March 2014 Update

Open Enrollment for the Marketplace at HealthCare.gov comes to an end on March 31st, 2014. Unless the federal administration extends this deadline, only individuals who qualify for a “Special Enrollment Period” will be permitted to enroll in a subsidized health insurance plan. While the state of Indiana continues to negotiate the use of the Healthy Indiana Plan (HIP) as a mechanism to expand Medicaid, state agencies have begun to release new information on major upcoming changes to the state programs. Our goal remains to provide you and your patients / clients / consumers with the ClaimAid Advantage.

More Information on Indiana’s 1634 Transition Released

  • The Indiana Family and Social Service Administration (FSSA) has released additional information on the transition impacting Spend Down and the Medicaid application processes.
  • What you need to know:  A general notice to Indiana ABD members has been mailed in the last few weeks providing general information about upcoming changes. The state of Indiana has posted a Comprehensive FAQ detailing many aspects of the transition. For the updated FAQ, please CLICK HERE. If you or your patients / clients have questions about this notification, you may direct them to a ClaimAid advocate or CONTACT US.

Third Party Payments of Premiums for Qualified Health Plans in the Marketplaces

  • In February, the Centers for Medicare and Medicaid Services (CMS) issued a memo permitting “payments from private, not-for-profit foundations” for Marketplace Qualified Health Plan (QHP) premiums.
  • What you need to know: This memo was in response to questions regarding a November, 2013 memo that stated “HHS discourages this practice and encourages issuers to reject such third party payments” with respect to payments made by hospitals and other healthcare providers. Additional guidance states that payments are acceptable “if they are made on behalf of QHP enrollees who satisfy defined criteria that are based on financial status and do not consider enrollees’ health status.” Also CMS “would expect that premium and any cost sharing payments cover the entire policy year.” For direct links to these memos, please click HERE and HERE.

Open Enrollment Deadline Approaches

  • Open Enrollment in Marketplace insurance plans at HealthCare.gov ends on March 31st, 2014.
  • What you need to know: Unless the federal administration extends this deadline, only individuals who qualify for a “Special Enrollment Period” will be permitted to enroll in a subsidized Marketplace health insurance plan. If your organization would like more information about how your patients may enroll after the end of Open Enrollment, please CONTACT US.

Contracted Staff and Hospital Presumptive Eligibility (HPE) 

  • Contracted staff may perform work related to Hospital Presumptive Eligibility (HPE) operations.
  • What you need to know:  After some initial conflicting guidance from Indiana FSSA and CMS, the state of Indiana has issued clarification that “hospitals may contract with third-party vendors to assist with HPE operations as long as the hospital takes responsibility for the presumptive eligibility (PE) determinations that result.” Official IHCP Banner information may be found by clicking HERE. If you have questions or would like more information on this new program, please CONTACT US.

For more details and up-to-date information, please contact J Hopkins, Vice President at 800.842.4052 x126 or by email at jhopkins@claimaid.com.