written piece of work. In addition to explaining the benefits, the benefit descriptions also includes a short "Why This Matters" statement which puts the information into a useful context. The documents could be improved, but even as they are, they're much better than what is often provided by health insurance companies and online quoting systems. Aggregating these descriptions in a single location 'should'make it easier for health care entrepreneurs to find new and helpful ways to provide this kind of information to consumers. The glossary (xii) uses plain language to describe terms such as co-insurance, deductible, balance billing, primary care provider and the like. Some terms, such as "formulary" are missing, but the list is relatively complete and will no doubt be updated to over time.
Health Insurance eXchange HIX-Ups #36 - SHOP (Small Health Group Option Program)
New Paradigm for Small Group Coverage
beginning in 2014
The California Health Benefit Exchange is really two exchanges in one. The SHOP (Small Health Group Option Program) Exchange will track coverage selection and eligibility at the individual level even though the individual is a member of an employer group. The Exchange will offer options to both groups and individuals. Their attachment or non-attachment to a group will determine their available coverage selections, rating and underwriting requirements within the exchange portal. An individual could flow back and forth from group to individual and back to group products within the Exchange as their employment circumstances changed.
Health Insurance eXchange HIX-Ups #37 - SHOP (Small Health Group Option Program)
Efficient Enrollment
beginning in 2014
The SHOP (Small Health Group Option Program) Exchange will provide a centralized online portal that can perform both enrollment and underwriting, showing only qualified options to a given enrollee. Enrollment and eligibility information is maintained by the Exchange and forwarded electronically to the carriers. The Exchange also manages all adds, changes and terminations.
Health Insurance eXchange HIX-Ups #38 - SHOP (Small Health Group Option Program)
Automated Billing
beginning in 2014
The SHOP (Small Health Group Option Program) Exchange will provide a consolidated monthly bill to the employer. The Exchange would pay carriers all premiums not paid through subsidy and carriers would consider it payment in full. Subsidies would be applied as they were paid out by the government. All billing invoices, both current and historical, will be available to employers and individuals on demand through the web portal.
Health Insurance eXchange HIX-Ups #39 - Health Insurance California Employees
Lower-cost health plan for many Californians
beginning in 2014
An estimated 3.5 million Californians will be eligible for federal tax credits to slash the cost of their health coverage when they begin buying policies through the California Health Benefit Exchange in 2014. Tax credits will be available to low- and middle-income people once insurers begin selling policies through the Exchange. The tax credits that help pay insurance costs will go directly to insurers, lowering premiums for those who are uninsured or do not have coverage through jobs.
Health Insurance eXchange HIX-Ups #40 - K. I. S. S.
Made Simple to Use
beginning in 2014
The Exchange portal will be able to ask a handful of initial qualifying questions and make a preliminary determination if an applicant may be eligible for MediCal, Healthy Families, or a subsidy through the Exchange. Those that are not will be presented only with the standard online enrollment form, just like they would fill out at a carrier or broker website. Only those who seem to be eligible will be asked additional questions - in the event of an Exchange subsidy - or they will be sent to the eligibility portals for MediCal and/or Healthy Families.
Health Insurance eXchange HIX-Ups #41 - MOE (Maintenance of Effort)
Medicaid MOE Requirement
(anticipated to be on January 1, 2014
States are presently required per by the American Recovery and Reinvestment Act of 2009 (ARRA) and as a condition of receiving the enhanced FMAP(Federal Medical Assistance Percentages), to maintain their eligibility levels for Medicaid until the Secretary of HHS (Health and Human Services) deems the states’ new HIX (Health Insurance eXchange)s to be fully operational (anticipated to be on January 1, 2014). They are required to maintain their eligibility levels for children in Medicaid and CHIP through September 30, 2019. Although Congress is still debating the so-called reconciliation bill, which makes changes to certain parts of the health reform law, the MOE (xiv) (maintenance of effort) provisions in H.R. 3590 took effect when the President signed it.
Congress is working on legislation that would extend the ARRA MOE (and provide extra federal Medicaid funding to help states balance their budgets) through June 30, 2011. The health reform MOE will effectively extend the ARRA MOE (xv) on Medicaid until 2014. The ARRA MOE does not affect CHIP programs, but the new health reform MOE does.
Health Insurance eXchange HIX-Ups #43 - MOE (Maintenance of Effort)
Eligibility and Enrollment Policies / Procedures
As of March 23, 2010
States must maintain the eligibility and enrollment policies and procedures that were in ??effect on March 23, 2010 when H.R. 3590 was signed into law. Cuts that have been enacted but that are not yet part of the state’s Medicaid or CHIP plan cannot proceed. States shall maintain the ability to expand their programs or implement more generous enrollment policies should they choose at any time.
If a state violates either MOE (for Medicaid or CHIP), it will lose all federal matching funding ??for its entire Medicaid program until the violation is corrected.
Health Insurance eXchange HIX-Ups #44 - MOE Exemption(s) (xiv)
MOE NOT Applicable to...
Between January 1, 2011, and December 31, 2013
Between January 1, 2011, and December 31, 2013, states are exempt from the Medicaid MOE (xiv) ??for non-pregnant, non-disabled adults with incomes greater than 133 percent of the FPL (federal poverty level) if they certify to the Secretary of HHS (Health & Human Services that they are facing a budget deficit for the current year or will face one for the succeeding year.
Health Insurance eXchange HIX-Ups #45 - In a Nut Shell... (xvi)
Health Insurance Exchanges and the Affordable Care Act: Eight Difficult Issues
Between January 1, 2011, and December 31, 2013
state-level health insurance exchanges to be created under the PPACA (Patient Protection and Affordable Care Act) are expected to play a major role in the purchase and sale of health insurance when they become fully operational in 2014. Eight (8) critical issues that the states and the federal government are likely to encounter whilst in the process of implementing the exchanges are (xvi) :
Governance (Administration)
Avoiding 'ADVERSE SELECTION'
Making Self - Funded Plans compatible
Making the Exchanges worthwhile to the Employer
Regulatory Authority Use
Transparency
Role in Eligibility Determination for Premium Credits, Cost Sharing Reduction payments, etc...
