The CMS’ Marketplace Stabilization Rule – What You Need to Know to Help Farmworkers Access Health Insurance
By Virginia Ruiz, Farmworker Justice
On April 13, the Centers for Medicare and Medicaid Services (CMS) released a final rule regarding market stabilization within the health insurance marketplace.[i] The rule makes several changes to current ACA provisions, including open enrollment, Special Enrollment Periods, and guaranteed availability, among others. It is likely that these changes will make access to health insurance more difficult for eligible farmworkers and their families.
Perhaps one of the most significant changes made in the rule is the shorter timeframe for open enrollment 2018. Like past open enrollment periods, this year’s open enrollment period was supposed to be from November 1st, 2017 to January 31st, 2018. Now, open enrollment 2018 will end six weeks sooner on Dec. 15th. Farmworkers, especially those who are limited English proficient or lack familiarity with the U.S. health care system, rely on in-person assistance to successfully enroll in health insurance through the marketplace. Farmworker enrollment efforts are often more time-intensive, requiring several appointments pre- and post-enrollment. Assuming that there are no changes in navigator funding, it will be critical that outreach and enrollment programs in farmworker communities are prepared to provide the same level of assistance within a shorter timeframe.
The rule also re-interprets the ACA’s guaranteed availability provision. Insurers are required to accept all consumers who enrolled, regardless of past payment history. Now, under the rule, insurers can penalize new consumers who re-enroll in health insurance and have premium debt from the last 12 months.[ii] Farmworkers who migrate or lack access to postal services may inadvertently miss a premium payment. Some farmworkers will need assistance to make timely monthly premium payments in order to avoid any future penalty.
Lastly, the rule made several changes to eligibility and enrollment during special enrollment periods (SEPs). Beginning in June, 100% pre-enrollment verification will be required for enrollment outside of the open enrollment period due to a permanent move, loss of minimum essential coverage, or Medicaid/CHIP denial. Enrollment will be pended until the verification process is complete, which involves submitting supporting documents to the marketplace (either online or by mail) within 30 days. This presents an enormous challenge to farmworkers, especially migratory workers and workers in the U.S. on H-2A temporary work visas, who may not have access to documents like leases or utility bills, or may not live in places where these documents are in their name. Fortunately, CMS recognized that not all consumers will be able to fulfill the verification requirements. CMS will implement “reasonable flexibility” that will allow individuals to send a letter about their situation if they are not able to provide sufficient supporting documentation. This may be an important tool for farmworker consumers who are unable to provide supporting documentation regarding their SEP eligibility.
Farmworkers and their families, given the risky and low-paying nature of farm work, need affordable and accessible healthcare options. The final CMS rule presents a new set of obstacles for farmworkers to obtain affordable health insurance. Assisters in farmworker communities will need to develop strategies to overcome these obstacles and maintain access to health insurance for eligible farmworkers and their families. FJ will continue to provide timely information around issues that affect farmworker access to health insurance.
[i] You can find the final rule at https://www.gpo.gov/fdsys/pkg/FR-2017-04-18/pdf/2017-07712.pdf.
[ii] The penalty would be added to their monthly premium and would only apply to consumers who are applying for health insurance with the same issuer or an issuer in the same control group.