On January 23, 2023, the Federal Communications Commission issued an important ruling that provides states with new flexibility to support enrollee outreach and communication efforts as part of their processes to unwind the Medicaid continuous coverage requirement. The ruling permits state agencies and their partners to send text messages and make phone calls to individuals about enrollment-related issues not only for Medicaid but for other state-run health insurance programs, including marketplace coverage. This expert perspective reviews the ruling and implications for states.
Design Considerations in Structuring Employee Choice for SHOP Exchange
Wakely Consulting Group
The Affordable Care Act (ACA) created the Small Business Health Options Program (“SHOP”) to create new marketplaces for small employers (and employees) to shop for and purchase employer subsidized health insurance coverage. In addition to small business tax credits, the primary value proposition for the SHOP is to facilitate employee choice. Wakely Consulting Group has prepared a brief highlighting the design approaches to SHOP that allow employers to provide a defined contribution while giving employees the choice of one or more products offered on the SHOP. Under this defined contribution approach, the employer’s main responsibility is a financial contribution toward employees’ health insurance premiums, which the employee can put toward the purchase of the coverage that he/she chooses. The brief walks through the different employee choice models and two distinct risk selection impacts and how to address them. Finally, it touches on five design variable for an exchange to consider in order to minimize consumer confusion and adverse risk selection.