Total Marketplace Eligibility Determinations, and
Marketplace Plan Selections By Marketplace Type and State (1) (2)
10-1-2013 to 3-1-2014
“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 these tables represent cumulative FFM Marketplace enrollment-related activity for 10-1-13 to 3-1-14. For additional methodological information, please refer to Appendix D of this report.
(2) We are no longer showing data on the total number of completed applications and total number of individuals applying for coverage in completed applications in this table because we believe that there is duplication in these metrics.
(3) “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.
(4) “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).
(5) “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 from accounts transferred via ‘flat file’ to states by the FFM. Quality assurance continues 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.
(6) “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.
(7) California - Number of assessed/determined for Medicaid/CHIP reflects new Medicaid applicants and some ongoing caseload eligibility activity that is conducted via the state’s Marketplace.
(8) Colorado – Colorado’s Marketplace, Connect for Health Colorado, uses real-time online determinations made by the Medicaid agency. Data for “Individuals Assessed Eligible for Medicaid/CHIP” includes individuals determined eligible under the Medicaid expansion and does not include CHP+ clients or those determined eligible who were previously eligible for coverage prior to the expansion of Medicaid.
(9) 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. 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.
(10) Massachusetts – Data for "Number of Individuals Determined Eligible for Enrollment into a QHP" are as of 11/30/13. Due to Massachusetts’ system constraints, data for “Individuals Determined or Assessed Eligible for Medicaid/CHIP” are not available at this time. Massachusetts’ cumulative data for “Individuals Who Have Selected a Marketplace Plan” does not include 48,000 new applicants above 133 percent FPL who are in Temporary Subsidized Coverage; these individuals will be processed for QHP Eligibility Determination and potential coverage retroactive to the current reporting period. There are also 109,000 persons between 133 and 300 percent FPL currently in extended Commonwealth Care coverage, who were scheduled to transition to QHP coverage following October 1, 2013, but who have not been processed due to systems problems. Another 32,000 persons with income >300% FPL currently in the Commonwealth Choice program are current members who are scheduled to be processed for QHP coverage by March 31, 2014. Without the systems obstacles faced by the Massachusetts Marketplace, the number of individuals enrolled in a QHP with the Massachusetts Health Connector as of 3/1/14 might be as many as 201,000.
(11) 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.
(12) Oregon - Oregon - Oregon's data for QHP eligible individuals broken out by financial assistance are estimates based on analysis of special-purpose enrollment files for the reporting period. "Total Eligible with APTC" is an estimate based on analysis of enrollment files sent to issuers through December 31, 2013. The total rolls up to actual total QHP eligible individuals. Cover Oregon will update with actuals as soon as its electronic reporting application is configured and tested to accurately report determinations.
(13) Washington -- Washington’s cumulative total 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. Additionally, the "Number of Individuals Enrolled in a QHP (Plan Selection)" is an undercount, as Washington is only able to report individuals who have both enrolled and paid for coverage.
(14) 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 3-7-2014.