Obama Admin To Update Rules for ACA Special Enrollment Periods
On Monday, the Obama administration announced it will tighten the requirements for special enrollment periods, which allow U.S. residents to enroll in health coverage through the federal exchange outside of the Affordable Care Act's regular open enrollment period, the Wall Street Journal reports (Armour/Radnofsky, Wall Street Journal, 1/12).
Individuals who have "qualifying life events" -- such as moving to another state, getting married, having a new child, losing previous coverage or becoming a U.S. citizen -- are eligible to enroll in exchange coverage within 60 days of such events, even if it is not during an open enrollment period. Further, individuals who are no longer eligible to remain on their parents' health plans also can enroll in exchange plans outside of the ACA's open enrollment periods.
Between Feb. 23, 2015, and June 30, 2015, about 950,000 U.S. residents signed up for coverage through the federal exchange under a special enrollment period (California Healthline, 8/14/15).
The Obama administration in a notice published in the Federal Register last month said it had "heard concerns that these special enrollment periods may be subject to abuse." The administration requested evidence supporting such claims.
Insurers, States Raise Concerns
According to the New York Times, insurers say special enrollment periods destabilize markets and cause premiums to rise.
Insurers and state officials noted the federal government has done little to confirm whether individuals who use special enrollment periods are in fact eligible to do so. The National Association of Insurance Commissioners in a letter sent to HHS noted, "State regulators are concerned that consumers are not required to provide documentation to substantiate their eligibility for a special enrollment period."
Further, some insurers have said the special enrollment periods' lack of verification allows individuals to wait to enroll in health plans until they need medical services, which can drive up costs. Steven Kelmar, an executive vice president at Aetna, in a letter sent to HHS Secretary Sylvia Mathews Burwell wrote, "Many individuals have no incentive to enroll in coverage during open enrollment, but can wait until they are sick or need services before enrolling and drop coverage immediately after receiving services, making the annual open enrollment period meaningless."
In a separate letter to HHS, the Blue Cross and Blue Shield Association wrote, "Individuals enrolled through special enrollment periods are utilizing up to 55% more services than their open enrollment counterparts."
Anthony Barrueta, a senior vice president at Kaiser Permanente, said the potential for misuse of special enrollment periods "poses a significant threat to the affordability of coverage, and to the viability" of the ACA's exchanges.
Consumer Advocates Weigh In
Meanwhile, consumer advocates said they have not seen any evidence suggesting individuals are misusing the special enrollment periods. Christine Speidel, a lawyer at Vermont Legal Aid, said, "Most consumers are confused by the rules on special enrollment periods and do not understand the system well enough to try to game it."
Further, consumer advocates noted that some special enrollment periods were created in response to government issues. For example, in some cases, consumers sought to sign up during the regular enrollment period but were delayed by errors with government computer systems (Pear, New York Times, 1/9).
Obama Admin To Update Special Enrollment Period Rules
Acting CMS Administrator Andy Slavitt said the administration will eliminate certain criteria for special enrollment periods, as well as make criteria language easier to understand. Slavitt noted that the changes are necessary because "bad actors" have been misusing the special enrollment periods.
In addition, Slavitt said the administration has established a task force to ensure consumers are truthful when using the special enrollment periods. According to Slavitt, the task force has ended coverage for U.S. residents who signed up for coverage during a special enrollment period but did not have legitimate reasons for doing so (Wall Street Journal, 1/11).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.