Author: Matt Cummings

Trump Administration releases guidance on Medicaid work requirements

What happened?  

In a major shift that could affect millions of low-income people receiving benefits, The Trump Administration announced Thursday, January 11, that it will open the door for states to require work requirements for Medicaid recipients.  

The guidance was published in a letter from CMS Deputy Administrator Brian Neale to State Medicaid Directors Thursday morning. In the letter, Deputy Administrator Neale stated that the move would help “improve Medicaid enrollee health and well-being through incentivizing work and community engagement.” 

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What can healthcare payers learn from consumer retail?

The Commerce Department announced last week that U.S. retail sales have surged 0.8% for the month of November, which was more than double the rate economists had predicted. As consumers flock to retailers like Amazon and Walmart this holiday season, here are 5 takeaways healthcare Payers can learn from them:

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Repealing individual mandate: not as bad as once feared?


On Wednesday, December 13th, leaders from both the House and Senate will meet in Washington to finalize the Tax Cuts and Jobs Bill. If they decide to include removing the individual mandate, this will undoubtedly have an impact on healthcare in America – but it may be not as extreme as originally thought.

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Tax bill takes toll on individual mandate


On Saturday, December 2nd, the U.S. Senate passed The Tax Cuts and Jobs Act, which was drafted in a Republican effort to reform the U.S. tax code. This follows the passage of Congress’ version of the bill, which took place on November 16th. One of the key differences between the two bills is that the Senate’s version includes a provision that effectively removes the Affordable Care Act’s individual mandate, which requires all individuals to purchase health insurance.

As leaders from the Senate and Congress meet to discuss how to reconcile the two versions of the bill, the healthcare industry is waiting to see if the mandate will be removed and what some of the ramifications could be.

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DE Proxy: What You Need to Know About Enrolling Without


The 2018 Open Enrollment Period (OEP) kicked off last week featuring a significant new option for consumers: Direct Enrollment Proxy Pathway (aka DE Proxy).

Replacing the traditional “DE Classic” method, this new enrollment option streamlines the process by allowing approved third-party websites to enroll members without redirecting them to Here’s what you need to know about it:

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President Trump Signs Executive Order on Health Care

What Happened?

President Trump on Thursday, signed an executive order directing the Departments of Treasury, Labor and HHS to consider loosening rules controlling the issuance of health coverage by groups and businesses as well as the duration of short-term that don’t currently meet ACA rules[1].

“With these actions, we are moving toward lower costs and more options in the health-care market…”, Trump said during the signing ceremony in the Roosevelt Room in the White House.

Supporters of the executive order say that it will help to improve access, increase choices and lower costs for healthcare. Sen. Rand Paul (R-KY), who worked closely with the President on the order called it, “The biggest free market reform of healthcare in a decade”.

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Retail Titans Flock to Private Exchanges

With an industry-wide emphasis on consumerization, more companies have been drawing their attention to private exchanges. Instead of simply picking a health plan for employees to participate in, employers are providing their employees with financial support to choose their own coverage options.

Retail titans that are embracing private exchanges, like Starbucks and Wal-Mart, see the opportunities.

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Cost-Sharing Reduction (CSR) Reconciliation FAQ

At Softheon, as we continue to research Cost-Sharing Reduction (CSR) Reconciliation information, we have found that one of our biggest challenges is finding answers to our own questions!  Our dedicated staff works hard to proactively monitor all CMS requirements and guidance.  Working with many QHP Issuers, we are lucky enough to be exposed to multiple types of questions, comments, and concerns.  In attempts to share our insight, our research team has compiled a list of the top questions QHP Issuers are consistently asking.

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