CMS Should Plan for Delayed Opening of Exchanges, Groups Say

Nov. 1, 2011 – 5:33 p.m.

CMS Should Plan for Delayed Opening of Exchanges, Groups Say

By John Reichard, CQ HealthBeat Editor

State officials and insurers are urging the Centers for Medicare and Medicaid Services to begin planning for delays in launching some functions of health insurance exchanges under the health care law, saying that short time frames and limited vendor capacity to create the marketplaces make such planning prudent.

The National Association of Medicaid Directors said, in a comment on proposed requirements for exchange determinations of Medicaid eligibility, that “for many states the combination of diminished state capacity and limitations on vendor expertise. . . .present a significant challenge to meeting the statutory deadlines.”

Oct. 31 was the last day to submit comments on the exchange regulations.

Exchanges that open Jan. 1, 2014 under the health care law (PL 111-148, PL 111-152) must provide a “one-stop shop” for uninsured Americans trying to line up health care coverage. That entails determining whether an exchange customer is eligible for Medicaid, subsidies to buy private coverage or some other option.

But state Medicaid directors say that federal agencies should “begin working with states to develop transitional, phase-in, and contingency plans, to be deployed in the event that some states are unable to establish a seamless, coordinated system and networks to conduct real-time eligibility determinations and interact with the exchange by the statutory deadlines.”

Federal officials also need educate consumers about what to expect in terms of “real-time determinations” of eligibility, the NAMD advises CMS.

“Thus, while extensive planning is underway to streamline and automate the application process, a significant number of Medicaid applicants may not receive a ‘real-time’ eligibility decision,” NAMD said.

In its comments, America’s Health Insurance Plans (AHIP) said that deadlines for building exchanges are “quite challenging.” If final rules on exchanges are delayed, “the implementation time frame should be re-evaluated in consultation with the states and the health plan community,” AHIP said.

The insurer trade group added that CMS should ensure that quality improvement strategies adopted by exchanges are consistent from state to state, that exchanges should not exclude health plans based on their premium charges, and that exchanges developed for small businesses should not be expanded eventually to include the large group market.

In its comments, the Federation of American Hospitals (FAH) said that hospitals “remain a portal for enrollment in Medicaid and CHIP,” the Childrens’ Health Insurance Program. Hospitals should be able to serve as “navigators” that under the health care law help guide exchange customers understanding their insurance options, FAH said. “Hospitals face-to-face interaction with patients makes hospitals a natural point of access not only for Medicaid and CHIP, but also for all insurance affordability programs,” it added.

Source: CQ Online News

Same-day coverage of the people and events shaping health care policy from Washington.

© 2011 CQ Roll Call All Rights Reserved.


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