CMS Announces Two New Enrollment Changes in ACA Exchanges

While Affordable Care Act (ACA) talks have hit a stalemate in the Senate, the Centers for Medicare & Medicaid Services (CMS) made good on its promise to make changes to the regulation in an attempt to both ease the regulatory burden and potentially increase enrollment in 2018. CMS made two enrollment changes for the small business Exchange and the individual Exchange. While the impact on consumers is not yet clear, the two moves will dynamically change the relationship between brokers, agents, and consumers and may actually be an efficient step by the new administration to boost coverage sign ups in 2018.

CMS Sunsets Use of Healthcare.gov for Small Business Exchange

First, on May 15, 2017, CMS announced it will no longer use healthcare.gov for enrollment functions. Healthcare.gov will continue to determine the eligibility for tax credits for small employers but will no longer handle enrollment, payment, and benefit functions – these will be relegated to agents and brokers registered with the Federally-Facilitated Small Business Health Options Program (FF-SHOP). CMS stated that State-Based Exchanges can continue to operate online enrollment or adopt the federal approach. The FF-SHOP currently covers 38,749 people.

Seema Verma stated the change was aimed to reduce ACA burdens on consumers and small businesses and make it easier for them to purchase coverage. While this move will do little in the way of assisting small businesses, the clear winners are brokers, agents, and insurers. The change will promote agent and broker participation in providing small business offerings. It is also in line with CMS’ new priority of deregulation by removing healthcare.gov barriers for insurers.

CMS Will Allow Direct Enrollment through Third-Party Sites

Also on May 17, CMS released new guidance stating it will now allow Federally-Facilitated Exchange users to sign up for coverage directly with web brokers and insurers. Currently, users are redirected to healthcare.gov to complete enrollment, a process that has long been touted as burdensome. The third parties will be responsible for verifying eligibility for enrollment, tax credits, and subsidies. They will also be required to hire third-party auditors to certify compliance and must apply with CMS and gain approval to directly enroll customers. This move will certainly relieve burdensome requirements for insurers and brokers. It may also boost Exchange enrollment as CMS has noticed customers who initiated applications never completed them once they were re-routed to healthcare.gov to complete the application process.

In closing one critical note to point out is this new guidance shows CMS is actively working to make changes to ACA regulations and guidance where there is authority. We should expect much more action below the waterline from CMS this summer.

 

Resources:

The Gorman Health Group 2017 Forum concluded recently in New Orleans with over 200 of our closest clients and partners. John Gorman provides key takeaways from the event here. Make sure to join us next year!

 

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