WHY IT MATTERS THAT MORE PEOPLE SIGNED UP FOR ACA HEALTH COVERAGE IN 2018

From The ACA Times, let's take a look at ACA Health Coverage in 2018.


It was meant to have the opposite effect.

The Trump administration’s decision to undermine the Affordable Care Act (ACA) by shortening the annual open enrollment period to 45-days and cutting funding to promote open enrollment was predicted to reduce the number of people who might seek insurance coverage for 2018 on HealthCare.gov.

Instead, more than 600,000 people signed up for health insurance under the ACA in the first four days of enrollment. According to Reuters: “The Centers for Medicare & Medicaid Services, a division of the Department of Health and Human Services, said that during the period of Nov. 1 through Nov. 4, 601,462 people, including 137,322 new consumers, selected plans in the 39 states that use the federal website HealthCare.gov.”

Access to healthcare remains top of mind for Americans. For instance, exit polls in Virginia for state elections found healthcareto be the most pressing issue on the minds of voters who elected a Democratic governor in that state. And entrepreneurs and small businesses owners and employees are among those that benefit greatly from having access to healthcare insurance plans through the ACA.

For employers, all this, along with recent guidance from the IRS, points to the ACA continuing strong and the employer mandate being enforced. If you haven’t done so already, now is the time to assess your compliance with the ACA and what data you need to file ACA related forms with the IRS for the 2017 tax year.

 

Read the original article.

Source:
Sheen R. (20 November 2017). "WHY IT MATTERS THAT MORE PEOPLE SIGNED UP FOR ACA HEALTH COVERAGE IN 2018" [Web blog post]. Retrieved from address https://acatimes.com/why-it-matters-that-more-people-signed-up-for-aca-health-coverage-in-2018/


FREE ACA RESOURCES FOR SMALL BUSINESSES

From The ACA Times, we've pulled this article that lists out some helpful resources for small businesses.


The federal government provides free online resources to help small businesses better understand the requirements of the Affordable Care Act (ACA) and how they might be able to offer health insurance to their employees. Here are some we thought might be helpful.

How the Affordable Care Act affects small businesses: This web page hosted by HealthCare.gov explains how the ACA can impact a small business with 1 to 50 full-time equivalent employees.

SHOP Guide: This web page on Healthcare.gov provides information for small businesses on how they can offer a Small Business Health Options Program (SHOP) insurance to their employees. The web page has links to help businesses learn more about SHOP and whether they qualify to offer such coverage to employees.

The Small Business Health Care Tax Credit: Healthcare.gov, the Taxpayer Advocate Service and the IRS both provide web pages that provide information that helps small businesses determine if they are eligible to take advantage of tax credits if they offer SHOP to their employees.

The Future of SHOP: The Centers for Medicare and Medicaid Services (CMS) is providing information on how CMS will be exploring a more efficient implementation of the Federally-facilitated SHOP Marketplaces in order to promote insurance company and agent/broker participation and make it easier for small employers to offer SHOP plans to their employees, while maintaining access to the Small Business Health Care Tax Credit.

 

Read the original article here.

Source:
Sheen R. (21 November 2017). "FREE ACA RESOURCES FOR SMALL BUSINESSES" [Web blog post]. Retrieved from address https://acatimes.com/free-aca-resources-for-small-businesses/


Taking your time during enrollment pays off

Open enrollment season is fast approaching. Before you cringe at the thought of choosing benefits, give thought to the process. Open enrollment is like eating at a buffet restaurant; you get to pick and choose from various items until you’re satisfied.

Like picking unhealthy foods that leave you feeling unfulfilled, taking little time to analyze what you need during open enrollment season can expose you to unintended risk. If you’re contemplating what benefit options to select this year, here’s how taking your time pays off in the long run.

Know Your Benefit Options

Depending on your employer, you likely have many benefit options to select. Unum, for example, offers eight different options with additional variations in many of those options. Many know about health or dental coverage but may not know why they may need Accident, Critical Illness or Hospital Indemnity insurance. If you don’t know why you may need certain coverage, ask your Human Resources department for assistance.

Additionally, don’t let the options overwhelm you to the point of inaction or lack of thought. Instead, be thoughtful in your choices. “Take your time. There’s a lot of information to review and factors to consider as you make benefits decisions. If you rush through it, you may miss some important coverage, or end up over-insured,” says MC Guenther, Director, Employee and Corporate Communications.

Employers typically allow several weeks for Open Enrollment season, so make sure to take your time and become informed on your choices.

The Benefit of Picking the Right Benefits

Picking the best fit for your benefit needs doesn’t simply come down to cost. Yes, cost is important, but there are other advantages to selecting the right benefit, such as:

• Staying in good overall health. Health insurance obviously has an impact on this but so does dental insurance, and to a lesser extent vision insurance.

• You have the appropriate coverage in time of need. Disability insurance, for example, is something you never hope to use but is very beneficial when you need it.

• You save money. You may find by comparing two benefit options that one plan offers savings not found in the other, while also providing the same coverage.

Ultimately, taking your time and doing your due diligence will help you be better informed of the options and pick the best benefits package for you and your family.

Know How Your Benefits Work

As mentioned previously, knowing how a chosen benefit works is key to proper coverage. However, many don’t have a full understanding of how their plan works. In fact, the International Foundation of Employee Benefits reports that only 19 percent of organizations believe their employees have a high-level understanding of their benefits. If you don’t have a full understanding of how a benefit works, ask your Human Resources area – they are there to help you.

Let’s take a look at one example in how a lump sum benefit works. You can find lump sum benefits in things like Accident, Critical Illness or Hospital Indemnity coverage options.

The lump sum benefit provides the entire coverage in one payment. Guenther explains how this works, “If you are diagnosed with a covered illness and have a $20,000 critical illness policy, for instance, you’ll receive all $20,000 at once. This lets you decide when and how to spend the money with no strings attached.”

This differs from a fixed sum option found in some benefits that only offer payment to cover the actual expense. There are other differences in benefit options, of course, so it pays to understand the differences to pick the best benefits package for your family.

Overlooked Benefit Options

Most individuals know the importance of taking advantage of health, dental or life insurance benefits. Those only scratch the surface of available benefits. You also have other things to keep in mind like disability, vision or wellness programs – and it doesn’t end there.

“Some benefit vendors may offer some free value-added services to their benefits. These could include an employee assistance program, free financial planning and education tools, or emergency travel assistance,” says Guenther, adding that a wide array of options may be available for little to no cost.

Your needs will vary from others in your organization, but it pays to take advantage of all the benefits made available to you as you never know how they may help you in a time of need. As Guenther adds, “Think of your benefits as pieces of a puzzle. Together, they form a strong safety net against the financial impacts of illness or injury.” Make sure to patiently put your puzzle together to set yourself in the best situation possible.

Open Enrollment season can be overwhelming, but with a bit of work and using the resources made available to you, it’s possible to form a great benefits package for your family.

 

You can read the original article here.

Source:
Schmoll J. (6 November 2017). "Taking your time during enrollment pays off" [Web blog post]. Retrieved from address http://workwell.unum.com/2017/11/taking-your-time-during-enrollment-pays-off/?utm_sq=flhc3tx9gh&utm_source=Twitter&utm_medium=social&utm_campaign=workwelltweets&utm_content=Benefiting+you


More than Half of Uninsured People Eligible for Marketplace Insurance Could Pay Less for Health Plan than Individual Mandate Penalty

Things are not looking up for the uninsured. Pay less and reach out to your health insurance professionals today. Want more facts? Check out this blog article from Kaiser Family Foundation.


new Kaiser Family Foundation analysis finds that more than half (54% or 5.9 million) of the 10.7 million people who are uninsured and eligible to purchase an Affordable Care Act marketplace plan in 2018 could pay less in premiums for health insurance than they would owe as an individual mandate tax penalty for lacking coverage.

Within that 5.8 million, about 4.5 million (42% of the total) could obtain a bronze-level plan at no cost in 2018, after taking income-related premium tax credits into account, the analysis finds.

Most people without insurance who are eligible to buy marketplace coverage qualify for subsidies in the form of tax credits to help pay premiums for marketplace plans (8.3 million out of 10.7 million). Among those eligible for premium subsidies, the analysis finds that 70 percent could pay less in premiums than what they’d owe as a tax penalty for lacking coverage, with 54 percent able to purchase a bronze plan at no cost and 16 percent contributing less to their health insurance premium than the tax penalty they owe.

Among the 2.4 million uninsured, marketplace-eligible people who do not qualify for a premium subsidy, 2 percent would be able to pay less for marketplace insurance than they’d owe for their 2018 penalty, the analysis finds.

The Affordable Care Act’s individual mandate requires that most people have health coverage or be subject to a tax penalty unless they qualify for certain exemptions. The individual mandate is still in effect, though Congress may consider repealing it as part of tax legislation.

Consumers can compare their estimated 2018 individual mandate penalty with the cost of marketplace insurance in their area with KFF’s new Individual Mandate Penalty Calculator.

The deadline for ACA open enrollment in most states is Dec. 15, 2017.

 

You can read the original article here.

Source:

Kaiser Family Foundation (9 November 2017). "ANALYSIS: More than Half of Uninsured People Eligible for Marketplace Insurance Could Pay Less for Health Plan than Individual Mandate Penalty" [Web blog post]. Retrieved from address https://www.kff.org/health-reform/press-release/analysis-more-than-half-of-uninsured-people-eligible-for-marketplace-insurance-could-pay-less-for-health-plan-than-individual-mandate-penalty/


Pressure Builds To Cut Medicare Patients In On Prescription Deals

In this article from Kaiser Health News, the stupendous rise of prescription costs is finally addressed. What steps are being taken to reduce costs for Medicare patients? Find out below.


Medicare enrollees, who have watched their out-of-pocket spending on prescription drugs climb in recent years, might be in for a break.

Federal officials are exploring how beneficiaries could get a share of certain behind-the-scenes fees and discounts negotiated by insurers and pharmacy benefit managers, or PBMs, who together administer Medicare’s Part D drug program. Supporters say this could help enrollees by reducing the price tag of their prescription drugs and slow their approach to the coverage gap in the Part D program.

The Centers for Medicare & Medicaid Services (CMS) could disclose the fees to the public and apply them to what enrollees pay for their drugs. However, there’s no guarantee that such an approach would be included in a proposed rule change that could land any day, according to several experts familiar with the discussions.

“It’s obvious something has to be done about this. This is causing higher drug prices for patients and taxpayers,” Rep. Earl “Buddy” Carter (R-Ga.), a pharmacist, said this week.

While Medicare itself cannot negotiate drug prices, the health insurers and PBMs have long been able to negotiate with manufacturers who are willing to pay rebates and other discounts so their products win a good spot on a health plan’s list of approved drugs.

Federal officials described these fees in a January fact sheet as direct and indirect remuneration, or DIR fees.

In recent years, pharmacies and specialty pharmacies have also begun paying fees to PBMs. These fees, which are different than the rebates and discounts offered by manufacturers, can be controversial, in part, because they are retroactive or “clawed back” from the pharmacies.

The controversy is also part of the reason advocates, such as pharmacy organizations, have lobbied for this kind of policy change.

PBMs have long contended that they help contain costs and are improving drug availability rather than driving up prices.

Pressure has been building for the administration to take action. Earlier this year, the federal agency’s fact sheet set the stage for change, describing how the fees kept Medicare Part D monthly premiums lower but translated to higher out-of-pocket spending by enrollees and increased costs to the program overall.

In early October, Carter led a group of more than 50 House members in a letter urging Medicare to dedicate a share of the fees to reducing the price paid by Part D beneficiaries when they buy a drug. Also in the House, Rep. Morgan Griffith (R-Va.) introduced a related bill.

On the Senate side, Chuck Grassley (R-Iowa) and 10 other senators sent a letter in July to CMS Administrator Seema Verma as well as officials at the Department of Health and Human Services asking for more transparency in the fees — which could lead to a drop in soaring drug prices if patients get a share of the action.

A response from Verma last month notes that the agency is analyzing how altering DIR requirements would affect Part D beneficiary premiums — a key point that muted previous political conversations.

But advocates say the tone of discussions with the agency and on Capitol Hill have changed this year. That’s partly because Medicare beneficiaries have become more vocal about their rising out-of-pocket costs, increasing scrutiny of these fees.

Ellen Miller, a 70-year-old Medicare enrollee in New York City’s borough of Queens, sent a letter to the Trump administration demanding lower drug prices. Miller’s prescription prices went up this year, sending her into the Medicare “doughnut hole” by April, compared with October in 2016. With coverage, Miller pays about $200 a month for several prescriptions that help her cope with COPD, or chronic obstructive pulmonary disease, as well as another chronic illness.

In the doughnut hole, where coverage drops until catastrophic coverage kicks in, her out-of-pocket costs climb to $600 a month.

It’s “ridiculous, and that doesn’t count my medical bills,” Miller said.

The number of Medicare Part D enrollees with high out-of-pocket costs, like Miller, is on the rise. And in 2015, 3.6 million Medicare Part D enrollees had drug spending above the program’s catastrophic threshold of $7,062, according to a report released this week by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

Supporters of the rule change say making the fees more transparent and applying them to what enrollees pay would provide relief for beneficiaries like Miller.

The Pharmaceutical Care Management Association (PCMA), which represents the PBMs who negotiate the rebates and discounts, says changing the fees would endanger the Part D program.

“In Medicare Part D, you have one of the most successful programs in health care,” said Mark Merritt, president and chief executive of PCMA. “Why anybody would choose to destabilize the program is beyond me.”

CMS declined to comment on a vague reference to a pending rule change, which was posted in September.

For now, though, according to the CMS fact sheet, the fees pose two compounding problems for seniors and the agency:

  • Enrollees pay more out-of-pocket for each drug, causing them to reach the program’s coverage gap quicker. In 2018, the so-called doughnut hole begins once an enrollee and the plan spends $3,750 and ends at $5,000 out-of-pocket, and then catastrophic coverage begins.
  • Medicare, thus taxpayers, pays more for each beneficiary. Once enrollees reach the threshold for catastrophic coverage, Medicare pays the bulk cost of the drugs.

CVS Health, one of the nation’s top three PBMs, released a statement in February calling the fees part of a pay-for-performance program that helps improve patient care. The fees, CVS noted, are fully disclosed and help drive down how much Medicare pays plans that help run the program.

“CVS Health is not profiting from this program,” the company noted.

Express Scripts, also among the nation’s top three PBMs, agreed that the fees lower costs and give incentives for the pharmacies to deliver quality care. As for criticism from the pharmacies, Jennifer Luddy, director of corporate communications for the company, said, “We’re not administering fees in a way that penalizes a pharmacy over something they cannot control.”

Regardless, even if a rule is changed or a law is passed, there is some question as to how easily the fees can translate into lower costs for seniors, in part because the negotiations are so complicated.

When the Medicare Payment Advisory Commission, which provides guidance to Congress, discussed the negotiations in September, Commissioner Jack Hoadley thanked the presenters and said, “In my eyes, what you’ve revealed is a real maze of financial … entanglements.”

Tara O’Neill Hayes, deputy director of health care policy at the conservative American Action Forum, said passing on the discounts and fees to beneficiaries when they buy the drug could be difficult because costs crystallize only after a sale has occurred.

“They can’t be known,” said Hayes, who created an illustration of the negotiations.

“There’s money flowing many different ways between many different stakeholders,” Hayes said.

 

Source:
Tribble S. (10 November 2017). "Pressure Builds To Cut Medicare Patients In On Prescription Deals" [Web blog post]. Retrieved from address https://khn.org/news/pressure-builds-to-cut-medicare-patients-in-on-prescription-deals/


Taking A Page From Pharma’s Playbook To Fight The Opioid Crisis

From Kaiser Health News, here is the latest: an interview with Dr. Mary Meengs, medical director at the Humboldt Independent Practice Association, on curbing opioid addiction through the reduction of prescription painkillers.


Dr. Mary Meengs remembers the days, a couple of decades ago, when pharmaceutical salespeople would drop into her family practice in Chicago, eager to catch a moment between patients so they could pitch her a new drug.

Now living in Humboldt County, Calif., Meengs is taking a page from the pharmaceutical industry’s playbook with an opposite goal in mind: to reduce the use of prescription painkillers.

Meengs, medical director at the Humboldt Independent Practice Association, is one of 10 California doctors and pharmacists funded by Obama-era federal grants to persuade medical colleagues in Northern California to help curb opioid addiction by altering their prescribing habits.

She committed this past summer to a two-year project consisting of occasional visits to medical providers in California’s most rural areas, where opioid deaths and prescribing rates are high.

“I view it as peer education,” Meengs said. “They don’t have to attend a lecture half an hour away. I’m doing it at [their] convenience.”

This one-on-one, personalized medical education is called “academic detailing” — lifted from the term “pharmaceutical detailing” used by industry salespeople.

Detailing is “like fighting fire with fire,” said Dr. Jerry Avorn, a Harvard Medical School professor who helped develop the concept 38 years ago. “There is some poetic justice in the fact that these programs are using the same kind of marketing approach to disseminate helpful evidence-based information as some [drug] companies were using … to disseminate less helpful and occasionally distorted information.”

Recent lawsuits have alleged that drug companies pushed painkillers too aggressively, laying the groundwork for widespread opioid addiction.

Avorn noted that detailing has also been used to persuade doctors to cut back on unnecessary antibiotics and to discourage the use of expensive Alzheimer’s disease medications that have side effects.

Kaiser Permanente, a large medical system that operates in California, as well as seven other states and Washington, D.C., has used the approach to change the opioid-prescribing methods of its doctors since at least 2013. (Kaiser Health News is not affiliated with Kaiser Permanente.)

In California, detailing is just one of the ways in which state health officials are attempting to curtail opioid addiction. The state is also expanding access to medication-assisted addiction treatment under a different, $90 million grant through the federal 21st Century Cures Act.

The total budget for the detailing project in California is less than $2 million. The state’s Department of Public Health oversees it, but the money comes from the federal Centers for Disease Control and Prevention through a program called “Prevention for States,” which provides funding for 29 states to help combat prescription drug overdoses.

The California doctors and pharmacists who conduct the detailing conversations are focusing on their peers in the three counties hardest hit by opioid addiction: Lake, Shasta and Humboldt.

They arrive armed with binders full of facts and figures from the CDC to help inform their fellow providers about easing patients off prescription painkillers, treating addiction with medication and writing more prescriptions for naloxone, a drug that reverses the toxic effects of an overdose.

“Academic detailing is a sales pitch, an evidence-based … sales pitch,” said Dr. Phillip Coffin, director of substance-use research at San Francisco’s Department of Public Health — the agency hired by the state to train the detailers.

In an earlier effort, Coffin said, his department conducted detailing sessions with 40 San Francisco doctors, who have since increased their prescriptions of naloxone elevenfold.

“One-on-one time with the providers, even if it was just three or four minutes, was hugely beneficial,” Coffin said. He noted that the discussions usually focused on specific patients, which is “way more helpful” than talking generally about prescription practices.

Meengs and her fellow detailers hope to make a dent in the magnitude of addiction in sparsely populated Humboldt County, where the opioid death rate was the second-highest in California last year — almost five times the statewide average. Thirty-three people died of opioid overdoses in Humboldt last year.

One recent afternoon, Meengs paid a visit during the lunch hour to Fortuna Family Medical Group in Fortuna, a town of about 12,000 people in Humboldt County.

“Anybody here ever known somebody, a patient, who passed away from an overdose?” Meengs asked the group — a physician, two nurses and a physician assistant — who gathered around her in the waiting room, which they had temporarily closed to patients.

“I think we all do,” replied the physician, Dr. Ruben Brinckhaus.

Brinckhaus said about half the patients at the practice have a prescription for an opioid, anti-anxiety drug or other controlled substance. Some of them had been introduced to the drugs years ago by other prescribers.

Dr. Ruben Brinckhaus says his small family practice in Fortuna, Calif., has been trying to wean patients off opiates. (Pauline Bartolone/California Healthline)

Meengs’ main goal was to discuss ways in which the Fortuna group could wean its patients off opioids. But she was not there to scold or lecture them. She asked the providers what their challenges were, so she could help them overcome them.

Meengs will keep making office calls until August 2019 in the hope that changes in the prescribing behavior of doctors will eventually help tame the addiction crisis.

“It’s a big ship to turn around,” said Meengs. “It takes time.”

 

Source:
Bartolone P. (14 November 2017). "Taking A Page From Pharma’s Playbook To Fight The Opioid Crisis" [Web blog post]. Retrieved from address https://khn.org/news/taking-a-page-from-pharmas-playbook-to-fight-the-opioid-crisis/

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Understanding your Letter 226-J

Letter 226-J is the initial letter issued to Applicable Large Employers (ALEs) to notify them that they may be liable for an Employer Shared Responsibility Payment (ESRP). The determination of whether an ALE may be liable for an ESRP and the amount of the proposed ESRP in Letter 226-J are based on information from Forms 1094-C and 1095-C filed by the ALE and the individual income tax returns filed by the ALE’s employees.

What you need to do

  • Read your letter and attachments carefully. These documents explain the ESRP process and how the information received affects the computation.
  • The letter fully explains the steps to take if you agree or disagree with the proposed ESRP computation.
  • Complete the response form (Form 14764) indicating your agreement or disagreement with the letter.
  • If you disagree with the proposed ESRP liability, you must provide a full explanation of your disagreement and/or indicate changes needed on Form 14765 (PTC Listing). Return all documents as instructed in the letter by the response date.
  • If you agree with the proposed ESRP liability, follow the instructions to sign the response form and return with full payment in the envelope provided.

You may want to

  • Review the information reported on Forms 1094-C and 1095-C for the applicable year to confirm that the information filed with the IRS was accurate because the IRS uses that information to compute the ESRP.
  • Keep a copy of the letter and any documents you submit.
  • Contact us using the information provided in the letter if you have any questions or need additional time to respond.
  • Send us a Form 2848 (Power of Attorney and Declaration of Representative) to allow someone to contact us on your behalf. Note that the Form 2848 must state specifically the year and that it is for the Section 4980H Shared Responsibility Payment.

Answers to Common Questions

Why did I receive this letter?
The IRS used the information you provided on Forms 1094/5-C and determined that you are potentially liable for an ESRP.

Where did the IRS get the information used to compute the ESRP?
The IRS used form 1094/5-C filed by the ALE and the individual income tax returns of your full-time employees to identify if they were allowed a premium tax credit.

Is this letter a bill?
No, the letter is the initial proposal of the ESRP

What do I need to do?
Review the letter and attachments carefully and complete the response form by the date provided.

What do I do if the information is wrong or I disagree?
Follow the instructions in the letter to provide corrected information for consideration by the IRS. The IRS will reply with an acknowledgement letter informing you of their final determination.

Do I have appeal rights?
Yes, the acknowledgement letter that you receive will spell out all your rights, including your right to appeal.

General Information

For more info visit ACA information center for Applicable Large Employers

Here’s an excerpt from the 226J letter, and a link to the official sample.

 

Source:

IRS (9 November 2017). "Understanding your Letter 226-J" [Web blog post]. Retrieved from address https://www.irs.gov/individuals/understanding-your-letter-226-j


Some States Roll Back ‘Retroactive Medicaid,’ A Buffer For The Poor — And For Hospitals

From Kaiser Health News, let's take a look at the latest regarding Medicaid.


If you’re poor, uninsured and fall seriously ill, in most states if you qualify for Medicaid — but weren’t enrolled at the time — the program will pay your medical bills going back three months. It protects hospitals, too, from having to absorb the costs of caring for these patients.

But a growing number of states are rescinding this benefit known as “retroactive eligibility.” On Nov. 1, Iowa joined three states that have eliminated retroactive coverage for some groups of Medicaid patients since the Affordable Care Act passed. Each state had to secure approval by the federal government.

Retroactive eligibility has been a feature of Medicaid for decades, reflecting the program’s emphasis on providing a safety net for poor, disabled and other vulnerable people. In contrast to private insurance, determining Medicaid eligibility can be complex and the application process daunting, advocates say. A patient’s medical condition also may keep families from applying promptly for coverage.

All four states — Arkansas, Indiana and New Hampshire, in addition to Iowa — have expanded Medicaid under the health law, which allowed states to include adults with incomes up to 138 percent of the federal poverty level, or about $16,000 for one person. So, in theory, most adults are required to have insurance under the ACA. In practice, each state still has a significant number of uninsured, ranging from 5 to 8 percent of the population.

The retroactive coverage “can compensate for the sorts of errors and lapses that can so easily occur on the part of both the applicant and the government bureaucracy” that delay applications, said Gordon Bonnyman, staff attorney at the Tennessee Justice Center, a public interest law firm that represents low-income and uninsured residents.

State and federal officials say eliminating the retroactive coverage helps encourage people to sign up for and maintain coverage when they’re healthy rather than waiting until they’re sick to enroll. It also fits into federal officials’ efforts to make Medicaid, the federal-state program that provides health care for low-income adults and children, more like private insurance.

But consumer advocates and health care providers say the shift will saddle patients with hefty medical bills and leave hospitals to absorb more uncompensated care when patients can’t pay. Some worry this could be the start of a trend.

In Iowa, the change applies to just about anyone coming into Medicaid — except for pregnant women and children under age 1. The change will affect up to 40,000 residents annually and save the program more than $36 million a year.

“We’re making it a lot more likely that Medicaid-eligible members are going to incur significant medical debt,” said Mary Nelle Trefz, health policy associate at the Child & Family Policy Center in Des Moines, whose organization opposed the change.

When someone has a traumatic health event, the initial focus is to get them stabilized, not figure out how to pay for it, said MaryBeth Musumeci, associate director of the Program on Medicaid and the Uninsured at the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

Patients may neglect to apply immediately for Medicaid, leaving them financially responsible for days or months of care they received before they got in their application, even though they may have been eligible for Medicaid all along.

That’s not the only issue, advocates say. Unlike the commercial insurance market where re-enrollment through someone’s employer is routine, Medicaid requires that beneficiaries’ eligibility be reassesed every year.

“People fall through the cracks,” said Andrea Callow, associate director of Medicaid initiatives at Families USA, a consumer advocacy group.

In addition, complications can arise for people who might need Medicaid coverage for long-term care services. “The criteria are complicated. For a layperson to find those criteria and figure out if they’re eligible” is challenging and they may need extra time, said Musumeci. Once patients have secured coverage, they may already have accrued hefty expenses.

Maybe so, but some people argue that a 90-day retroactive eligibility guarantee is counterproductive.

“We’re trying to get people to behave more responsibly, not less responsibly,” said Gail Wilensky, an economist who oversaw the Medicaid and Medicare programs in the early 1990s under President George H.W. Bush. “That is not the signal you’re sending” with three months of retroactive eligibility. A 30-day time frame is more reasonable, Wilensky said.

In contrast to Iowa, the waivers in Arkansas, Indiana and New Hamsphire generally apply only to adults who gained coverage under the law’s Medicaid expansion. (Indiana’s waiver also applies to other groups.)

Kentucky has a request pending that, like Iowa, would eliminate retroactive Medicaid eligibility except for pregnant women and children under 1, according to KFF.

Under federal law, officials can waive some Medicaid coverage rules to give states flexibility to experiment with different approaches to providing services. And retroactive eligibility waivers in Medicaid are hardly new. A few states like Tennessee have had them in place for years. Tennessee officials eliminated retroactive eligibility for all Medicaid beneficiaries in 1994 when the state significantly expanded coverage under TennCare, as Medicaid is known there. At the time, the state even allowed uninsured people to buy into the program who wouldn’t otherwise qualify based on income, said Bonnyman.

“There was no reason for anybody to be uninsured except undocumented immigrants,” said Bonnyman. “It didn’t seem to have the potential for harm.”

But state officials revamped that program after serious financial problems. Eligibility for TennCare has become more restrictive again.

Other states that waived retroactive coverage for at least some Medicaid groups include Delaware, Maryland, Massachusetts and Utah, according to the Kaiser Family Foundation.

Bonnyman said his group frequently works with Medicaid beneficiaries who have medical bills they can’t afford that accumulated during the months before they applied for Medicaid.

“If you’re a moderate- to low-income working family, one or two days in the hospital is enough to ruin you financially,” he said.

 

You can read the original article here.

Source:
Andrews M. (14 November 2017). "Some States Roll Back ‘Retroactive Medicaid,’ A Buffer For The Poor — And For Hospitals" [Web blog post]. Retrieved from address https://khn.org/news/some-states-roll-back-retroactive-medicaid-a-buffer-for-the-poor-and-for-hospitals/


The Latest: House passes sweeping GOP tax overhaul

WASHINGTON (AP) — The Latest on House consideration of the tax overhaul (all times local):

1:50 p.m.

The House has passed a sweeping Republican tax bill cutting taxes for corporations and many people. It puts GOP leaders closer to delivering to President Donald Trump a crucial legislative achievement after nearly a year of failures.

The House voted 227-205 along party lines to approve the bill, which would bring the biggest revamp of the U.S. tax system in three decades.

Most of the House bill’s reductions would go to business. Both the Senate and House would slash the 35 percent corporate tax rate to 20 percent and reduce levies on millions of partnerships and certain corporations, including many small businesses.

Personal income tax rates for many would be reduced through some deductions, and credits would be reduced or eliminated. But projected federal deficits would grow by $1.5 trillion over the coming decade.

U.S. President Donald Trump has arrived at the Capitol to encourage House Republicans who are about to push a $1.5 trillion tax package through their chamber. (Nov. 16)

___

12:15 p.m.

Democrats are using new projections by Congress’ nonpartisan tax analysts to call the Senate Republican tax bill a boon to the wealthy that boosts middle-income families’ taxes.

The Joint Committee on Taxation estimated that starting in 2021, many families earning less than $30,000 would have tax increases under the bill. By 2027, families earning up to $75,000 would face higher levies, while those earning more would get tax cuts.

Republicans say the new calculations reflect two provisions in the bill.

The Senate measure ends personal income tax cuts beginning in 2026 because Republicans needed to reduce the bill’s costs to obey the chamber’s budget rules.

It also abolishes the requirement under former President Barack Obama’s health care law that people buy insurance. That means fewer people getting federally subsidized coverage — which analysts consider a tax boost.

___

11:35 a.m.

President Donald Trump has arrived at the Capitol to encourage House Republicans who are about to push a $1.5 trillion tax package through their chamber.

The closed-door meeting comes as GOP leaders hope that by Christmas, they will give Trump and themselves their first legislative triumph this year.

House approval was expected later Thursday of the plan to slash corporate tax rates and reduce personal income tax rates while eliminating some deductions and credits.

The Senate Finance Committee is aiming to pass its separate version by week’s end. But some GOP senators want changes.

Republicans say the final measure will bestow lower levies on millions of Americans and spur economic growth by reducing business taxes. Democrats say the measure is disproportionately tilted toward corporations and the wealthy.

___

10:45 a.m.

Republicans drove a $1.5 trillion tax overhaul toward House passage Thursday. But Senate GOP dissenters also emerged in a sign that party leaders have problems to resolve before Congress can give President Donald Trump his first legislative triumph.

Trump was heading to the Capitol for a pep rally with House Republicans, shortly before the chamber was expected to approve the measure over solid Democratic opposition. There were just a handful of GOP opponents in the House, unhappy because the measure sharply curbs deductions for state and local taxes, but all agreed that passage seemed certain.

Like a similar package nearing approval by the GOP-led Senate Finance Committee, most of the House measure’s reductions would go to business. Personal income tax rates for many would be reduced, but some deductions and credits would be reduced or eliminated. Federal deficits would grow by $1.5 trillion over the coming decade.

U.S. President Donald Trump has arrived at the Capitol to encourage House Republicans who are about to push a $1.5 trillion tax package through their chamber. (Nov. 16)

You can read the original article here.

Source:

Associate Press (16 November 2017). "The Latest: House passes sweeping GOP tax overhaul" [Web blog post]. Retrieved from address https://apnews.com/b3297c1e443b40049beebcd832aaadc8?utm_campaign=SocialFlow&utm_source=Twitter&utm_medium=AP

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Critical compliance changes for next year: An open enrollment checklist

Keeping up-to-date with health care is one of our top priorities. From HR Morning, here is a comprehensive list of everything you need to know so far going into 2018.


As HR pros immerse themselves in negotiating plan changes for this year’s open enrollment, it’s critical to keep these new 2018 regulation changes front and center.

To help, here’s a checklist of changes you’ll need to be aware of when making plan-design moves:

1. Mental Health Parity reg changes enforced

Beginning January 1, 2018, plans that require “fail first” or “step therapy” could violate the Parity Act’s “non-quantitative treatment limitation” (NQTL) rules. Under the NQTL rules, plans can’t be more restrictive for mental health/substance abuse benefits than they are for medical/surgical ones.

Here’s an example of a fail-first strategy: Requiring mental health or addiction patients to try an intensive outpatient program before admission to an inpatient treatment if the same restriction doesn’t apply to medical/surgical benefits.

2. New Summary of Benefits and Coverage (SBC) template

Under the ACA, plans were required to start using the new SBC template on or after April 1, 2017.

For calendar year plans, that means this is the first enrollment with the new template, which includes new coverage examples and updates about cost-sharing. You can find more details on and instructions for the new form here: bit.ly/temp544

3. Women’s preventive care

The Women’s Preventive Services Guidelines were updated for 2018 calendar plans to include a number of items that must be covered without any cost-sharing. The list includes breast cancer screenings for average-risk women, screenings for cervical cancer, diabetes mellitus and more.

 

See the original article here.

Source:

Bilski J. (17 October 2017). "Critical compliance changes for next year: An open enrollment checklist" [Web blog post]. Retrieved from address http://www.hrmorning.com/critical-compliance-changes-for-next-year-an-open-enrollment-checklist/