by Andrew Walden

According to a US Department of Health and Human Services (HHS) report issued December 11, 2013, some state health exchange reports—possibly including Hawaii—contain duplicate enrollments. 

Another discrepancy identified by HHS indicates that the “Number of Individuals Who Have Selected a Marketplace Plan” is “pre-effectuated” -- including individuals who have not made any premium payments.

The acknowledged failure of the Hawaii Health Connector to connect with State of Hawaii Medicaid eligibility systems is cited as an explanation for the absence of Hawaii figures on “Determined or Assessed Eligible for Medicaid / CHIP.”

HHS explains, “the (Hawaii Health Connector) is in the process of receiving data from the state Medicaid department on applicants who have been determined ineligible for Medicaid or CHIP. It is anticipated that the proportion of QHP eligible individuals with Financial Assistance will increase as these applicants are transferred from the Medicaid agency to the Marketplace.”

HHS reports only 444 “pre-effectuated” persons signed up for insurance via the Hawaii Health Connector.  This between October 1 and November 30.  This figure was never reported publicly.  State Health Connector officials reported 574 sign-ups at their board meeting December 6, 2013.  It was not clear what time period this referred to.  Testifying at a December 12, 2013 legislative informational briefing, Health Connector officials stated that 683 signed up as of December 9, 2013.  Based on the HHS report, it appears that all of these numbers are pre-effectuated. 

Hawai’i Free Press requested comment from the Hawaii Health Connector on the discrepancies between this report and the figures Health Connector officials have given to the public and the legislature.  We will update this article if a response is received.

Here are key excerpts from the federal report:

HEALTH INSURANCE MARKETPLACE: DECEMBER ENROLLMENT REPORT

This is the second in a series of issue briefs highlighting national and state-level enrollment-related information for the Health Insurance Marketplace (Marketplace hereafter). This brief includes data for states that are implementing their own Marketplaces (also known as State-Based Marketplaces or SBMs), and states with Marketplaces that are supported by or fully-run by the Department of Health and Human Services (including those run in partnership with states, also known as the Federally-facilitated Marketplace or FFM)….

This report features cumulative data for the two month period because some people apply, shop, and select a plan across monthly reporting periods. We believe that this cumulative data provides the best “snapshot” of Marketplace enrollment activity to date. We are working to eliminate “duplication” associated with counting people in more than one month – some SBM data systems are still working to unduplicate counts in their cumulative data, so all duplication has not yet been removed from this report….

The data reported here have been generated by the information systems of the Centers for Medicare & Medicaid Services (CMS), based on information reported to CMS by SBMs…. Data for certain metrics are not yet available for some SBM states due to information system issues….

We believe that the information contained in this issue brief provides the most systematic “snapshot” of enrollment-related activity in the Marketplaces to date because the data for the various metrics are counted using comparable definitions for data elements across states, and between the SBMs and FFM. It is important to note that the SBM enrollment-related data that are reported in this issue brief represent state data that have been reported to CMS, and may differ from comparable data that have previously been publicly reported on SBM websites or in media reports because that data may be based on different time periods or metric definitions from those used in this report….

Hawaii (12)

• 3,661 -- Total Number of Completed Applications (2)
• 4,974 -- Total Individuals Applying for Coverage in Completed Applications (3)
• 2,987 -- Total Eligible to Enroll in a Marketplace Plan (4)
• 117 --  Eligible to Enroll in a Marketplace Plan with Financial Assistance (5)
• N/A -- Determined or Assessed Eligible for Medicaid / CHIP by the Marketplace (6)
• 1,987 -- Pending/ Other(7)
• 444 -- Number of Individuals Who Have Selected a Marketplace Plan(8)

Notes:

“N/A” means that the data for the respective metric is not yet available for a given state.

(1) Unless otherwise noted, the data in this table represent cumulative Marketplace enrollment-related activity for 10/1/13 to 11/30/13. For additional methodological information, please refer to Appendix B of this report.

(2) “Completed Applications” represents the total number of electronic and paper applications that were submitted to the Marketplace during the reference period with sufficient information to begin performing eligibility determinations for enrollment in a plan through the Marketplace and, if appropriate, sufficient information to begin performing eligibility determinations for advance payments of the premium tax credit and cost-sharing reductions, and eligibility assessments or determinations for Medicaid and CHIP.

(3) “Individuals Applying for Coverage in Completed Applications” represents the total number of individuals included in Completed Applications that were submitted to the Marketplace during the applicable reference period. This number does not include individuals applying through the SHOP. Note: SBM data on the number of Individuals Determined Eligible to Enroll in a plan through the Marketplace and the number of Individuals Determined or Assessed Eligible for Medicaid / CHIP by the Marketplace do not add to the total number of persons applying for coverage in completed applications due to missing data and differences in process flows for Marketplace Plans and Medicaid/CHIP eligibility determinations / assessments.

(4) “Individuals Determined Eligible to Enroll in a Plan Through the Marketplace” (i.e., a Marketplace plan) represents the total number of individuals for whom a Completed Application has been received and who are determined to be eligible for plan enrollment through the Marketplace during the reference period, whether or not they qualify for advance payments of the premium tax credit or cost-sharing reductions. These individuals may or may not have enrolled in coverage by the end of the reference period. Individuals who have been determined or assessed eligible for Medicaid or CHIP are not included.

(5) “Individuals Determined Eligible to Enroll in a Plan Through the Marketplace with Financial Assistance” represents the total number of individuals determined eligible to enroll in a Marketplace plan who qualify for an advance premium tax credit (APTC), with or without a cost-sharing reduction (CSR).

(6) “Individuals Determined or Assessed Eligible for Medicaid / CHIP by the Marketplace” represents the number of individuals who have been determined or assessed by the Marketplace as eligible for Medicaid or CHIP, based on modified adjusted gross income (MAGI). In some states, Completed Applications for individuals, whom the Marketplace has assessed as potentially eligible for Medicaid or CHIP, based on MAGI, are transferred to the relevant state agency for a final eligibility determination. In these “assessment states” the data include those accounts where a final decision is pending. In other states, the Marketplace has been delegated the final Medicaid/CHIP determination responsibility for these individuals. Thus, this data element includes FFM determinations and assessments, regardless of the state Medicaid/CHIP agency’s final eligibility determination. These data may vary slightly from accounts transferred via ‘flat file’ to states by the FFM. The Nov 13 report included data on some applications received in October that had not completed all steps required for a determination or assessment; these numbers have been updated here. Additional quality assurance is taking place on Medicaid assessments and determinations in advance of transfers to states and these figures might alter further based on that review. Note: this data element does not include eligibility determinations made by State Medicaid/CHIP agencies based on applications originally submitted to the State agency or other Medicaid/CHIP assessments or determinations.

(7) “Pending / Other”: A derived estimate for individuals who have a completed and processed application, who either: 1) have a pending eligibility determination or assessment for Marketplace plan or Medicaid/CHIP coverage; 2) have a completed eligibility determination or assessment for Marketplace plan or Medicaid/CHIP coverage that is not captured in the relevant column in this table for a given state due to system issues; or 3) have been deemed ineligible for Marketplace plan coverage. The Pending/Other totals shown in this table represent the sums of the corresponding state-level Pending/Other counts.

(8) “Individuals Who Have Selected a Marketplace plan” represents the total number of “Individuals Determined Eligible to Enroll in a plan Through the Marketplace” who have selected a plan (with or without the first premium payment having been received directly by the Marketplace or the issuer) during the reference period. This is also known as pre-effectuated enrollment….

(12) Hawaii -- Because the Hawaii Marketplace’s eligibility system is not integrated with its state Medicaid department, the data for “Individuals Assessed Eligible for Medicaid/CHIP” are not available at this time. In addition, the Marketplace is in the process of receiving data from the state Medicaid department on applicants who have been determined ineligible for Medicaid or CHIP. It is anticipated that the proportion of QHP eligible individuals with Financial Assistance will increase as these applicants are transferred from the Medicaid agency to the Marketplace….

READ … The Entire Report

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