Not qualified for Medicaid, 40,000 enroll in state plans

St. Louis insurer to expand 2015 offerings, legislators told

More than 40,000 people who did not qualify for Medicaid were enrolled as of Monday in plans on Arkansas’ health-insurance exchange, and more than 4,000 other plans had been canceled, according to figures released Thursday by the state Insurance Department.

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Insurance Commissioner Jay Bradford also told state lawmakers Thursday that St. Louis-based Centene Corp. has confirmed it intends to offer plans in every county for coverage starting in 2015, up from 29 counties this year.

Along with an earlier announcement by Little Rock-based QualChoice Health bInsurance that it will likely offer plans statewide next year, the decision by Centene means people in every county next year should be able to choose plans from at least four companies.

For coverage starting this year, consumers in 24 counties have choices from only two companies - Arkansas Blue Cross and Blue Shield and the national Blue Cross and Blue Shield Association.

“All companies are going to go into all areas next go around,” Bradford told members of the House and Senate public health committees.

He credited the so-called private option created under a state law passed last year. The program allows most people who qualify for the state’s expanded Medicaid program to receive coverage through a plan on the state’s insurance exchange, with Medicaid paying the premium.

As of March 31, 121,442 Arkansans were enrolled in the program.

“I think it speaks real well to what you all have done,” Bradford told legislators.

A spokesman for Centene Corp. didn’t return a call seeking comment.

Sen. David Sanders, R-Little Rock and a sponsor of the legislation creating the private option, noted that Centene’s insurance business in Arkansas had previously been limited to primarily administering a Medicaid program that provided limited health benefits to small-business employees.

He said the expansion of insurance companies’ offerings into new areas is “exactly what we wanted” in crafting the private option.

“Obviously one of the key criticisms has been that there really is not competition,” Sanders said. “Now we’re actually seeing it.”

The expansion of Medicaid, authorized by the federal health-care overhaul law and approved last year by the state Legislature, extended eligibility to adults with incomes of up to138 percent of the poverty level: $16,105 for an individual, for instance, or $32,913 for a family of four.

Federal tax-credit subsidies are available through the exchange for those who don’t qualify for Medicaid and have incomes of less than 400 percent of the poverty level: $45,960 for an individual, for example, or $94,200 for a family of four.

This year, Arkansas Blue Cross and Blue Shield and its national affiliate are the only companies offering plans in all seven market areas delineated by the Insurance Department.

According to figures released Thursday by the state Department of Human Services, 52,305 people were enrolled in Medicaid-funded plans offered by Arkansas Blue Cross as of March 31, and 41,084 were in plans offered by the national company.

Centene, which markets plans under the name Ambetter Arkansas, is offering plans in the central, northwest and west-central regions. It had enrolled 27,024 people in private-option plans as of March 31, according to the Human Services Department.

QualChoice Health Insurance is offering plans in all but the southeast and southwest regions, which encompass 24 counties. Enrollment through the private option in QualChoice plans was stopped in early November, however, because of the company’s pending acquisition by Englewood, Colo.-based Catholic Health Initiatives.

Enrollment in the QualChoice plans is expected to resume after the purchase is approved by the Insurance Department.

Bradford said Thursday that he is waiting with “pen in hand” to approve the paperwork after it is submitted to the department.

He said he also hopes a fifth company, one offering multistate plans, will apply to provide plans in Arkansas next year.

The state has not released figures showing how many people who did not qualify for Medicaid have signed up for each company’s plans.

The tally released by the Insurance Department on Thursday shows overall enrollment among those ineligible for Medicaid grew by more than 2,100 people from April 7 to Monday, reaching 40,574.

Of those enrolled, 28,650 had made at least one premium payment, which is required before the coverage takes effect.

An additional 4,091 plans had been canceled, possibly because enrollees failed to pay premiums or decided to enroll in a different plan, according to the department.

Enrollment began Oct. 1 for coverage that started in January.

Those who qualify for Medicaid can enroll throughout the year. For others, the enrollment deadline was March 31, although those who started applications on a federal enrollment portal, healthcare. gov, before the deadline were given until April 15 to complete enrollment.

Those who submitted paper applications have until Wednesday to complete enrollment.

In figures released Tuesday, the department described the enrollment total as reaching 44,665 but did not say how many of those plans were no longer in effect.

Deputy Insurance Commissioner Cynthia Crone told legislators that the method used by the department is similar to that used by the U.S. Department of Health and Human Services.

A department official has said its enrollment totals do not include canceled plans, however.

Crone also told legislators that next year, coverage for hearing aids and temporomandibular joint, or TMJ, disorders will be part of the state’s essential health benefits “benchmark” plan, meaning the benefits will be required to be covered by individual plans and those offered to the employees of businesses with up to 50 employees.

State laws require the coverage for hearing aids and TMJ to be offered by insurance companies at the time a policy is sold. This year, companies offering plans on the exchange satisfied that requirement in some instances by offering riders - separate, add-on policies - that could be purchased directly from the companies. The state laws do not require consumers to purchase the coverage.

The federal Centers for Medicare and Medicaid Services notified the Insurance Department that next year, it would not allow riders to be sold along with plans on the exchange, but it agreed to allow the benefits to be added to the state’s benchmark plan, Crone said.

She said most companies indicated the additional benefits would increase premiums by about $2 per month, although one “outlier” indicated it would add an additional $30.

Sanders said he would have preferred finding a way to satisfy the laws without making the benefits mandatory, but added, “It’s not a huge item.”

“I do think what we’re going to have over the next few years are real conversations about all of mandated coverage that we have in the state of Arkansas and what that does to the cost of care,” Sanders said.

Front Section, Pages 1 on 04/25/2014

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