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SC Receives $2.4 Million Bonus for Child Medicaid Enrollment

Children MedicaidSouth Carolina has received a $2.4 million bonus for enrolling children in the federal Medicaid program, reports the Centers for Medicare and Medicaid Services.

State officials say the money will go to offset the costs of enrolling more children.

So how did the state earn the bonus? South Carolina has increased enrollment by using food stamp data to identify eligible candidates, as any child in a family that qualifies for food stamps also qualifies for Medicaid.

Twenty-two other states have also earned bonuses, totaling $306 million. Last year, South Carolina earned a $2.7 million bonus for enrolling children in the Medicaid program.

(Story via the Associated Press)

Feds To Unveil Health-Insurance Exchange Details

From The Wall Street Journal:

Associated Press/Don Berwick, head of the Centers for Medicare and Medicaid Services, will help unveil the plan Wednesday.


Consumers shopping for health insurance will soon get a peek at a new standard form—akin to the nutrition label on food products—that will lay out the details of each policy, from deductibles to how much it might cost to have a baby.

Federal regulators are expected to unveil the proposed summary form, part of the health-care overhaul law, on Wednesday, and the requirement is supposed to take effect next March.”Now, every consumer will have clear, easy-to-read, and concise information that tells them what they need to know,” said Erin Shields, spokeswoman for the Department of Health and Human Services. Officials including Don Berwick, administrator of the Centers for Medicare and Medicaid Services, are scheduled to announce the proposal.
“Now, every consumer will have clear, easy-to-read, and concise information that tells them what they need to know,” said Erin Shields, spokeswoman for the Department of Health and Human Services. Officials including Don Berwick, administrator of the Centers for Medicare and Medicaid Services, are scheduled to announce the proposal.

Currently, states mandate certain disclosures from health insurers, but they vary by state. The information often comes as part of a document known as the certificate of coverage or evidence of coverage, which can run to dozens of densely written pages and is often supplied only after a consumer has signed up for a policy. Employers offering coverage typically provide materials to their workers, but these also don’t follow any common national format.

“It’s very inconsistent,” said Karen Pollitz, a senior fellow at the nonpartisan Kaiser Family Foundation and a former Health and Human Services official.

The proposed new summary is expected to closely follow a draft version from a committee convened by the National Association of Insurance Commissioners, people with knowledge of the matter said. Health and Human Services is expected to finalize the form after a public comment period.

Insurers said they were concerned about the potential cost and administrative burden of the new requirement, particularly if they have to create different iterations of the form for every possible plan design a consumer could explore and for every single employer.

“Some plans would be providing tens of thousands of versions of this document,” said a spokesman for America’s Health Insurance Plans, an industry group.

The summary form has often been compared to the food-nutrition label, though it is substantially longer, and at six pages the draft offers considerable detail. For instance, it would not only tell consumers their overall deductibles, or the amount they must pay before coverage kicks in, but would also explain deductibles for specific categories, such as drug coverage. In addition to flagging the limit on a consumer’s out-of-pocket expenses, the form would lay out which expenses don’t count toward that limit.

A list of medical events and associated services, such as home health care and emergency transportation, would likely be shown along with the consumer’s costs for each. The summary would also explain the consumer’s possible expenses for three common situations: having a baby, treating breast cancer and managing diabetes.

The form would likely be given to people shopping for plans, before they are locked into a selection, by means including insurance agents, email, or websites where policies are sold. Under the health law, it is also supposed to be supplied to workers with employer coverage, when they sign up for plans as new hires or during open enrollment. However, regulators are likely to ask for comment on whether alternative equivalent documents might be acceptable for big employers, people with knowledge of the matter said.

“It would be a big deal to consumers, because they will have a standard way of receiving information,” said Amir Mostafaie, director of quality and training at eHealth Inc., parent company of the online insurance marketplace eHealthInsurance.com.

Research has shown consumers are often confused about the details of their insurance. In a McKinsey & Co. survey of consumers, 72% agreed that health plans are sometimes so complicated it is difficult to understand what is covered or what services cost, according to the consulting firm, which polled around 11,000 people under age 65 late last year and early in 2011. In addition, 57% said that they found the process of choosing health insurance overwhelming.

For insurers, the new form would likely have the biggest sales impact in the individual insurance market, which is expected to grow substantially after 2014, when most of the health-care overhaul takes effect. Already, companies are increasingly focused on how to craft marketing and brand-promotion efforts that will resonate with consumers.

“It’s not an industry that has been consumer-centric,” said Raj Bal, a former executive at insurer WellPoint Inc. who is now an industry consultant. Once it is in effect, the form will likely help shape plan designs and promotion.


PCIP Provides Bridge For Looming Healthcare Reform

From Forbes:

By DAVID A. LIEB –07.25.11, 10:21 AM EDT

JEFFERSON CITY, Mo. — One of the first prongs of President Barack Obama’s health care law has been in effect now for a year, and the result in Missouri is that about 500 additional people with chronic health problems now have insurance.

It is, by most accounts, an underwhelming result. Missouri’s experience is pretty typical of the national norm, which is causing even some supporters of the federal health care law to question how it is being implemented.

One of the less-publicized provisions of the 2010 law required a Pre-Existing Condition Insurance Plan in each state. Backed by $5 billion of federal subsidies, the health plans are intended to provide insurance at lower prices than typically available to people with health problems who have been uninsured for at least six months.

The new health insurance plans provide a bridge to 2014, when a new requirement kicks in prohibiting insurers from charging higher premiums to people based on their health status. That’s the same year that most people will be required to have health insurance or face tax penalties, and that people will be able to purchase coverage through new online health insurance markets called exchanges.

When Missouri began taking applications in July 2010 for its federally mandated Pre-existing Condition Insurance Plan, officials expected to cover about 3,000 people, said Vernita McMurtrey, executive director of the Missouri Health Insurance Pool. One year later, it has just one-sixth of that amount – about 500 enrollees.

Missouri is not unique.

“Enrollment is fairly low across all states,” said Jennifer Tolbert, director of state health policy at the nonpartisan Kaiser Family Foundation.

Relying on estimates from the Congressional Budget Office and a unit of the Centers for Medicare and Medicaid Services, the U.S. Department of Health and Human Services said last July that it believed between 200,000 and 400,000 people likely would enroll in the new health plans.

The actual number is but a fraction of that. Through May 31, a total of 24,712 people nationwide were enrolled in the pre-existing condition insurance plans.

Health care analysts and insurance executives cite several reasons for the lackluster response.

Chiefly, the health insurance premiums still are more expensive than many people can afford – or want – to pay.

Federal law prohibits the plans from charging more than the state’s standard individual health insurance premium for people of a similar age. That means chronically ill people can get insurance policies at the same cost as healthy people. But many chronically ill people who have gone without insurance for six months either are unemployed or in low-wage jobs, which makes it difficult for them to afford even the standard premiums.

Under Missouri’s plan, for example, a 50-year-old man who opts for a $1,000 deductible would pay a monthly premium of $544, McMurtrey said.

That would consume about half the paycheck of someone working 40 hours a week in a minimum wage job, without accounting for taxes, housing payments, food, utilities and gas for a car.

Missouri lowered its premiums by 25 percent, effective Feb. 1, in an attempt to make the plan more affordable. Program administrators currently are analyzing whether they can lower rates again, McMurtrey said.

Until now, “Missouri hasn’t been really creative in how to get the lowest prices,” said Thomas McAuliffe, a policy analyst at the Missouri Foundation for Health.

Not helping matters was the fact that many people – at least initially – found Missouri’s application for the program confusing, McAuliffe said.

Another factor holding down enrollment is the requirement to first go without insurance for a half year, Tolbert said.

“There are probably a lot of people – at least some people – who have existing insurance, but it’s fairly limited, who would likely benefit by enrolling in the better coverage,” she said. But “they’re simply not going to be willing to go bare, as we say, for six months to access the better coverage.”

Still another factor is the tendency of some people to avoid purchasing insurance until they know it’s needed, said Larry Case, executive vice president of the Missouri Association of Insurance Agents. Even though vehicle liability insurance is required by state law, about 14 percent of Missouri drivers lack it, Case said. Some people purchase car insurance only because it’s necessary to license their vehicle, then quit making payments, he said.

Similarly, Case said, people have little incentive to purchase health insurance under the pre-existing condition plan until they know they are headed to the hospital or have a major medical expense upcoming.

McMurtrey said many people who enroll in the plan immediately use their health coverage, in some cases have major operations such as heart bypass surgeries or organ transplants within two or three weeks.

Although some health care analysts said Missouri’s program has not been sufficiently publicized, McMurtrey said she has traveled the state to discuss it at hospitals, nursing homes, community centers, schools and with any group that can spread the information among those with chronic health problems.

“Even though the 500 itself is not a high number, we are serving needy Missourians,” she said. “Quite honestly, across the country, none of the states have the enrollment we thought we would.”

Health Officials Move To Loosen State Requirements

By Noam N. Levey–July 12, 2011

Washington— The Obama administration moved Monday to ease some requirements on states to help them set up new insurance exchanges in 2014, a key feature of the healthcare law the president signed last year.The state-based exchanges are intended to make buying health insurance comparable to shopping the Internet for an airline ticket or a hotel room. And by 2019, the exchanges are expected to provide insurance for an estimated 24 million Americans who don’t get their health insurance from their employer, according to the nonpartisan Congressional Budget Office.

Small employers with fewer than 100 workers also will be able to use the exchanges, which will have to offer plans with a minimum level of coverage. No plans will be able to deny coverage to people with pre-existing conditions.

Health Care Reform Saves Seniors A Combined $260 Million

From The Hill:

By Julian Pecquet – 06/28/11 10:07 AM ET

Almost half a million seniors on Medicare had saved a combined $260 million on their medicines by the end of last month thanks to the healthcare reform law, the Obama administration announced Tuesday.

A total of 478,272 people have taken advantage of the law’s 50 percent prescription discount for seniors in the Medicare “doughnut hole,” according to the Centers for Medicare and Medicaid Services. The month of May saw a sharp increase in the number of beneficiaries benefiting from the provision, up 76 percent from 270,900 at the end of April.

“As more and more beneficiaries hit the donut hole through the rest of this year,” CMS Administrator Don Berwick said in a statement, “the numbers will continue to climb. All of these beneficiaries will see savings on their drug costs that were not available in previous years.”

The agency also released a state-by-state breakdown of the numbers, showing that California saw the greatest benefit, with 54,586 seniors saving almost $30 million.