Special Enrollment Periods: Analyzing Enrollee Risk, Improving Policy Responses 

Grant: #73801

Grantee Institution: Urban Institute

Principal Investigator: Stan Dorn, J.D.

Grant Period: September 1, 2016 - February 28, 2017

Budget: $144,618

This project is funded as part of the Robert Wood Johnson Foundation’s solicitation “Policy-Relevant Insurance Studies” (PRIS), which supports studies that evaluate or predict the effects of policies or policy changes related to health insurance coverage. The goal of this research is to inform state and federal policies to assure stability in the Affordable Care Act marketplaces, particularly the 2018 federal risk adjustment formula. Using data from major marketplace carriers, this project will: (1) compare the characteristics and costs of special enrolloment period (SEP) and open enrollment period (OEP) enrollees; (2) analyze claims for individual market enrollees to determine if risk adjustment undercompensates for SEP risk selection; and, if so, (3) identify risk adjustment methodologies that more adequately address this risk selection.