“N/A” means that the data for the respective metric is not yet available for a given state.
(1) Unless otherwise noted, the data in this table represent cumulative Marketplace enrollment-related activity for 10/1/13 to 11/30/13. For additional methodological information, please refer to Appendix B of this report.
(2) “Completed Applications” represents the total number of electronic and paper applications that were submitted to the Marketplace during the reference period with sufficient information to begin performing eligibility determinations for enrollment in a plan through the Marketplace and, if appropriate, sufficient information to begin performing eligibility determinations for advance payments of the premium tax credit and cost-sharing reductions, and eligibility assessments or determinations for Medicaid and CHIP.
(3) “Individuals Applying for Coverage in Completed Applications” represents the total number of individuals included in Completed Applications that were submitted to the Marketplace during the applicable reference period. This number does not include individuals applying through the SHOP. Note: SBM data on the number of Individuals Determined Eligible to Enroll in a plan through the Marketplace and the number of Individuals Determined or Assessed Eligible for Medicaid / CHIP by the Marketplace do not add to the total number of persons applying for coverage in completed applications due to missing data and differences in process flows for Marketplace Plans and Medicaid/CHIP eligibility determinations / assessments.
(4) “Individuals Determined Eligible to Enroll in a Plan Through the Marketplace” (i.e., a Marketplace plan) represents the total number of individuals for whom a Completed Application has been received and who are determined to be eligible for plan enrollment through the Marketplace 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.
(5) “Individuals Determined Eligible to Enroll in a Plan Through the Marketplace with Financial Assistance” represents the total number of individuals determined eligible to enroll in a Marketplace plan who qualify for an advance premium tax credit (APTC), with or without a cost-sharing reduction (CSR).
(6) “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 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 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. These data may vary slightly from accounts transferred via ‘flat file’ to states by the FFM. The Nov 13 report included data on some applications received in October that had not completed all steps required for a determination or assessment; these numbers have been updated here. Additional quality assurance is taking place on Medicaid assessments and determinations in advance of transfers to states and these figures might alter further based on that review. Note: this data element does not include eligibility determinations made by State Medicaid/CHIP agencies based on applications originally submitted to the State agency or other Medicaid/CHIP assessments or determinations.
(7) “Pending / Other”: A derived estimate for individuals who have a completed and processed application, who either: 1) have a pending eligibility determination or assessment for Marketplace plan or Medicaid/CHIP coverage; 2) have a completed eligibility determination or assessment for Marketplace plan or Medicaid/CHIP coverage that is not captured in the relevant column in this table for a given state due to system issues; or 3) have been deemed ineligible for Marketplace plan coverage. The Pending/Other totals shown in this table represent the sums of the corresponding state-level Pending/Other counts.
(8) “Individuals Who Have Selected a Marketplace plan” represents the total number of “Individuals Determined Eligible to Enroll in a plan Through the Marketplace” who have selected a plan (with or without the first premium payment having been received directly by the Marketplace or the issuer) during the reference period. This is also known as pre-effectuated enrollment.
(9) California -- California's cumulative data for "Determined or Assessed Eligible for Medicaid/CHIP by the Marketplace" and “Number of Individuals Who Have Selected a Marketplace Plan” for 10/1/13 through 11/30/13 includes two days of duplicate activity (11/1/13 and 11/2/13) that have not yet been verified by the state and removed from the total.
(10) Colorado -- Colorado’s data for “Eligible to Enroll in a Marketplace Plan with Financial Assistance” is marked as “N/A” because the state is verifying its numbers. Additionally, because the Colorado Marketplace does not have an integrated eligibility system, data for “Individuals Assessed Eligible for Medicaid/CHIP” are not available.
(11) District of Columbia -- Data are currently not available for the District of Columbia on the number of individuals applying for coverage, deemed eligible for or enrolled in Marketplace plan, or or enrolled in Medicaid/CHIP; the District of Columbia’s information systems record data by accounts rather than number of individuals or covered lives. In many instances, the accounts reflect two or more individuals.
(12) Hawaii -- Because the Hawaii Marketplace’s eligibility system is not integrated with its state Medicaid department, the data for “Individuals Assessed Eligible for Medicaid/CHIP” are not available at this time. In addition, the Marketplace is in the process of receiving data from the state Medicaid department on applicants who have been determined ineligible for Medicaid or CHIP. It is anticipated that the proportion of QHP eligible individuals with Financial Assistance will increase as these applicants are transferred from the Medicaid agency to the Marketplace. (13) Massachusetts – Massachusetts’s “Total Number of Completed Applications” does not include completed paper applications. Additionally, due to Massachusetts’s system constraints, cumulative values for several measures are not available at this time.
(14) Minnesota -- Minnesota's cumulative data for “Individuals Determined Eligible to Enroll in a Marketplace Plan,” “Individuals Determined Eligible to Enroll in a Marketplace Plan with Financial Assistance,” and “Individuals Who Have Selected a Marketplace Plan” do not include adults between 133% and 200% of the Federal Poverty Level (FPL) because these individuals are enrolled in the MinnesotaCare program. In addition, children up to 275% FPL are covered through the Medicaid program. Hence, when comparing Minnesota's cumulative data for these indicators with other State-Based Marketplaces, the number of individuals determined eligible for MinnesotaCare and enrolled in MinnesotaCare are worth noting. For example, MNCare’s enrollment of 5,703 during 10/1 – 11/30 might be added to the 4478 Individuals Who Have Selected a Market Plan, for a comparable total of 10,181
(15) New York -- • New York -- New York’s cumulative totals for “Number of Persons Applying for Coverage in Completed Applications” are estimates.
(16) Oregon -- Between 10/01 and 11/02, Oregon had not yet started using its electronic eligibility determination system. In that period, Cover Oregon began receiving and processing paper applications (including applications by postal mail, fax, and fillable PDF). The “Completed Applications” indicator for this period reflects complete paper applications received. Midway through the time period 11/03 – 11/30, Oregon began using its electronic determination system to process paper applications. The “Completed Applications” indicator in this period reflects all applications that were ready to process for determination in the period.
(17) Washington -- Washington’s cumulative for “Individuals Assessed Eligible for Medicaid/CHIP” may include some persons whose eligibility is being re-determined rather than newly determined. For example, an application for a family may include parents applying to the Marketplace for initial coverage, while children are already covered.
(18) Idaho and New Mexico are Federally supported SBMs for 2014; they are using the FFM platform for 2014.
Source: Centers for Medicare & Medicaid Services, as of 12-10-2013.