Health Insurance Marketplace: Summary Enrollment Report For the Initial Annual Open Enrollment Period. Appendix E: Total Marketplace Eligibility Determinations, and Marketplace Plan Selections by Marketplace Type and State, 10-1-2013 to 3-31-2014 (including Additional SEP Activity Through 4-19-14)

05/01/2014

Total Marketplace Eligibility Determinations, and Marketplace Plan Selections By Marketplace Type and State (1) (2) 10-1-2013 to 3-31-2014 (Including SEP Activity through 4-19-14)

State Name   Determined or Assessed Eligible for Medicaid / CHIP by the Marketplace
(5)
Number of Individuals Who Have Selected a Marketplace Plan
(6)
Total Eligible to Enroll in a Marketplace Plan
(3)
Eligible to Enroll in a Marketplace Plan with Financial Assistance
(4)
Number Number Number Number
FFM Subtotal 9,529,265 6,129,462 1,960,240 5,446,178
MARKETPLACE TOTAL, All States 13,547,592 8,748,037 6,724,660 8,019,763
States Implementing Their Own Marketplaces (SBMs)
California (7)  1,886,867 1,458,433 1,700,000 1,405,102
Colorado (8)  205,910 88,208 181,983 125,402
Connecticut  113,390 80,354 138,908 79,192
District of Columbia  15,437 4,033 19,464 10,714
Hawaii (9)  15,694 4,549 N/A 8,592
Kentucky  201,593 91,092 357,990 82,747
Maryland  99,298 84,015 163,602 67,757
Massachusetts (10)  31,695 N/A N/A 31,695
Minnesota (11)  101,645 36,217 144,481 48,495
Nevada  134,942 89,683 182,946 45,390
New York  707,638 369,380 646,018 370,451
Oregon (12)  124,840 99,902 207,329 68,308
Rhode Island  43,295 32,471 70,243 28,485
Vermont  95,203 28,797 41,704 38,048
Washington (13)  240,880 151,441 909,752 163,207
SBM Subtotal  4,018,327 2,618,575 4,764,420 2,573,585
States With Marketplaces that are Supported by or Fully-Run by HHS (FFM)
Idaho (14)  107,849 83,662 10,709 76,061
New Mexico (14)  58,628 39,543 30,147 32,062
Alabama  195,779 105,059 22,564 97,870
Alaska  21,915 14,898 4,172 12,890
Arizona  216,951 144,376 101,282 120,071
Arkansas  80,709 53,958 73,681 43,446
Delaware  24,721 16,170 11,200 14,087
Florida  1,603,575 1,114,877 180,479 983,775
Georgia  572,025 343,925 91,914 316,543
Illinois  369,696 242,255 181,070 217,492
Indiana  229,815 155,961 94,495 132,423
Iowa  57,184 37,328 36,891 29,163
Kansas 99,380 59,601 13,961 57,013
Louisiana 184,041 113,337 14,359 101,778
Maine 68,541 48,531 7,103 44,258
Michigan 467,878 297,742 67,217 272,539
Mississippi 117,518 72,219 13,779 61,494
Missouri 268,764 166,440 45,513 152,335
Montana 55,675 39,572 4,638 36,584
Nebraska 74,606 50,382 9,879 42,975
New Hampshire 64,901 39,818 7,235 40,262
New Jersey 301,965 193,286 179,872 161,775
North Carolina 581,173 396,212 73,898 357,584
North Dakota 16,627 11,974 6,843 10,597
Ohio 285,967 185,780 156,899 154,668
Oklahoma 127,915 76,301 17,374 69,221
Pennsylvania 549,205 332,915 42,335 318,077
South Carolina 213,974 134,969 28,359 118,324
South Dakota 24,147 16,243 3,850 13,104
Tennessee 305,628 169,470 83,591 151,352
Texas 1,371,157 835,519 141,494 733,757
Utah 130,945 97,621 50,268 84,601
Virginia 392,340 231,534 48,660 216,356
West Virginia 36,749 24,634 21,019 19,856
Wisconsin 230,516 168,721 81,274 139,815
Wyoming 20,806 14,629 2,216 11,970

Notes:

“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 data on the number of unique individuals who have been determined eligible to enroll in a Marketplace plan through the SBMs and FFM, and have selected a plan (with or without the first premium payment having been received by the issuer). Special Enrollment Period (SEP) activity includes plan selections that were made between 4-1-14 and 4-19-14 by those who qualified for an SEP because they were “in line” on 3-31-14, as well as those who experienced a qualifying life event or a complex situation related to applying for coverage in the Marketplace. For additional methodological information, please refer to Appendix F 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 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 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: Marketplace Medicaid & CHIP eligibility determination and assessment data in this report cannot be added to eligibility determination data in the March 2014 Monthly Applications, Eligibility Determinations, and Enrollment report. 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 March 2014 Monthly 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 March 2014 Monthly 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 March..

(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 – The Number of assessed/determined for Medicaid/CHIP includes activity only through March 31, 2014. Also, the data 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 – 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 160,000 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 112,192 persons between 133 and 300 percent FPL currently 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. Without the systems obstacles faced by the Massachusetts Marketplace, the number of individuals enrolled in a QHP with the Massachusetts Health Connector as of 4/15/14 might be as many as 303,000.

(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. The total rolls up to actual total QHP eligible individuals.

(13) Washington -- Washington’s cumulative total for “Individuals Assessed Eligible for Medicaid/CHIP” includes some persons whose eligibility is being re-determined rather than newly determined. 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 4-29-2014.

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