Health Insurance Marketplace: March Enrollment Report. For the period: October 1, 2013 - March 1, 2014. Appendix C. Total Marketplace Eligibility Determinations, and Marketplace Plan Selections by Marketplace Type and State, 10-1-2013 to 3-1-2014


Total Marketplace Eligibility Determinations, and

Marketplace Plan Selections By Marketplace Type and State (1) (2)

10-1-2013 to 3-1-2014

State Name Number of Individuals Determined Eligible to Enroll in a Marketplace Plan Determined or Assessed Eligible for Medicaid / CHIP by the Marketplace
Number of Individuals Who Have Selected a Marketplace Plan
Total Eligible to Enroll in a Marketplace Plan
Eligible to Enroll in a Marketplace Plan with Financial Assistance
Number Number Number Number
States Implementing Their Own Marketplaces (SBMs)
California (7)  1,190,260 897,256 1,136,000 868,936
Colorado (8)  145,877 57,605 135,560 83,469
Connecticut  85,804 59,638 73,842 57,465
District of Columbia  10,515 2,271 10,877 6,249
Hawaii (9)  10,968 2,628 N/A 4,661
Kentucky  165,684 67,323 222,448 54,945
Maryland  50,900 42,786 103,670 38,070
Massachusetts (10)  5,943 N/A N/A 12,965
Minnesota (11)  95,862 33,929 77,647 32,030
Nevada  94,926 61,008 125,272 28,535
New York  533,948 258,556 310,645 244,618
Oregon (12)  76,223 60,142 104,715 38,806
Rhode Island  30,158 22,155 45,226 18,902
Vermont  64,645 20,823 24,266 24,326
Washington (13)  197,220 117,751 628,893 107,262
SBM Subtotal  2,758,933 1,703,871 2,999,061 1,621,239
States With Marketplaces that are Supported by or Fully-Run by HHS (FFM)
Idaho (14)  74,085 54,624 9,443 43,861
New Mexico (14)  35,416 22,203 20,620 15,012
Alabama 134,329 67,379 17,980 55,034
Alaska 13,893 35,416 8,872 2,901 6,666
Arizona  137,069 84,008 66,991 57,611
Arkansas  58,173 38,500 57,455 27,395
Delaware  15,085 9,023 7,663 6,538
Florida  990,455 621,139 124,363 442,087
Georgia  341,650 181,790 62,162 139,371
Illinois  246,188 151,238 131,995 113,733
Indiana  145,189 93,720 65,846 64,972
Iowa  40,113 24,467 28,981 15,346
Kansas  65,057 36,083 10,344 29,309
Louisiana  107,480 59,896 9,105 45,561
Maine 47,444 31,634 5,494 25,412
Michigan 313,644 187,057 40,347 144,587
Mississippi 68,562 36,687 8,753 25,554
Missouri 170,180 96,985 32,890 74,469
Montana 39,917 27,192 3,643 22,542
Nebraska 54,311 35,213 10,557 25,582
New Hampshire 43,256 24,326 5,409 21,578
New Jersey 187,231 110,509 123,092 74,370
North Carolina 390,925 251,953 55,691 200,546
North Dakota 10,394 7,032 4,812 5,238
Ohio 193,152 115,611 97,477 78,925
Oklahoma 78,444 41,964 11,709 32,882
Pennsylvania 349,151 195,218 32,793 159,821
South Carolina 136,414 77,173 19,747 55,830
South Dakota 16,047 9,884 2,862 6,765
Tennessee 204,075 105,003 55,672 77,867
Texas 758,344 414,272 94,954 295,025
Utah 78,258 55,994 36,353 39,902
Virginia 251,566 133,492 33,897 102,815
West Virginia 25,133 15,965 16,569 10,599
Wisconsin 158,048 107,157 68,655 71,443
Wyoming 14,296 9,507 1,646 6,838
FFM Subtotal 5,992,974 3,542,770 1,378,871 2,621,086
MARKETPLACE TOTAL, All States 8,751,907 5,246,641 4,377,932 4,242,325


“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.

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