|Total Marketplace Eligibility Determinations, and Marketplace Plan Selections in State-Based Marketplaces Using Their Own Marketplace Platforms, By State, 2015 (1) 11-15-2014 to 1-17-2015|
|State Name||Number of Individuals Determined Eligible to Enroll through the Marketplace for 2015 Coverage||Number of Individuals Determined or Assessed Eligible for Medicaid / CHIP by the Marketplace (4)||Number of Individuals With 2015 Marketplace Plan Selections (5)|
|Total Eligible to Enroll in a Marketplace Plan (2)||Eligible to Enroll in a Marketplace Plan with Financial Assistance (3)|
|State-Based Marketplaces(SBMs) Using Their Own Marketplace Platforms|
|District of Columbia||4,527||846||N/A||17,485|
|Hawaii (8) (11)||10,890||3,618||N/A||6,868|
|Idaho (8) (9)||170,705||126,436||202,126||90,567|
|New York (10)||937,235||448,618||213,428||357,241|
|TOTAL - SBMs Using Their Own Marketplace Platforms||2,612,360||1,049,209||2,326,124||2,383,004|
“N/A” means that the data for the respective metric are not yet available for a given state.
(1) Unless otherwise noted, the data in this table represent cumulative Marketplace enrollment-related activity for 11-15-14 to 1-16-15. These data also do not include any enrollment-related activity relating to individuals who may have applied for and/or selected a 2014 Marketplace plan during the reporting period, as a result of having been granted a Special Enrollment Period (SEP). This table only reflects data for the individual market Marketplaces. For additional technical notes information, please refer to Appendix D of this report.
(2) “Individuals Determined Eligible to Enroll in a Plan Through the Marketplace” (i.e., enrollment through the Marketplaces for a 2015 Marketplace plan) represents the total number of individuals for whom a Completed Application has been received for the 2015 plan year (including any individuals with active 2014 Marketplace enrollments who returned to the Marketplaces and updated their information), and who are determined to be eligible for plan enrollment through the Marketplaces during the reference period, whether or not they qualify for advance payments of the premium tax credit or cost-sharing reductions. These individuals may or may not have enrolled in coverage by the end of the reference period. Individuals who have been determined or assessed eligible for Medicaid or CHIP are not included. Note: This number only includes data for individuals who applied for 2015 Marketplace coverage in completed applications. It does not include individuals who were automatically reenrolled. Thus, the number determined eligible for 2015 coverage may be lower than the total number of 2015 plan selections (which includes reenrollees).
(3) “Individuals Determined Eligible to Enroll in a Plan Through the Marketplace with Financial Assistance” (i.e., enrollment through the Marketplace for a 2015 Marketplace plan with Financial Assistance) represents the total number of individuals determined eligible to enroll through the Marketplace in a Marketplace plan who qualify for an advance premium tax credit (APTC), with or without a cost-sharing reduction (CSR) for the 2015 plan year (including any individuals with active 2014 Marketplace enrollments who returned to the Marketplace and updated their information). These individuals may or may not have enrolled in coverage by the end of the reference period. Note: This number only includes data for individuals who applied for 2015 Marketplace coverage in completed applications. It does not include individuals who were automatically reenrolled. Thus, the number determined eligible for 2015 coverage may be lower than the total number of 2015 plan selections with financial assistance (which includes reenrollees).
(4) “Individuals Determined or Assessed Eligible for Medicaid / CHIP by the Marketplace” represents the number of individuals who have been determined or assessed by the Marketplace as eligible for Medicaid or CHIP based on their modified adjusted gross income (MAGI). In some states, completed applications for individuals, whom the Marketplace has assessed as potentially eligible for Medicaid or CHIP, based on MAGI, are transferred to the relevant state agency for a final eligibility determination. In these “assessment states” the data include those accounts where a final decision is pending. In other states, the Marketplace has been delegated the final Medicaid/CHIP eligibility determination responsibility for these individuals. Thus, this data element includes FFM determinations and assessments, regardless of the state Medicaid/CHIP agency’s final eligibility determination, if applicable. These data may vary from accounts transferred via “flat file” to states by the FFM. Quality assurance continues on Medicaid assessments and determinations. Note: Marketplace Medicaid/CHIP eligibility determination and assessment data in this report cannot be added to eligibility determination data in the most recent monthly Medicaid and CHIP Applications, Eligibility Determinations, and Enrollment report (available on Medicaid.gov) which covers data through November 2014. In the Marketplaces, some of the individuals assessed or determined eligible for Medicaid or CHIP by the Marketplace and reported in this report may also be reported in the monthly Medicaid and CHIP Applications, Eligibility Determinations, and Enrollment Report when the state has made an eligibility determination based on the information provided by the Marketplace. Total Medicaid/CHIP enrollment is reported in the monthly Medicaid and CHIP Applications, Eligibility Determinations, and Enrollment Report, and is a point-in-time count of total enrollment in the Medicaid and CHIP programs at the end of the monthly reporting period.
(5) “Individuals With 2015 Marketplace Plan Selections” represents the total number of individuals determined eligible to enroll in a plan through the marketplace” who have selected a 2015 Marketplace medical plan for enrollment through the Marketplaces or, after December 15, have been automatically reenrolled in Marketplace coverage (with or without the first premium payment having been received directly by the issuer) during the reference period. This is also known as pre-effectuated enrollment, because enrollment is not considered effectuated until the first premium payment is made, and this figure includes plan selections for which enrollment has not yet been effectuated. These data do not include a count of the number of individuals who have selected a standalone dental plan; or individuals who may have selected a 2014 Marketplace plan during the reporting period, as a result of having been granted a Special Enrollment Period (SEP), however New York was unable to separate out SEP data for the period 11/15-14-12-31-14.
(6) California: The data that are being reported for California are for the following reporting period 11-15-14 --1-18-15. As of 1/18/15, plan selections for CA have been processed for 947,000 of 1,120,000 enrollees who entered the renewal process. As of 1-18-14, 0f the 947,000, 360,000 actively renewed their plan selections. The remaining 2014 enrollees are being transitioned to the Medicaid program or continue to be processed for renewal.
(7) Minnesota reports total plan selection data and re-enrollment data, but cannot breakout data on new enrollments because of an inability to distinguish new enrollments from reenrollments that were manually processed. As a result, the system also undercounts reenrollments.
(8) Total Marketplace plan selections do not include automatic reenrollees for the following four states: Hawaii, Idaho, Maryland, and Massachusetts.
(9) Idaho is an SBM that changed Marketplace platforms for the 2015 coverage year (Idaho transitioned from using the HealthCare.gov platform to using its own platform). Additionally, Massachusetts and Maryland changed their eligibility and enrollment system vendors for the 2015 coverage year. All of the plan selections for these states are being treated as new consumers for operational enrollment and reporting purposes.
(10) New York is currently unable to distinguish between Marketplace plan selections for the 2014 coverage year and Marketplace plan selections for the 2015 coverage year during the period 11-15-2014-12/31-2014. Therefore, the plan selection data that are reported by New York may include a small number of plan selections from new consumers who were approved for a special enrollment period for 2014 Marketplace coverage between 11-15-14 and 12-31-2014.
Source: Centers for Medicare & Medicaid Services, as of 1-26-15.