The Scoop: December 18, 2019 Edition

Welcome to this week’s round-up of state-level health reform news, including:

Open enrollment still underway in eight states and DC

Open enrollment for individual-market health insurance ended at 3 a.m. EST today in the 38 states that use HealthCare.gov. But in eight other states and Washington, DC, enrollment is still ongoing, with varying end dates:

  • Minnesota: December 23
  • Washington: December 30
  • Rhode Island: December 31
  • Connecticut: January 15
  • Colorado: January 15
  • Massachusetts: January 23
  • California: January 31
  • DC: January 31
  • New York: January 31

January 1 effective dates are still available in most of those states (Minnesota, Rhode Island, Colorado, Massachusetts, California, and DC). (See more details here.) In the others, residents can enroll with February 1 effective dates.

In states where open enrollment has ended, you’ll need a qualifying event in order to enroll or make a change to your coverage for 2020. You can learn more about the rules for qualifying events in the individual market in our guide to special enrollment periods.

Kentucky’s Medicaid work requirement is officially dead

Kentucky’s new governor, Andy Beshear took office last week. And as promised, one of his first acts as governor was to officially terminate the Kentucky HEALTH waiver. The waiver, which called for a Medicaid work requirement, premiums for some enrollees, and a termination of retroactive eligibility, was twice approved by the federal government. But although the state originally intended to implement the work requirement in mid-2018, a judge overturned it (twice) and it never took effect.

Controversy: Should Idaho’s enhanced short-term plans be on-exchange?

Four Democratic federal lawmakers have sent a letter to CMS, asking the agency to prohibit Idaho from offering the state’s new “enhanced” short-term health plans on-exchange. The plans are currently only available off-exchange, but Idaho officials hope to have them on-exchange by mid-2020.

The enhanced short-term plans are much more robust than standard short-term plans, but they do not comply with all of the Affordable Care Act’s rules. As we explained in a Twitter thread, there are valid arguments on both sides of this controversy.

South Carolina becomes the first non-expansion state with an approved Medicaid work requirement

CMS approved South Carolina’s Medicaid work requirement proposal last week, marking the first time a work requirement has been approved for a state that hasn’t expanded Medicaid under the ACA. Because coverage hasn’t been expanded, the only able-bodied non-elderly adults with Medicaid coverage in South Carolina are very low-income parents. Consumer advocates worry that thousands of low-income parents could lose their coverage as a result of the work requirement, which is expected to be implemented by mid-2020.

Under the terms of a separate waiver that was approved simultaneously, South Carolina plans to extend Medicaid eligibility for parents up to 100 percent of the poverty level (from the current 67 percent threshold). But these newly eligible parents will have to comply with the work requirement in order to qualify for Medicaid.

Nebraska Medicaid expansion waiver submitted

Nebraska has submitted its Heritage Health Medicaid expansion proposal to CMS for review, more than a year after voters in the state approved a Medicaid expansion ballot initiative. Although the ballot initiative called for straight expansion under the terms of the ACA, Nebraska is taking a much more complicated approach. The state’s proposal calls for two tiers of coverage, with enhanced benefits (dental, vision, and over-the-counter drug coverage) for people who comply with various requirements, including a work requirement that begins in year two. Nebraska plans to begin enrolling people in expanded Medicaid in August, for coverage effective in October 2020.

Georgia’s 1332 waiver would dramatically change state’s insurance market

Last month, Georgia unveiled the details of its proposed 1332 waiver, which would make a variety of dramatic changes to the state’s insurance market. Georgia’s proposal is the first to incorporate the more relaxed 1332 waiver guidelines that the Trump administration published last year. It calls for the elimination of Georgia’s ACA marketplace, and would allow premium subsidies to be used for non-ACA-compliant health plans.

At the Center for Budget and Policy Priorities, Aviva Aron-Dine, Tara Straw, and Sarah Lueck have done a deep dive into Georgia’s proposal, explaining how it’s harmful to people with low-to-moderate incomes and/or pre-existing conditions. It’s well worth reading to gain an understanding of Georgia’s proposal and the effects it could have.

Federal spending bill protects Silver loading, repeals three ACA taxes

On December 17, the U.S. House of Representatives passed H.R.1865. The $1.4 trillion spending package – expected to be approved by the Senate and signed into law by President Trump – is necessary in order to avoid a repeat of last winter’s government shut-down.

The bill protects insurers’ ability to continue to add the cost of cost-sharing reductions to Silver plan rates for 2021. This approach, known as Silver loading, is beneficial for consumers, but HHS had previously indicated that they might consider changing the rules around this (HHS is currently working on rule making for 2021 plans).

The spending bill also repeals three ACA taxes:

  • The Cadillac tax, as of 2020 (this tax never took effect, as it was perpetually delayed)
  • The health insurance tax, as of 2021 (this tax was suspended in 2017 and 2019; it will be collected in 2020)
  • The medical device tax, as of 2020

New Jersey passes legislation to cap out-of-pocket prescription costs

Last week, we told you about a New Jersey bill to cap out-of-pocket prescription costs that had been taken up in the state Senate. This week, the Senate passed the bill unanimously. Assuming it’s signed into law, it will take effect 90 days after it’s enacted, and will apply to state-regulated (ie, non-self-insured) health plans issued or renewed after that date. Out-of-pocket prescription drug costs will be capped at $100 per month per drug, or $200 per month per drug if the policy is a bronze or catastrophic plan. HDHPs are exempt from the new rule until the insured has met the minimum HDHP deductible required under IRS regulations.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.