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CMS proposed rule aims to boost ACA enrollment, reinstate navigator duties – MedCity News

The Biden administration is proposing some major changes to Affordable Care Act marketplaces, including expanding the enrollment period by 30 days in 2022 and beyond.

The extension would allow consumers more time to review plan choices, seek in-person assistance and enroll in a plan that best meets their needs, stated the Centers for Medicare & Medicaid Services in a fact sheet released on Monday that described the proposed provisions.

If finalized, the new annual open enrollment period for all individual market exchanges and off-exchange individual market plans would change to Nov. 1-Jan. 15.

Another provision included in the proposed rule would allow exchanges to create a monthly special enrollment period for consumers with a household income of less than 150% of the federal poverty level.

In one of his first acts as president, Joe Biden signed an executive order that established a special enrollment period from Feb. 15 to May 15. In that time, 1.2 million Americans signed up for insurance through HealthCare.gov.

“The success of the special enrollment period opportunity clearly shows the demand for quality, affordable coverage,” said CMS Administrator Chiquita Brooks-LaSure in a news release. “These latest steps aim to better fund outreach efforts and eliminate barriers to coverage. We’re making high-quality, low-cost coverage more accessible than ever.”

Biden’s CMS also proposes expanding the duties of exchange navigators who work with vulnerable and underserved populations to help them find affordable coverage.

The Trump administration struck a huge blow to the navigator program, slashing funding from $63 million in 2016 to $10 million in 2018. But, in April, CMS announced that they will give $80 million in funding to ACA navigators for the 2022 plan year.

Now, CMS wants to reinstate previous requirements that navigators provide consumers with information and assistance on post-enrollment topics, such as the eligibility appeals process and the exchange-related components of the premium tax credit reconciliation process.

But to account for this increase in navigator funding and to support further consumer outreach, user fees for the federally facilitated exchanges will go up to 2.75% of premiums from 2.25%. For state-based exchanges on the federal platform, user fees will jump to 2.25% of premiums from 1.75%.

Photo: zimmytws, Getty Images

 

 

 

 

 

 

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