By William Koczan, Senior Manager-Medicaid, Dina Rice-English, Senior Manager-Medicaid, John Barrera, Senior Manager-Medicaid, Victoria Acevedo, Manager-Medicaid.
President Biden has made healthcare a top priority for his administration as evidenced by the Executive Order he issued on 1/28/21 shortly after taking office. In this order, titled “Executive Order on Strengthening Medicaid and the Affordable Care Act,” Biden wrote, “It is the policy of my Administration to protect and strengthen Medicaid and the ACA and to make high-quality healthcare accessible and affordable for every American. ”What is not clearly defined at this time are the steps his administration plans to take to make this policy a reality.
But one item we know that the Biden administration is keen on ending is the Medicaid work requirement rules that some states had adopted during the previous administration. The Biden Administration has also indicated it will be strongly encouraging the 12 states in the union that have not adopted Medicaid expansion under the Affordable Care Act (ACA) to do so. There are millions of people in these states who remain uninsured. Additional state adaptation of Medicaid expansion will help the administration achieve its mission of making healthcare more accessible.
President Biden also signed an executive order that opened the ACA special enrollment period from February 15 to May 15. The executive order will affect 36 states. This executive order has also established the recommencement of federal funding for advertising and outreach regarding enrollment. It is unclear how beneficial this order will be due to the modest enrollments last year, but with increased advertising, the goal is to reach more consumers who are seeking alternative coverage on the federal ACA exchange.
In addition, the Biden Administration plans to reinstate the individual mandate portion of the ACA, including a potential restoration of penalties for not having health coverage. Furthermore, the Biden Administration has discussed a cap on the amount consumers can spend on their insurance plan. At present, individuals can spend up to 10% of their income on health insurance. The Biden Administration has been considering a plan that will cap that amount at 8.5%. This proposal would need to go through the legislative process in order to be effectuated.
What we know is that Americans have faced many challenges in the past 12 months, experiencing record-breaking unemployment numbers, financial downfalls, and health crises. Many people that previously had health insurance through employment were experiencing for the first time what millions of other uninsured Americans have dealt with for years, and even decades: that having affordable healthcare is difficult to obtain, and what is considered “affordable” may not necessarily be within their means.
CBIZ will continue to monitor and keep you updated on issues of Medicaid eligibility, healthcare accessibility and other key pieces of legislation or regulation that will affect provider reimbursement. If you have any immediate questions about how these new regulations may affect your organization, please contact Juan Chico at firstname.lastname@example.org or at 609-918-0990.
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