More About Judy Solomon

Judy Solomon

Solomon is Vice President for Health Policy at the Center on Budget and Policy Priorities, where she focuses on Medicaid and the Children’s Health Insurance Program and issues related to the implementation of health reform, particularly policies to make coverage available and affordable for low-income people.

Full bio and recent public appearances | Research archive at CBPP.org


Haven’t Enrolled in Marketplace Health Coverage? Three Things to Know

April 8, 2014 at 11:31 am

More than 7 million people had signed up for private coverage by the time open enrollment in health reform’s insurance marketplaces ended March 31.  But, what about those who are still trying to enroll — and those who don’t need coverage now but may need it later in the year when their circumstances change?  Here are three basic points on who can sign up between now and November 15, when the next open enrollment period begins:

First, people eligible for Medicaid can sign up any time — unlike private coverage, Medicaid has no limited enrollment period.  Medicaid eligibility varies by state but, in states that chose to expand Medicaid under health reform, people with income up to 138 percent of the poverty line (about $27,000 for a family of three) can enroll.

Second, people who began signing up in the federal marketplace at healthcare.gov by March 31 have until April 15 to finish and enroll in a plan.  And people who experienced problems with healthcare.gov or have other exceptional circumstances can get additional time.  In states with their own marketplaces, the deadlines vary, so check the marketplace website for details.

Third, many people who lose other coverage (such as Medicaid or job-based coverage) or experience other changes can enroll in marketplace coverage during “special enrollment periods” (SEPs).

Most major life changes trigger a SEP:

  • Losing other health coverage;
  • Moving to a different state, or even within a state if the move changes which plans are available;
  • Getting married; and
  • Having a baby or adopting a child.

But some significant life changes don’t trigger a SEP by themselves, such as getting divorced (unless the person getting divorced loses coverage or moves).  Losing a job without losing coverage also doesn’t trigger a SEP.

For more information on special enrollment periods and other health reform topics, check out CBPP’s special project Health Reform:  Beyond the Basics.

Obama Budget Would Improve Access to Health Care for Underserved Populations

March 14, 2014 at 2:07 pm

As health reform enables millions of uninsured Americans to gain health insurance, the need for preventive and primary care services and those who provide them will continue to grow.  The President’s 2015 budget includes a new initiative to strengthen the health workforce — particularly for underserved areas and populations with shortages of providers — and ensure adequate payments for primary care physicians, physician assistants, and nurse practitioners who see Medicaid patients.  It deserves Congress’ approval.

The initiative would:

  • Expand the National Health Service Corps, which boosts the number of health care providers in high-need communities through scholarships and other kinds of support.  The program would receive an extra $4 billion over fiscal years 2015 through 2020, allowing it to support 15,000 providers (up from the current 9,000) delivering care to more than 16 million people.
  • Provide $5.2 billion over ten years for a new competitive grant program for medical residency positions that would encourage primary care physicians to practice in rural and other underserved areas.
  • Continue Medicaid’s enhanced payment rate for primary care services, scheduled to end on December 31, 2014, through December 2015, at a total cost of $5.4 billion.  This provision requires states to pay providers at the Medicare rate; the federal government covers 100 percent of the boost from the state’s regular Medicaid rate. The President’s budget also would extend the enhanced Medicaid rate beyond primary care physicians to include physician assistants and nurse practitioners.

Addressing Confusion About Young Adults’ Coverage Options Under Health Reform

October 29, 2013 at 5:00 pm

Despite today’s suggestions to the contrary by House Budget Committee Chairman Paul Ryan, health reform offers young adults an unprecedented range of choices for affordable health insurance coverage.  It’s allowed more than 3 million young adults under age 26 to obtain coverage under their parents’ policies, and millions more have now gained access to coverage that will begin in January, when new, federally financed premium subsidies will help reduce what low- and moderate-income people will have to pay for coverage.

Chairman Ryan overlooked those features again today.  Similar to his assertions of earlier this year, he incorrectly claimed at a House Ways and Committee hearing today that under health reform, young adults under age 26 who earn between 100 and 400 percent of the poverty line will be ineligible for federal tax credits to help pay their premiums for plans through the new health insurance marketplaces (also known as exchanges) if they can get coverage under their parents’ plan.  (Unfortunately, Marilyn Tavenner, the Centers for Medicare and Medicaid Services’ administrator, incorrectly agreed at today’s hearing that these young adults would not qualify for subsidies.)

That’s simply not true.  Most young adults have multiple coverage options.  They can obtain coverage through their parents’ plan if available, or through their own employer if their job offers health coverage.  Young adults may also qualify for Medicaid depending on their income and on whether their state has chosen to adopt health reform’s Medicaid expansion to cover low-income adults.

For young adults who are ineligible for Medicaid, premium tax credits would be an option as well, as long as they have incomes in the subsidy-eligibility range (100 percent to 400 percent of poverty), their parents don’t claim them as dependents on their tax returns, and their employers haven’t offered them affordable and adequate coverage.  The fact that they also can enroll under their parents’ policy does not in and of itself preclude them from obtaining exchange coverage using the premium credits.

Young adults have to choose their coverage options carefully, considering, for example, each available option’s costs, benefits, and provider networks.  But the bottom line is that more young people have greater access to much-needed health insurance coverage.

“Coverage Gap” Could Narrow as More States Look to Expand Medicaid Under Health Reform

October 21, 2013 at 9:05 am

With 25 states already expanding Medicaid to low-income adults under health reform, governors in New Hampshire and Ohio want their states to expand their programs as well, which would extend coverage hundreds of thousands of currently uninsured adults, according to state estimates.

Last year’s Supreme Court decision upholding health reform gave states the choice of whether to implement the Medicaid expansion — which allows states to extend coverage to adults below 133 percent of the federal poverty line in 2014.  Expanding Medicaid is a very good financial deal for states.  The federal government will pick up 100 percent of the cost of the expansion to newly eligible individuals for the first three years and no less than 90 percent of the cost on a permanent basis.

In New Hampshire, a bipartisan panel endorsed a proposal to expand Medicaid last week. Governor Maggie Hassan has called a special session of the legislature in November to vote on the plan, which would cover as many as 50,000 adults in the state.  And in a potentially promising move for 275,000 Ohioans, Governor John Kasich is appealing to a state legislative panel to vote today to approve the expansion there.

These moves would help reduce the so-called “coverage gap” into which more than 5 million Americans may fall, because their incomes are below the thresholds to qualify for premium subsidies to help buy health insurance through the new marketplaces, their incomes are too high for the existing Medicaid programs, and they live in states that aren’t planning to adopt the Medicaid expansion.

Moreover, expansion would make good financial sense for New Hampshire and Ohio.  In the 25 states that have decided to expand Medicaid, a recent Kaiser Commission on Medicaid and the Uninsured’s survey showed that state spending on Medicaid will grow by 4.4 percent in 2014 — compared with 6.1 percent for the states that are not moving forward with expansion.

Shutdown Deal Won’t Affect Health Reform Subsidies

October 17, 2013 at 4:09 pm

Let’s clear up any confusion:  yesterday’s deal to reopen the government and raise the debt limit doesn’t change the procedures for verifying applicants’ eligibility for new federal health insurance subsidies under health reform.  That’s appropriate, since these procedures are perfectly adequate as they now stand.

Instead, a provision in yesterday’s deal requires the Health and Human Services (HHS) Secretary to certify that the new health insurance marketplaces (formerly called exchanges) are verifying eligibility in a manner that’s consistent with the requirements of health reform (i.e., the Affordable Care Act); at that point, the subsidies can start.  The Secretary must also provide a report to Congress by January 1 that describes the procedures used to verify eligibility.

The provision also requires HHS’ Inspector General (IG) to report to Congress on the effectiveness of those procedures, but that report isn’t due until July 1, giving the IG the time to make a fair assessment.

Here’s how the verification procedures work:

Under health reform, people who buy private coverage through the new marketplaces may qualify for subsidies to help make coverage affordable.  Contrary to critics’ claims that marketplaces will rely on the “honor system” to determine applicants’ eligibility for the subsidies, all marketplaces — both state- and federally run — will rigorously verify applicants’ income and require applicants to provide information on any coverage that employers offer.

All marketplaces must first check the applicant’s reported income against a federal database that contains data on the applicant’s federal income tax returns, as well as information on any Social Security benefits that the applicant claims.  Marketplaces also will compare the applicant’s information with employers’ wage information provided by Equifax, a major credit reporting agency.  If the information that the applicant provides conflicts with the electronic data, the applicant must explain the discrepancy, provide additional documentation, or both.

Complaints about gaps in the income verification process surfaced in July, when HHS simplified the verification process for the small number of cases in which (1) an applicant’s reported income is much lower than the income reported on his or her last tax return, (2) information from electronic data sources isn’t available, and (3) the applicant doesn’t provide a reasonable explanation for the inconsistency.  HHS gave state-run marketplaces the option for 2014 only of accepting the applicant’s “attestation” and requesting further documentation in some rather than all of these cases.  (HHS issued guidance in August explaining that the federal marketplace, which will operate in 34 states, will request followup documentation in all cases.)

For any inaccuracies for a small share of subsidy recipients that could result, a back-up system will come into play in virtually all such cases.  The marketplaces only determine the amount of advance payments of the premium tax credits. The final amount of an individual’s premium credit is determined based on an individual’s actual income for the year that the person reported on his or her tax return, which the person files after the year is over.  Individuals who underreport their income will have to pay back excess advance payments of premium credits when they file their taxes.

Some Republicans sought to include in the budget deal a House-passed bill to bar the federal government from providing any subsidies until HHS’ IG certifies to Congress that “there is in place a program that successfully and consistently verifies” applicants’ information.  But as we have explained, the IG told Congress that it can’t evaluate whether the marketplaces are “successfully and consistently” verifying this information until they’re up and running and there are real cases to audit.