As MD’s Health Insurance Exchange Moves on to Next Phase, Enrollment Continues

Many Maryland residents can continue to sign up for health insurance under the Affordable Care Act even though the first open enrollment period for the state’s health insurance exchange – Maryland Health Connection --ended this week. In the meantime,  the state is  turning toward doing a better job of managing things for the next  open enrollment period, which begins on November 15.

While there are various deadline for getting health insurance under the Affordable Care Act, there are also several exceptions. Medicaid enrollment is available year-round. As a result of Maryland’s decision to expand Medicaid under the new law, thousands of residents are newly eligible. Though many have already enrolled, those who  have not—or did not previously qualify—don’t  need to  wait for the next open enrollment period to do so. They can enroll at any time.

Second, many others are still eligible to enroll in private coverage through Maryland’s exchange. This includes those who were not able to sign up during the open enrollment period due to technical problems, provided that they called the hotline the state set up to report their problem. This likely includes thousands of residents.

In addition, the law makes available ‘‘Special Enrollment Periods’’ that allow anyone who  has experienced a change in circumstances during the year to sign up outside the normal enrollment period. This can include getting married, having a child, losing a job or employer-sponsored insurance, divorce, or the death of a spouse. Further, if your income  income changes and you become  eligible for subsidies to help you pay for  private insurance, you can  enroll or re-enroll in subsidized coverage at any time. More information on Special Enrollment Periods is available at the Maryland Health Connection.

Of course, the state now faces  the task of overhauling its exchange before open enrollment begins anew in November. This involves both correcting the problems that plagued the Maryland Health Connection since its launch last year, as well as efforts to build on the successes of the exchange’s first year.

On Tuesday, Maryland’s Health Exchange Board voted to replace its flawed information systems  with the technology used to run Connecticut’s largely successful state exchange, implemented and maintained by the consulting company Deloitte. Secretary of Health and Mental Hygiene Joshua Sharfstein and Isabela FitzGerald, Maryland’s Secretary of Information Technology, explained that doing so was the least expensive option and also met Maryland’s timeframe and needs. Connecticut’s exchange is described as “a simpler, streamlined system.” Rebuilding the exchange would take too long and would be too expensive ($66 million). Moving to the federal exchange would pose similar problems and  raise additional issues about the exchange’s ability to communicate with the state Medicaid program. While the software code for Connecticut’s exchange is in the public domain and thus freely available, Secretary FitzGerald expects that it will still cost the state $40-50 million to implement. It is still  unclear how much of this cost will be covered by the federal government, as much of the $125 million for the original exchange was.

However, just as Maryland is working to correct the missteps from this first year of running its health insurance exchange, lawmakers should also recognize and build upon its successes. First, we already know that Maryland surpassed its initial enrollment projections. Almost 300,000 men, women and children  are known to have enrolled - 232,000 in Medicaid and 63,000 in private plans – and this does not reflect the surge of sign-ups during the final days of open enrollment, nor those who have more time to enroll due to technical difficulties.

Many of these people are newly ensured, and all will enjoy more financial security as a result of being covered. This is important progress. This large increase in the number of Marylanders with health coverage followed “a decade or more of people losing health coverage and a steady erosion in the financial protection of insurance, [which] put middle-income families at risk” nationwide, according to a recent report by the Commonwealth Fund.

In the coming weeks and months, we will delve deeper into the issues surrounding Maryland’s implementation of the Affordable Care Act, considering both what worked and what did not, discuss policy options for improvement and reform, and provide data and analysis on how health reform is impacting Maryland. Keep checking back here for more.

Streamlining New Medicaid Enrollments a Win-Win for Maryland

Lawmakers in Annapolis have the opportunity to provide more Marylanders with health coverage and make state government more efficient at the same time.

Although Maryland has expanded Medicaid eligibility under the Affordable Care Act, tens of thousands of eligible residents are not yet enrolled. That could be corrected by legislation -- the Medicaid Streamlined Eligibility Act (HB 954) -- that would automatically enroll individuals in Medicaid if they are eligible  for the federal Supplemental Nutrition Assistance  Program (SNAP) or  if their children are eligible for Medicaid. The legislation, which was the subject of a committee hearing this week, would also allow 12-month continuous Medicaid eligibility for parents and children.

Besides increasing access to health coverage, adopting these measures would end costly, duplicative verification processes  for safety net programs with similar eligibility levels. That’s particularly true of the provision that would link Medicaid and SNAP eligibility.

Some 84.4 percent of all households receiving SNAP benefits in Maryland also are eligible for Medicaid – nearly 218,000 households. Maryland expanded Medicaid eligibility to anyone earning up to138 percent of the poverty line  ($27,310 a year for a family of three), and the vast majority of SNAP participants have incomes at or below this level.

In addition, most of the funding to pay for the increased Medicaid coverage would come from the federal government, not the state. The Department of Legislative Services expects that federal dollars will cover the entire cost for 90 percent of those who  would enroll in Medicaid through this streamlined process.   

Source: Maryland Department of Legislative Services (click to enlarge)

Note: The estimates for FY 2015 and FY 2016 include costs for all aspects of HB 954.

Medicaid is an efficient program that makes beneficiaries healthier by improving access to preventive and primary care. Its per-beneficiary costs are lower than those of private insurance, and its costs have been growing more slowly than employer coverage.  

Enrolling Maryland residents in Medicaid if they are already participating in SNAP will help make sure more Marylanders get the health coverage they need – and the economic security and peace of mind that go with it. It also would allow Maryland to identify and enroll eligible people more quickly and with less paperwork. 

Despite Setbacks, Affordable Care Act Helping MDers Obtain Health Coverage

Well over 85,000 Marylanders obtained health coverage through Maryland’s implementation of the Affordable Care Act (ACA) since the state began carrying out key components of the health reform law three weeks ago, according to the Maryland Department of Health and Mental Hygiene. For many of these enrollees this marks the first time they have been able to afford coverage in a long time, or ever.

Maryland has been a leader in implementing the ACA, a law with many complementary elements that are designed to both provide health coverage to millions of Americans that currently go without care, as well as improve the value of existing plans. To do so, the ACA establishes health insurance exchanges, or marketplaces where citizens can view and compare health insurance options, find out if they are eligible to receive federal subsidies to purchase a plan or qualify for Medicaid, and enroll. Anyone with income up to 400 percent of the federal poverty level ($45,960 for an individual; $94,200 for a family of four) is eligible for federal subsidies to purchase insurance through the exchanges.

The nationwide rollout of the Affordable Care Act (otherwise known as Obamacare) has been fraught with missteps. Glitches associated with HealthCare.gov, the federal insurance marketplace operating in 34 states, have been well documented. Other reports have emerged of potential unintended consequences, including a recent story in the Sun about Maryland community colleges cutting the hours of adjunct faculty in order to avoid having to comply with the requirement that large employers provide health insurance to employees that work 30+ hours per week.

Maryland set up its own exchange, the Maryland Health Connection. This too has had a rocky start, with technical difficulties of its own that have prevented many residents from being able to sign up or view the various options available to them. Nonetheless, these problems are less severe than those of the federal exchange and are being repaired more rapidly. Indeed, the Maryland Health Connection reports that the site has been increasingly able to handle the high demand for coverage, demonstrated by the more than 300,000 unique visitors to the exchange website and 33,000 calls to its call centers since opening on October 1. Of these visitors, more than 40,000 people have created identity-verified accounts for their households, and more than 27,000 have learned whether or not they are eligible for subsidies. Further, as of October 23, more than 3,100 Maryland households have successfully enrolled in an insurance plan through the Maryland Health Connection.

While these results are inadequate to meet the needs of Maryland’s 800,000 uninsured residents, who comprise 14 percent of the state’s population, they are promising nonetheless. The Maryland Health Connection’s data shows that enrollment has been increasing steadily since its debut on October 1:

Cumulative Household Enrollment through the Maryland Health Connection

Source: Maryland Health Connection weekly reports

(click to enlarge)

Further, interest among younger adults, whose enrollment is considered key to keeping premiums low on plans sold through the exchange, is relatively high. According to the Maryland Health Connection’s most recent report, the 25-29 age group has created the most accounts, followed by the 30-34 age group.

Another important element in the ACA’s effort to expand health coverage is the expansion of Medicaid eligibility to anyone whose income is at or below 133 percent of the federal poverty level ($15,282 for an individual; $31,322 for a family of four). The Supreme Court made expansion optional for states, and Maryland is one 26 states that have chosen to move forward with this expansion. The Maryland Health Connection reports that 82,473 currently uninsured Marylanders are signed up to be automatically enrolled in Medicaid coverage beginning in 2014. And while a recent article in the Wall Street Journal raises concerns that Maryland’s “aggressive” approach to enrolling residents in Medicaid coverage will “siphon off” younger, healthier residents from the exchanges, the Maryland Health Connection’s data thus far suggests this is not the case. Further, because the federal government is picking up 92 percent of the costs of expanding Medicaid over the next ten years, Medicaid expansion is an efficient way to provide health coverage to low income residents that also saves money in Maryland’s state budget.

The problems that have emerged since the launch of the state and federal health insurance exchanges are important to identify and address as quickly as possible. Nonetheless, Maryland’s leadership in implementing the ACA has to date resulted in well over 85,000 newly covered residents. And while the numbers of Marylanders that have signed up for coverage through the Maryland Health Connection remain relatively low in light of official expectations that 150,000 people will in the first year, the state’s data suggests that these numbers are steadily increasing as repairs are made to the exchange’s website. Further, the experience of Massachusetts, whose state insurance exchange served as the model for the ACA, suggests that many will sign up towards the end of the open enrollment period, which closes on March 31, 2014. Success will be measured by who is signed up at the end of the enrollment period, not the first few weeks. During this time, it is important for Maryland to continue its proactive push to implement and improve the Affordable Care Act to ensure that all of its residents have access to the care they need. 

Week Ahead

Last week we blogged about Maryland's economic growth in 2012.

Also last week, the Tax Foundation released a study that named Maryland the most generous state, based on percentage of state taxpayers claiming charitable deductions on their 2012 returns.Over forty percent of Marylanders took this deduction last year, with a median charitable donation of $2,969 and an aggregate state contribution of nearly $4 billion. (Note that MBTPI and others have  shown that the Tax Foundation's Business Tax Climate and "Tax Freedom Day" studies are not a good guide to states' tax policies. This data from the the Tax Foundation on charitable deductions is okay).

Additionally, the Bureau of Labor Statistics (BLS) released its monthly employment figures last Friday, showing the nation's private sector added 178,000 jobs in May. Workforce participation and unemployment both grew by 0.1 percent last month as more people sought work.

For the week of June 10th through June 16th:

• On Monday, June 10th, the Maryland Community Health Resources Commission is hosting a public forum with the Maryland Health Benefit Exchange and the Department of Health and Mental Hygiene for safety net providers, MCOs, and commercial carriers from 1pm to 3pm at the Todd Performing Arts Center Lobby at 1000 College Circle in Wye Mills.
• On Tuesday, June 11th, the Maryland Commission on Cybersecurity Innovation Excellence meets to report on its activities at 9am in the University of Maryland University College's Salon A at 3501 University Boulevard East in Adelphi.
• Also on Tuesday, the Advisory Council for Alternative Response holds its monthly meeting at 1pm in the Department of Human Resources building's room 1044 at 311 West Saratoga Street in Baltimore.
• On Wednesday, June 12th, Board of Public Works has a general meeting at 1pm in the Governor's Reception Room on the second floor of the State House in Annapolis.
• Also on Wednesday, the Maryland Community Health Resources Commission hosts another public forum with the Maryland Health Benefit Exchange and the Department of Health and Mental Hygiene for safety net providers, MCOs, and commercial carriers from 10am to noon at the Howard County Health Department at 7180 Columbia Gateway Drive in Columbia.
• On Thursday, June 13th, the Maryland Health Insurance Plan Board of Directors meets at 9am in 1 Calvert Plaza's suite 630 at 201  E. Baltimore Street in Baltimore.
• Also on Thursday at 9am, the Interagency Committee on School Construction holds its regular meeting in Conference Room 1 on the 8th floor of the Grasmick Education Building at 200 W. Baltimore Street in Baltimore.

The Week Ahead (Tax Day Edition)

Happy Tax Day (really)! We're thankful yet again for all the things our federal and state taxes pay for--like education, healthcare, and public safety.

Last week we published a follow up post to our pre-session discussion of the three big bad wolves threatening Maryland's budget. We also blogged about the important non-budget legislation passed in the 2013 session, and on unfinished business.

MBTPI is co-hosting a Legislative Reception next week on Tuesday, April 23rd, to celebrate the end of the 2013 legislative session and we want you to be part of it. Click through to find out more or to register for this free event.

For the week of April 15th through April 21st:

• Our friends at Maryland Hunger Solutions are holding a conference call for organizations interested in or engaged in food stamp outreach from 9:30-10:30am on Wednesday, April 17th. The call will focus on the benefits of joining the Maryland Food Supplement Program State Outreach Plan, including the potential for federal reimbursement for staff time and marketing activities related to these efforts. Click here to register.
• That same morning the Board of Public Works meets at 10am.
• The Interagency Committee on School Construction holds their regular meeting at 9am on Thursday, April 18th in Baltimore. School construction, particularly in Baltimore City, was an important issue in the 2013 session.
• Also on Thursday, the Maryland Health Care Commission meets at 1pm.
• On Friday, April 19th, the Bureau of Labor Statistics releases state-level employment figures for March.

Cigarette tax will help budget and save lives

Md. Citizens' Health Initiative

The legislature is considering legislation to increase taxes on cigarettes. This would both raise funds to help resolve Maryland's remaining "structural budget deficit," and would discourage smoking - especially among teenagers and young adults.

Senate Bill 700 and House Bill 683 would increase the tobacco tax rate from $2.00 to $3.00 per pack. It would also increase the tax rate on other tobacco products (like chewing tobacco and pipe tobacco) from 30 percent to 95 percent of the wholesale price (excluding certain cigars), and mandates minimum and maximum tax rates for certain other tobacco products. These bills would also guarantee at least $21 million in annual funding for tobacco cessation programs, beginning in fiscal year 2015, and divert additional funding to other health care programs.


The Maryland Budget and Tax Policy Institute supports these bills because of the significant public health benefits of reducing smoking. Previous increases in the tobacco tax have reduced smoking in Maryland twice as fast as the national average, saving lives and taxpayers’ money by reducing the need for health care. Adding another dollar to the per-pack cost, along with the other increases in SB 700 and HB 683, will save many more lives.

It will also raise money for important health programs—perhaps as much as $81.5 million in fiscal year 2014 according to the fiscal note.

SB 700 and HB 683 would also put the brakes on the disturbing upward trend in cigar use by young Marylanders. Increasing the tax on these products to put them more on par with cigarettes would quickly reduce the number of underage users of these products, protecting their health and well-being.

The Week Ahead

Last week Neil blogged about the continued moderately good news coming out of the Board of Revenue Estimates, and the recommendation of the Spending Affordability Committee. However, as Neil points out Congressional action or inaction may still have a large effect on Maryland's budget.

The new General Assembly website has gone live. There are still a few glitches, but advocates should familiarize themselves with the new website now before the start of session 2013.
 
Monday, December 17th

• Alcoholic Beverages Article Review Committee meets to complete its review of material dealing with multiple licensing plans (Various Titles, Subtitle 14A of the Alcoholic Beverages Article) and miscellaneous provisions. 5pm in Judicial Training Room 3, 2009F Commerce Park Drive, Annapolis.
• Maryland Health Care Reform Coordinating Council meets. 10am in room 240, House Office Building, Annapolis.

Tuesday, December 18th

• House Health and Government Operations Committee reviews draft palliative care legislation. 10am in room 241, House Office Building, Annapolis.
• Joint Committee on Access to Mental Health Services is briefed on the effect of the Affordable Care Act on access to mental health services and the DHMH Behavioral Health Integration Report.

Wednesday, December 19th

• Board of Public Works meets. 10am in the Governor's Reception Room, State House, Annapolis.
• Workgroup on Access to Habilitative Services Benefits meets. 9:30-11:30am in the Maryland Insurance Administration Hearing Room, 22nd Floor of St. Paul Plaza, 200 St. Paul Place, Baltimore.
• General Provisions Article Review Committee reviews drafts of Title 4 "Public Information Act" and Title 5 "Maryland Public Ethics Law" changes. 3pm in room 241, House Office Building, Annapolis. 
• Maryland Nonprofits offers a webinar on Starting a Nonprofit: Planning and Preparation. This is a paid training, for more information or to register go to their events page.

Thursday, December 20th

• Maryland Health Care Commission meets. 1pm in conference room 100, Maryland Health Care Commission, 4160 Patterson Avenue, Baltimore.
• Board of Directors of the Maryland Health Insurance Plan (MHIP) holds a public session. Topics will include prescription drug utilization, MHIP Tier 4 prescription drug cost sharing alternatives; and a procurement update. The Board also holds a closed session about the MHIP Executive Director search. Participants can attend the meeting in person or by conference call Dial in: 888-603-9632 Participant passcode: 2184969. 9am in suite 630, 1 Calvert Plaza, 201 E. Baltimore Street, Baltimore. 

Friday, December 21st

• Bureau of Labor Statistics releases state employment data for November. Maryland's unemployment rate fell in October, to just 6.7 percent.