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You are here: Home / Newsletter / UPDATES TO MARKETPLACE PREMIUMS AND MEDICAID WAIVERS

UPDATES TO MARKETPLACE PREMIUMS AND MEDICAID WAIVERS

August 9, 2024 by Nuria Piracha

The NDNRC newsletter will be published on a biweekly basis until the end of the summer.

The Kaiser Family Foundation (KFF) reported on the increase in the Affordable Care Act (ACA) Marketplace premiums increasing in 2025. This 7% increase is due to health care prices for hospital care and the use of specialty drugs. A more detailed breakdown of this average premium increase can be reviewed on the KFF health system tracker.

KFF released an overall landscape of dual-eligible individuals for Medicare and Medicaid. Key takeaways included:

  • 94% of full-benefit dual-eligible individuals obtain health benefits from separate coverage arrangements
  • Coverage combinations for these individuals vary greatly from state to state
  • For those with Medicaid coverage arrangements, over half were enrolled through various Medicaid delivery systems

Section 1115 waivers will be making changes to Medicaid eligibility, benefits, payments, and relevant policies for state Medicaid agencies. The KFF created a landscape overview of approved and pending Section 1115 waivers. Communication is a key factor in obtaining critical health information and through these changes, health equity can be reached for these marginalized populations.

The Department of Health and Human Services continues to strengthen accessibility for people with limited English proficiency and people with disabilities through multiple action plans and increased funding.

Increased Marketplace Premiums for 2025 and Updates on Section 1115. Logo of the Department of Health and Human Services. Photo graphic with image of woman smiling and man in wheelchair taking a selfie with friend.

As of August 1, states have reported renewal outcomes for more than half of those enrolled in Medicaid/CHIP, according to data from the KFF with 15 million renewals still remaining. 26% of those who completed the renewal process were disenrolled and 54.3 million enrollees were able to qualify for renewed coverage. The large range of disenrollment rates in each state varies, with the highest of 57% being in Montana and the lowest of 12% in North Carolina. Out of all states with available data, 69% of all those disenrolled were due to procedural reasons.

KFF created a Medicaid postpartum coverage tracker, showing all states and their approval for limited coverage extensions. At this point, two states are planning to implement a 12-month extension, 1 state has limited coverage extension, and the rest of the states have implemented this extension. This is great news for pregnant people with disabilities.

The total number of ACA Marketplace enrollees that obtain tax credits have increased by 50% since 2017, with mostly low-income populations accounting for the increase in enrollment. These and more trends are due to the Inflation Reduction Act, according to KFF.

The National Academy for State Health Policy covered updates to development and implementation of Medicaid amendments to allow for community health worker (CHW) reimbursements. The importance of CHWs allows for engagement, care coordination, lived experience, and community-led changes in marginalized communities, like the disability community.

The Commonwealth Fund released a report on community health centers in meeting primary care needs through federally qualified health centers (FQHCs). FQHCs are community-based clinics that are federally funded and greatly aid lower income populations.

Archives of our weekly updates are available on the NDNRC website. Follow us on Twitter/X at @NDNRC!

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