Rhode Island: THIS is what I meant about "live purging" of unpaid enrollments

Last week, the Rhode Island exchange reported a total of 34,627 QHP selections--paid and unpaid, as they're always careful to note.

The breakdown at the time was:

• 30,165 renewed/re-enrolled from 2015
• 4,462 newly-added for 2016

They also noted that:

• 27,124 of the 34,627 individuals are enrolled in 2016 coverage through HSRI, and have paid their first month’s premium.

Given that the thru-date was after New Year's, it was inevitable that another chunk of those who selected QHPs would be dropped soon...and sure enough, HealthSourceRI has done so in this week's report:

INDIVIDUAL AND FAMILY ENROLLMENT • As of January 9, 2016:

• 30,015 individuals are enrolled in 2016 coverage through HSRI, paid and unpaid.*

• 4,333 of the 30,015 individuals have selected a plan for 2016 coverage and are new to HSRI this year or returning after being enrolled with HSRI at some point during a prior year.

• 28,756 of the 30,015 individuals are enrolled in 2016 coverage through HSRI, and have paid their first month’s premium.

*Individuals who selected plans for January 2016 coverage but did not make a payment were cancelled after the passing of the payment deadline, causing a decrease to the unpaid enrollment count last week.

OK, here's where things get messy. What Rhode Island has done (they and a few other states have done this in the past as well) is to purge the unpaid enrollees who have already passed the payment deadline. That does not mean that all unpaid enrollments have been purged, however, since anyone who enrolled between 12/30 - 1/09 isn't set to have their policies effectuated until February 1st, which means their payments aren't due until towards the end of January.

This is fine...except that the RI report doesn't say outright exactly how many have been cancelled, making it a bit tricky to figure out the grand total of QHP selections through 1/09/16.

What's interesting here is that the renewed number has stayed exactly the same: 30,165. It's the new enrollment number which has dropped by 129 people.

As you can see, this is kind of messy. It's theoretically possible (but highly unlikely) that no one signed up between 1/03 - 1/09, while 129 people were cancelled. It's far more likely that, say, 500 people signed up, while 629 were cancelled, for a net reduction of 129.

Furthermore, an additional 4,483 renewed policies (likely auto-renewals) were cancelled/purged from the total as well.

Unfortunately, this makes it very difficult to know which number to plug into the Spreadsheet (and the Graph). In terms of QHP selections to date, Rhode Island is likely somewhere around 35,000 (well within striking distance of my 36K target by 1/31). However, due to the way they report their data, there's no "inclusive" total as there is with most of the other states (Massachusetts is the other exception, as they don't even report QHPs at all until they've been paid for).

In terms of the national total, RI is small enough that it won't make a lick of difference; whether their "official" number on the ASPE report turns out to be the ~35,000 QHPs selected (what I'm tracking), the 30,000 "semi-purged" figure or the 28,756 who've actually paid so far will amount to barely a rounding error. For the "State by State Goals Attained" table/graph, however, I'm going to have to include a special note starting tomorrow to explain the gap.

On a larger scale, however, this also ties in with the important reporting methodology change on the HC.gov Weekly Snapshots which I noted a week ago:

Plan Selections: The weekly and cumulative metrics provide a preliminary total of those who have submitted an application and selected a plan. Each week’s plan selections reflect the total number of plan selections for the week and cumulatively from the beginning of Open Enrollment to the end of the reporting period, net of any cancellations from a consumer or cancellations from an insurer during that time.

Because of further automation in communication with issuers, the number of net plan selections reported this year account for issuer-initiated plan cancellations that occur before the end of Open Enrollment for reasons such as non-payment of premiums. This change will result in a larger number of cancellations being accounted for during Open Enrollment than last year. Last year, these cancellations were reflected only in reports on effectuated enrollment after the end of Open Enrollment. As a result, there may also be a smaller difference this year between plan selections at the end of Open Enrollment and subsequent effectuated enrollment, although some difference will remain because plan cancellations related to non-payment of premium will frequently occur after the end of Open Enrollment.

As far as I can tell, it sounds like CMS is doing the same thing with their weekly Snapshot reports this year that HealthSourceRI has done: The number of QHP Selections each week has already been reduced by an unknown number of people who had already had their policy selections cancelled for one reason or another prior to the report "thru" date.

Again, this is messy. Let's say a state had 100,000 people select QHPs. Let's say that 90,000 of those had their January payment due as of 12/23/15; the rest are scheduled to start on February 1st.

Next, let's say that only 85K of those 90K made their payments in time, and another 5K were disqualified for some other reason (immigration status, for example). Meanwhile, the additional 10K are cooling their heals, as their payments aren't due yet anyway.

How is CMS reporting the number? Last year they would've reported the full 100,000, only dropping cancelled enrollees when the 1st Quarterly Effectuation report is released. This year, however, are they dropping the 10K who didn't pay up? The 5K who were dropped for immigration status? Both?

Depending on the answer to that, the number included on the Weekly Snapshot (and counted as part of the cumulative total) could be:

• 100,000 (everyone)
• 95,000 (everyone minus the 5K immigrant cancellations)
• 90,000 (everyone minus the 10K non-payers)
• 85,000 (everyone minus both groups)
• Some number in between, since it's possible that CMS receives hard cancellation data from some carriers in that state but not from others...or that it's more up to date from some carriers than others.

See the dilemma this presents?

This is why I've already changed my official call from a solid 14.7 million to a "range" of 14.0 - 14.7 million...and I might have to drop it further still, even if the true number of "QHP selections" actually ends up being around 14.7 million.

(sigh) Messy indeed...