Page 2 of 17

CMS signals support for Medicaid work requirements

Earlier this month, the head of the Centers for Medicare and Medicaid Services (CMS), Seema Verma, made an announcement conveying that CMS would approve waiver applications from states that would require Medicaid enrollees to participate in “community engagement” activities, otherwise known as work requirements. This follows a letter co-authored by Verma that encouraged state Medicaid directors to use these waivers to modify their Medicaid programs to empower consumers. To advocates, work requirements are a way to empower Medicaid enrollees by encouraging them to be independent, self-sufficient consumers of healthcare.

Here’s what you should know about the proposed work requirements for Medicaid:

Continue reading

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:

Continue reading

Major changes to 1332 waivers could be coming

1332 waivers, or state innovation waivers, allow states to apply to the federal government to waive certain provisions of the Affordable Care Act (ACA) and pursue innovative strategies for providing residents with access to quality, affordable insurance while retaining the law’s basic protections. However, there are two developments currently in motion that could make significant changes to these waivers.

One is the Alexander-Murray bill, which is indirectly connected to the Congressional tax bill currently in the process of reconciliation between the Senate and the House. The other is a bill currently being drafted by Senators Orrin Hatch (R-UT) and Mike Crapo (R-ID) that would overhaul the 1332 process, altering many of the original stipulations laid out by the ACA.

Continue reading

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.

Continue reading

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.

Continue reading

Hidden benefits of medicaid expansion

Although there is still an ongoing debate in many states over whether or not to expand Medicaid, in the 33 states that have, unexpected benefits are starting to surface.

When the Patient Protection and Affordable Care Act (ACA) laid the framework for Medicaid Expansion, it allowed states to expand the income level needed to qualify for Medicaid. This gave a large number of Americans access to coverage. But it turns out this wasn’t the only benefit.

Continue reading

How can an e-billing platform revolutionize health plan members’ experience?

In today’s click-to-buy world, consumers have limited patience for slow, outdated technology. This is especially true when it comes to online payments. Since the rise of Amazon, people expect to select what they want, pay, and move on. Although this is especially true when purchasing health insurance, it is far from the reality most people face when purchasing their plans.

The health insurance industry has seen a marked shift from affordability to accessibility. Along with this change comes a greater focus on the consumer experience. Now, the infamously outdated industry must stop and look at how far e-billing has advanced. Travel, airlines, and even banking industries have all made drastic updates, including user-friendly web design and mobile applications, to meet consumers’ needs. To retain members and continue growing their customer base, health plans must adapt.

Continue reading

A Guide to the 2017 SHOP Guaranteed Availability Window

While small businesses can enroll in the Small Business Health Options Program (SHOP) at any time, today kicks off a month-long guaranteed availability window that allows small businesses to enroll in SHOP plans without meeting the usual requirements.

Starting today, the Federally facilitated SHOP (FF-SHOP) on is closed. Small businesses in FF-SHOP states will not be able to enroll online (though they will still be able to check their eligibility online). From now on, these small businesses will have to use a broker or agent to enroll in SHOP, or, alternatively, they can enroll directly with a health plan.

Continue reading

A Victory for Maine Medicaid Could Be an Inspiration to Others

What happened?

In a first-of-its-kind vote, Maine residents elected to expand the state’s Medicaid program through a state-wide referendum on Tuesday, November 7.

The expansion easily passed with 59% of voters in favor. These results place a majority of Maine residents in opposition to the stance of their Governor, Paul LePage, who has vetoed five bills to expand Medicaid.

Maine was one of 19 states that did not initially expand Medicaid in reaction to the Patient Protection and Affordable Care Act (ACA) in 2010. The state previously expanded the program in 2003, increasing the eligible population and subsidizing private coverage, but LePage dismantled much of this framework when he took office in 2011.

Continue reading

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:

Continue reading

« Older posts Newer posts »

© 2018 Softheon

Theme by Anders NorenUp ↑