The Federal Administration makes ACA-Related announcements

As the Senate continues to craft a repeal package for the Affordable Care Act (ACA), the administration is taking more limited steps to influence implementation of the law, including three announcements this week:

Federally-Facilitated SHOP Enrollment 

The Centers for Medicare and Medicaid Services (CMS) announced on Monday, May 15, that it will be proposing a rule to have enrollment into Federally-facilitated Small Business Marketplace (known as Small Business Health Options Program or “SHOP”) health insurance plans go directly through insurers as of 2018.

The rule will not eliminate the Federally-facilitated SHOP (FF-SHOP) in full, but the FF-SHOP will stop facilitating online enrollments into FF-SHOP plans. The FF-SHOP will continue to certify FF-SHOP plans, determine eligibility for SHOP coverage, and serve as a window shopping portal.  However, once they are determined eligible and have chosen a plan, small employers will be directed to FF-SHOP insurers or registered agents / brokers to enroll. Eligible small employers will be able to continue accessing the Small Business Health Care Tax Credit.

Employers will be able to continue to enroll in 2017 FF-SHOP plans online through November 15, 2017. Employers that enroll in 2017 coverage can continue to use healthcare.gov to enroll employees and pay premiums until the end of the plan year.

This change only directly applies to FF-SHOPs.  State-based SHOPs (SB-SHOPs) will have the option to continue facilitating enrollment through the SB-SHOP online portal or to also adopt direct enrollment.

Federally-Facilitated Marketplace Enrollment

Similarly, CMS released guidance on Wednesday, May 17, enabling (but not requiring) full direct enrollment in individual market Federally-facilitated Marketplace (FFM) plans starting for open enrollment for plan year 2018. Unlike for the FF-SHOP, consumers will still have the option to enroll online through healthcare.gov. 

While direct enrollment was already allowed, consumers previously were redirected to healthcare.gov to complete the eligibility process prior to enrolling through an insurer or web-based broker. Under the new guidance, consumers can complete the process in full through a third-party website. 

This change applies to FFMs and State-Based Marketplaces on the Federal Platform (SBM-FPs). Technical rules and compliance requirements for completing the process were outlined, including for entities that wish to facilitate “direct enrollments.” Future guidance on privacy and security requirements may be issued.


1332 Checklist

In follow-up to its letter to Governors regarding the Section 1332 Waiver opportunity, CMS and the Department of Treasury released a Section 1332 checklist on May 16 designed to help states pursue ACA State Innovation Waivers. Section 1332 of the ACA allows states to waive specific ACA provisions as long as they apply according to the process set out in regulations and meet the following comparability requirements: 

  • The waiver will provide coverage to at least a comparable number of the state’s residents as would be provided without the waiver; 

  • The waiver will provide coverage and cost-sharing protections that are at least as affordable as would be provided without the waiver;

  • The waiver will provide for coverage that is at least as comprehensive as would be provided without the waiver; and 

  • The waiver will not increase the federal deficit.

Click here to read PCG’s updated overview of all Section 1332 Waiver requests, opportunities, and actions, including a detailed table of specific states’ requests and other ideas being considered (now reflecting the newest waiver proposal to be released from Minnesota).  

In distributing the checklist, the agencies reiterated their interest in working with states on waivers aimed at lowering premiums, improving market stability, and increasing consumer choice and, once again, highlighted the opportunity to use the waiver to implement high-risk pools and state-operated reinsurance programs. In the introduction to the checklist they specify that, if a state shows a reduction in federal premium tax credit spending resulting from initiatives such as state-operated reinsurance programs, the state could receive pass-through funding for the program from those savings. This is a request that Alaska has made in its pending Section 1332 Waiver request that CMS has highlighted as a model several times.

The checklist outlines what information states must submit to satisfy the required elements of a Section 1332 Waiver application, including relative to:

  • Public notice and comment requirements;

  • State legislative authority;

  • Waiver requests;

  • Quantitative analyses;

  • Implementation timeline; and 

  • Reporting requirements.

In several places, the checklist specifically notes the information that must be provided relative to a waiver request to support a reinsurance or high-risk pool program. It also flags that a state may want to waive the single risk pool requirement for such waivers.