The Centers for Medicare & Medicaid Services (CMS) released final regulations governing operation of the statewide health insurance marketplaces created by the Affordable Care Act (ACA). The statewide marketplaces, which opened in October 2013, provide access to private health coverage for individuals and small businesses and serve as a point of entry to Medicaid coverage in states that have elected to provide Medicaid coverage to all adults earning less than 138 percent of the federal poverty line (FPL).
The regulations clarify, among other things, that the ACA’s prohibition on discrimination based on race, color, national origin, disability, age, sex, gender identity or sexual orientation applies not only to the statewide marketplaces but also to related service providers and programs, including contractors, professional health insurance navigators, and application counselors. Programs that receive federal funding to serve a defined population, such as Ryan White HIV/AIDS assistance programs or Indian health providers, may qualify for exceptions to the extent that they are necessary to restrict services to members of their target population. This clarification ensures that programs designed to serve solely individuals with disabilities can continue to be able to offer health insurance navigation or counseling services to their target demographic. These programs may include those designed to help people with disabilities obtain health care that they need in order to obtain or retain employment such as benefits counselors under the Social Security Work Incentives Programs (WIPAs).
The regulations also require states to conduct regular health insurance marketplace surveys in order to monitor performance of the marketplaces, including enrollment rates and customer satisfaction. The surveys will include information about disability and employment status among enrollees. This data may prove valuable in tracking the effect of access to health care on employment for individuals with disabilities. In commentary, CMS announced that it plans on exploring ways that aggregated data from the surveys may be made available to the public.
CMS also clarified in its commentary on the regulations that, although the regulations prohibit health insurance navigators or other professionals from soliciting clients doorto-door, they do not prohibit navigators from providing in-home counseling or assistance to individuals with disabilities who have limited mobility. Benefits counselors for Social Security WIPAs should coordinate closely with navigators and other professionals to ensure that people with disabilities who have limited mobility or lack access to telephones receive the assistance they need to ensure continued health coverage as they enter or re-enter the workforce.
More information on these regulations, including the full text, is available via the CMS web site.http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/marketstandards-5-16-2014.html