In 2019, the Washington legislature enacted a bill requiring insurers on the state’s health insurance exchange to offer plans with standardized benefit designs, beginning in 2021. Colorado and Maryland are considering similar requirements. As these and other states consider the option of standardized health plans, they can benefit from the experiences of California, the District of Columbia (D.C.), Connecticut, Massachusetts, New York, Oregon, and Vermont, all of which require insurers to offer standardized benefit designs. This Expert Perspective outlines benefits and risks of plan standardization, and raises critical questions that states will need to consider, and offers a decision roadmap for states implementing a standardized benefit design requirement.
Consumer Assistance Resource Guide: Household Composition Eligibility Rules
Manatt Health Solutions
Early evidence from across the nation suggests that consumer assisters are playing a vital role in helping people enroll in the new coverage options made possible by the Affordable Care Act. The following resource guide on Household Composition Eligibility Rules is part of a Consumer Assistance Resource Guide series developed to help consumer assisters answer some of the most common eligibility and enrollment questions.
To be eligible for Medicaid, CHIP or Advance Premium Tax Credits and Cost Sharing Reductions, an applicant’s total household income must be below a certain level for the number of people in his or her household. This guide, prepared by Manatt Heath Solutions, explains how to determine who is included in an applicant’s household and covers special Medicaid household composition rules for households that include a pregnant woman; grandparents; unmarried, divorced, separated or non-custodial parents; or institutionalized or incarcerated family members. Additionally, the guide explains how eligibility is re-determined when an applicant’s household size changes during the year.