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Health Coverage Updates that Could Impact Your Program or Clients

Tuesday, August 20, 2019


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Getting Ready for Open Enrollment 

From the ACE TA Center Listserv - The following changes related to health care coverage and access to care could impact your program or clients.

More states adopt individual mandates for health coverage

In 2020, the federal government will no longer require people to pay a penalty if they do not have health insurance. However, several states have existing state-level individual mandates, and others have recently passed legislation for 2020 coverage.

  • Existing Legislation - DCMassachusetts, and New Jersey already require all eligible residents to maintain health coverage, or pay a penalty.
  • New Legislation - CaliforniaRhode Island, and Vermont recently passed individual mandates that go into effect January 1, 2020. However, a financial penalty has not yet been determined in Vermont.

New Final Rule on the Public Charge

The federal government recently published a final rule that (starting October 15, 2019) will change how it decides whether someone can enter the U.S. or get a green card. This rule is typically referred to as "public charge." 

Case managers, enrollment assisters and other front line staff should be aware that not all services are part of the “public charge test.” For example, subsidies for Marketplace health coverage (e.g., premium tax credits and cost-sharing reductions), and benefits provided by the Ryan White HIV/AIDS Program, WIC, and CHIP will not be counted in the public charge test. Learn more.

CMS ruling on co-pay accumulators

Co-pay accumulators are policies adopted by some insurance companies that no longer count the value of a manufacturer’s co-pay card towards an individual’s deductible or out-of-pocket maximum. After the value of the co-pay card is used, individuals would be required to pay the full deductible themselves. 

CMS (the Centers for Medicare and Medicaid Services) recently ruled that co-pay coupons must count towards deductible and out-of-pocket maximum when used for brand name drugs that have no generic equivalent.

Some states, including Virginia and West Virginia, have recently passed laws allowing co-pay assistance to count for all drugs, and similar legislation is pending elsewhere.

Man talking about renewal of his health plan and having obtained additional financial help

Register and Join the Aug. 21 Webinar

Basics of Health Coverage Enrollment: Strategies and Resources for New Program Staff

RWHAP recipients: Please share this opportunity with your subrecipient providers.



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