SACRAMENTO, Calif. — Covered California launched a virtual media tour on Wednesday to spread the word about the upcoming Medi-Cal to Covered California Enrollment Program and how it will help keep Californians covered.
...Well, just one day after the Bright Healthcare bombshell news broke, Texas-based health insurance broker Jenny Chumbley Hogue sounded the alarm on another large carrier bailing on Texas next year:
OLYMPIA, Wash. — Fourteen health insurers filed an average requested rate increase of 9.11% for Washington's individual health insurance market. The proposed plans and their rates are currently under review and final decisions will be made this fall.
"Nearly 250,000 people in Washington state get their health coverage through our individual market,” said Insurance Commissioner Mike Kreidler. “I'm pleased that so many insurers are filing plans again and to see such healthy competition. Now, we'll spend the next few months closely reviewing the companies' requests and the assumptions they’re making to be sure any rate change is justified.”
Back in February, I wrote about a bill introduced into the Illinois State Senate by Sen. Laura Fine (SD-09) which made my heart sing:
Amends the Department of Insurance Law.
Provides that the Department of Insurance shall establish the Office of the Healthcare Advocate.
Provides that the Office shall be administered by the Chief Health Care Advocate, who shall report to the Director of Insurance.
Amends the Illinois Insurance Code and the Health Maintenance Organization Act.
Provides that all individual and small group accident and health policies written subject to certain federal standards must file rates with the Department for approval.
Provides that unreasonable rate increases or inadequate rates shall be modified or disapproved.
Provides that when an insurer files a schedule or table of premium rates for individual or small group health benefit plans, the insurer shall post notice of the premium rate filings and a filing summary in plain language on the insurer's website.
Provides that the Department shall post all insurers' rate filings and summaries on the Department's website.
Provides that the Department shall open a 30-day public comment period on the date that a rate filing is posted on the website.
...With the recent trend of more & more states (most recently including Georgia) splitting off from the Federally Facilitated Marketplace (FFM) hosted via HealthCare.Gov, it's hardly surprising...but it's still a pretty big deal, especially given that Illinois is the 6th largest U.S. state by population. Via Amy Lotven of Inside Health Policy:
Illinois’ Department of Insurance would be authorized to operate a state-based exchange, starting in plan year 2026, under legislation introduced late Thursday by the Illinois Democratic House Majority Leader Robyn Gabel. Sources earlier this week told IHP they had heard state officials were working with lawmakers on exchange legislation and the bill could be unveiled by this week.
These free, in-person events will take place in Meriden, Norwich and Waterbury
HARTFORD, Conn. (May 24, 2023) — Access Health CT (AHCT) today announced it will host three free, in-person enrollment fairs in June to help HUSKY Health enrollees who have been affected by recent legislation. HUSKY Health is Connecticut’s Medicaid program. The events will take place in Meriden, Norwich and Waterbury.
Medicaid Unwinding is a term the federal government is using to describe the process of resuming the regular annual review of households for Medicaid eligibility after a three-year hiatus during COVID. The eligibility redetermination process resumed April 1. The Medicaid Unwinding process will be taking place over a 12-month period.
Connecticut residents who remain eligible for HUSKY Health will likely be automatically reenrolled; those who need to take action will receive mail with instructions about when they need to take action.
The main distinction between the New Mexico and Minnesota approaches has to do with which existing publicly-funded healthcare program they're based on. While New Mexico went with Medicaid (which half the state's population is already enrolled in anyway), Minnesota is basing theirs on their Basic Health Plan program, MinnesotaCare. I first wrote about this back in February.
Every year, I spend months painstakingly tracking every insurance carrier rate filing for the following year to determine just how much average insurance policy premiums on the individual market are projected to increase or decrease.
Carriers tendency to jump in and out of the market, repeatedly revise their requests, and the confusing blizzard of actual filing forms sometimes make it next to impossible to find the specific data I need. The actual data I need to compile my estimates are actually fairly simple, however. I really only need three pieces of information for each carrier:
CMS Approves Delaware Postpartum Coverage Expansion Under the American Rescue Plan
May 15: CMS marked another important maternal health milestone by approving Medicaid and Children’s Health Insurance Program (CHIP) postpartum coverage expansion in Delaware, an opportunity made possible through the American Rescue Plan. This approval marks 33 states and the District of Columbia that have extended postpartum Medicaid/CHIP coverage to a full year. Information about Delaware’s postpartum coverage extension for Medicaid can be found here; Delaware’s postpartum coverage extension for CHIP can be found here.
Theodore Mermigos,
Acting Director Division of Medicaid and Medical Assistance
Molly Magarik, Secretary, DHSS
Delaware Health and Social Services
P.O. Box 906 New Castle, DE 19720-0906
Ever since the ACA went into effect in 2011 (3 years before newly-sold policies had to be ACA compliant), to help reduce price gouging, insurance carriers have been required to spend a minimum of 80% of their premium revenue (85% for the large group market) on actual medical claims.
Put another way, their gross margins are limited to no more than 20% (or 15% in the large group market). Remember, that's their gross margin, not net; all operational expenses must come out of that 20% (15%). The idea is that they should be spending as much of your premium dollars as possible on actual healthcare, as opposed to junkets to Tahiti or marble staircases in the corporate offices, etc. Anything over that 20% (15%) gross margin has to be rebated to the policyholder.
With all the controversy over the frighteningly quick expansion of Artificial Intelligence (AI) systems over the past year or so into every facet of our lives, I decided to run a quick experiment using ChatGPT. My request was pretty simple:
"Write a blog post in the style of Charles Gaba."
I didn't include anything about healthcare or the Affordable Care Act...just my name.
Here's what it came back with, verbatim. I'm putting the whole thing in quotes because while it was sophisticated enough to make the topic of the post the history of the ACA and the U.S. healthcare system in general, I sure as hell didn't write this:
Title: The Healthcare Odyssey: Navigating the Waves of Change
Subtitle: Charting a Course Through the Turbulent Sea of Healthcare Reform
To: State Department Directors and Autonomous Agency Heads
From: Governor Gretchen Whitmer
The federal Families First Coronavirus Response Act, passed to respond to the COVID-19 pandemic, required Medicaid programs to keep participants continuously enrolled and provided additional federal funding to do so. In December 2022, Congress passed a law ending the continuous enrollment and winding down the associated federal funding. As a result, more than 3 million Michiganders will need to undergo redeterminations for Medicaid coverage or find alternative health insurance if they no longer qualify.
During the COVID pandemic emergency, Congress passed legislation which, among other things, required states to provide "continuous coverage" of people who enrolled in Medicaid or the CHIP program.
Normally Medicaid/CHIP enrollees have their eligibility statuses "redetermined" every month (or quarter in some states, I believe) to make sure they were still eligible for the program, but the Families First Coronavirus Response Act (FFCRA) stated that in order to receive increased federal funding of their Medicaid/CHIP programs, states couldn't kick anyone off as long as the public health emergency was in place (unless they died, moved out of state or asked to be disenrolled).
This requirement ended effective April 1st, 2023 via an omnibus bill passed back in December.
Back in 2021 when I was posting weekly (and later, monthly) analysis of COVID vaccination rates at the county level, several counties in particular caught my eye for different reasons. One of these was Marin County, California. As I noted at the time:
Of counties with more than 100,000 residents, the top-vaxxed are Marin County, CA (76.9% vaxxed); Sumter County, FL (76.4%); and Montgomery County, MD (76.2% vaxxed).
New York's implementation of the ACA's Basic Health Plan provision (Section 1331 of the law) is called the Essential Plan. It currently serves over eleven times as many people as Minnesota's "MinnesotaCare" program does (around 1.1 million vs. 100K). Part of this is obviously due to New York having a larger population, but that's only part of it (NY has 19.84M residents, just 3.5x higher than MN's 5.71M).
Under the ACA, most states have expanded Medicaid to people with income up to 138 percent of the poverty level. But people with incomes very close to the Medicaid eligibility cutoff frequently experience changes in income that result in switching from Medicaid to ACA’s qualified health plans (QHPs) and back. This “churning” creates fluctuating healthcare costs and premiums, and increased administrative work for the insureds, the QHP carriers and Medicaid programs.
There's been another development in the long, winding saga of the Kelley / Braidwood v. Becerra federal lawsuit, which seeks to strike down the Affordable Care Act's preventative services provisions requiring health insurance providers to cover a long list of preventative healthcare services at no out of pocket cost to enrollees.
For the full backstory behind this case (and why a plaintiff win against the government here would be far more devastating than "just" the specific provisions being struck down), read my prior post (with many updates) on the case.
The most recent development prior to today came on March 30th, 2023:
Judge Reed O'Connor STRIKES DOWN a major provision of the Affordable Care Act requiring insurers to cover a vast amount of preventive care cost-free (contraception, cancer screening, PrEP, a ton of pregnancy-related care). The ruling applies nationwide. https://t.co/wL26vkIPsd
NEW YORK – New York Attorney General Letitia James and Acting Department of Health (DOH) Commissioner Dr. James McDonald today warned New Yorkers about a new scam targeting New Yorkers enrolled in public health insurance programs and provided important tips to protect consumers. For the first time since March 2020, people enrolled in Medicaid, Child Health Plus and the Essential Plan will have to renew their health insurance coverage. Attorney General James and Acting Commissioner Dr. McDonald are urging New Yorkers to be vigilant in light of reports of scammers deceptively calling people and asking them to pay hundreds of dollars to maintain their health insurance.
“It is despicable that scammers are trying to exploit New Yorkers’ need for quality health insurance and uncertainty over ongoing Medicaid coverage,” said Attorney General James. “The best tool consumers and families have to combat scams is knowledge, and that is why I am committed to raising this issue. I urge everyone to follow our important tips, and anyone impacted by this scam to contact my office immediately.”
The Massachusetts Health Connector Board of Directors voted on Thursday, May 11, to ensure that health insurance plans used by five million Commonwealth residents to meet the state’s individual mandate continue to deliver high-value preventive services at no cost to consumers. This vote follows a March 2023 decision by a federal District Court in Texas to limit the scope of preventive services covered under the Affordable Care Act.
The proposed regulation amendments guarantee that Massachusetts residents with health insurance plans meeting state Minimum Creditable Coverage (MCC) standards will continue to receive key preventive services like cancer screenings, HIV prevention, and cholesterol-lowering medication without cost-sharing. These proposed regulation amendments protect coverage standards that are current practice in the Commonwealth.
FDA Finalizes Move to Recommend Individual Risk Assessment to Determine Eligibility for Blood Donations
Today, the U.S. Food and Drug Administration finalized recommendations for assessing blood donor eligibility using a set of individual risk-based questions to reduce the risk of transfusion-transmitted HIV. These questions will be the same for every donor, regardless of sexual orientation, sex or gender. Blood establishments may now implement these recommendations by revising their donor history questionnaires and procedures.
This updated policy is based on the best available scientific evidence and is in line with policies in place in countries like the United Kingdom and Canada. It will potentially expand the number of people eligible to donate blood, while also maintaining the appropriate safeguards to protect the safety of the blood supply.
An FDA advisory panel on Wednesday unanimously endorsed making daily birth control pills available over-the-counter for the first time, following two days of deliberations over whether patient misuse could lead to more unintended pregnancies.
Why it matters: If the FDA follows the recommendation and switches HRA Pharma's Opill away from prescription-only use, it could expand the availability of contraception and deepen partisan rifts over reproductive health in the post-Roe landscape.
HRA Pharma, part of consumer products giant Perrigo, expects a final decision from the FDA to come at some point this summer.
Driving the news: In a 17-0 vote, members of two FDA advisory committees decided that patients can properly follow Opill's labeling instructions — including taking the pill at around the same time every day — without consulting with a health provider.
New Opportunity To Enroll Through MNsure for Minnesotans With Unaffordable Job-Based Family Health Insurance
Special enrollment period open through October 31, 2023
ST. PAUL, Minn.—MNsure, Minnesota’s health insurance marketplace, is offering a special enrollment period (SEP) for Minnesotans who are currently enrolled in unaffordable family insurance through an employer with a renewal date other than January 1.
Under a new IRS rule, related household members who are covered by a family member’s employer-sponsored health insurance may be newly eligible to receive advanced premium tax credits through MNsure that lower the cost of private health plans. As a result, some eligible household members may be able to find a better deal on health insurance by shopping for a private plan through MNsure and saving on monthly premiums with a tax credit.
New Jersey Department of Banking and Insurance Establishes Extended Special Enrollment Period at Get Covered New Jersey for Individuals Losing NJ FamilyCare Coverage
TRENTON – New Jersey Department of Banking and Insurance Commissioner Marlene Caride today announced the creation of an extended Special Enrollment Period for individuals who are no longer eligible for NJ FamilyCare and qualify for health insurance through Get Covered New Jersey, the state’s Official Health Insurance Marketplace.
Per federal law, the Department of Human Services is restarting eligibility reviews for NJ FamilyCare as of April 1, which will result in some individuals who are no longer eligible being disenrolled from the program. For those who no longer qualify for NJ FamilyCare because their income is too high, they may be eligible to obtain health coverage through Get Covered New Jersey and may be able to get help paying for premiums.
Oscar Health will exit the California individual ACA insurance market for plan year 2024 as part of a push to make its insurance business profitable.
On a May 9 call with investors, transcribed by Seeking Alpha, Oscar Health CEO Mark Bertolini said the company is exiting underperforming markets to improve its profitability.
"The company has been disciplined in managing its portfolio and improving the sustainability of our margins over time," Mr. Bertolini said.
Oscar Health plans to reenter the California market in the future, Mr. Bertolini said.
Interim CFO Sid Sankaran said the California market represents less than 5 percent of Oscar Health's membership, with around 35,000 members in the state.
This suggests that Oscar has roughly 700,000 ACA exchange enrollees nationally, FWIW.
Shapiro Administration Working With Community Organizations To Help All Pennsylvanians Amid Major Federal Changes To Medicaid Renewals
Reading, PA - Pennsylvania Department of Human Services (DHS) Acting Secretary Dr. Val Arkoosh joined representatives from the Berks Community Health Center and Pennie® today to highlight how the Shapiro Administration, Pennie, and community organizations are collaborating to support Pennsylvanians through federal changes to Medicaid and CHIP renewal requirements so they can protect their health and stay covered.
CMS will beef up its outreach strategy and scale up a pilot program that connected navigators to specific consumers who are not eligible for Medicaid but could enroll in an Affordable Care Act plan through healthcare.gov to help ensure people who lose benefits during the ‘unwinding’ maintain their coverage, according to a slide-deck from a recent webinar.
As part of the effort, healthcare.gov will send those consumers additional reminder letters about enrolling in ACA coverage, with the first batch slated to go out in mid-May, and the assisters will contact those customers shortly afterward.
HHS has estimated that about 2.7 million of the 15 million or so Medicaid beneficiaries expected to lose coverage during the redetermination may be eligible for subsidized coverage through the marketplaces.
...Well, just one day after the Bright Healthcare bombshell news broke, Texas-based health insurance broker Jenny Chumbley Hogue sounded the alarm on another large carrier bailing on Texas next year:
Apple Health (Medicaid) renewal letters have begun mailing
The Washington State Health Care Authority (HCA), Washington Health Benefit Exchange (Exchange), and the Department of Social and Health Services (DSHS) have begun mailing letters to Washington Apple Health (Medicaid) clients reminding them to update their contact information and renew coverage to see if they still qualify.
For the first time in over three years, people on Apple Health could lose coverage if their family income has gone up. Federal requirements during the COVID-19 public health emergency (PHE) led to income checks being suspended to keep clients enrolled in Apple Health during the pandemic. However, last December’s federal omnibus spending bill directed states to resume evaluating eligibility of Medicaid enrollees on April 1 to wind down COVID-19 pandemic emergency measures.
This time, however, I have a heads up...it isn't official yet, but it looks like Missouri and Alaska are about to become the 33rd & 34th states to do so. Via David Lieb of the Associated Press:
JEFFERSON CITY, Mo. (AP) — Lower-income new mothers could gain a full year of Medicaid health-care coverage in Missouri under legislation given final approval Friday as part of a national push to improve maternal health.
Back in January, as the 2023 Open Enrollment Period wound down, I posted a colorful graph which tracked ACA Qualified Health Plan (QHP) enrollment over ten years of Open Enrollment Periods.
Today I'm doing the same thing for ACA Medicaid Expansion. The data comes from the Centers for Medicare & Medicaid Services monthly Medicaid Budget & Expenditure System reports.
Also keep in mind that if the remaining 10 states had expanded Medicaid under the ACA by now, the grand total would have been up to 3.5 million higher (around 27.9 million nationally).
Aside from various holdout states jumping in as the years have passed, the most notable milestone was the month that the COVID pandemic hit the U.S. in full force, shutting businesses down across the country in March 2020.
No further analysis or comment here; I just think this is a pretty cool graphic...and keep in mind that most of the ~23.5 million people represented here (again, likely over 24M today) would have been utterly screwed without the Affordable Care Act being in place when the pandemic hit. Click the image for a higher-resolution version; the states are listed on the right-hand side, though they might be difficult to make out:
Newly proposed standards and requirements would better ensure access to care, accountability, and transparency for Medicaid or CHIP services, including home and community-based services.
The Centers for Medicare & Medicaid Services (CMS) today unveiled two notices of proposed rulemaking (NPRMs), Ensuring Access to Medicaid Services (Access NPRM) and Managed Care Access, Finance, and Quality (Managed Care NPRM),that together would further strengthen access to and quality of care across Medicaid and the Children’s Health Insurance Program (CHIP), the nation’s largest health coverage programs. These rules build on Medicaid’s already strong foundation as an essential program for millions of families and individuals, especially children, pregnant people, older adults, and people with disabilities.
First Wave of Nevada Medicaid Redeterminations Happening Now
Those who lose health coverage through Medicaid can look for plans on NevadaHealthLink.com
(CARSON CITY, Nev.) – As the state unwinds from the federal public health emergency, the Division of Welfare and Supportive Services (DWSS) has begun the reevaluation of all Medicaid enrollments for the first time since 2020 during which you may lose coverage under Medicaid. In April, the first wave of recipients received their renewal packets in the mail. Those who did not respond or who no longer qualify based on income or other factors will lose their benefits starting June 1, 2023. Nevada Health Link is available as the go-to resource to help people stay insured.
For this, I'm assuming a similar 94% average effectuation rate as of February 1st (2 days from now) to the ASPE report from last year for QHP enrollees. Taken literally, that would mean 15,328,061 effectuated on-exchange ACA enrollees.
Every month for years now, the Centers for Medicare & Medicare Services (CMS) has published a monthly press release with a breakout of total Medicare, Medicaid & CHIP enrollment; the most recent one was posted in late February, and ran through November 2022.
In January 2023, 93,008,246 individuals were enrolled in Medicaid and CHIP.
85,915,795 individuals were enrolled in Medicaid in January 2023, an increase of 629,200 individuals from December 2022.
7,092,451 individuals were enrolled in CHIP in January 2023, an increase of 30,891 individuals from December 2022.
Since February 2020, enrollment in Medicaid and CHIP has increased by 22,358,006 individuals (31.6%).
Medicaid enrollment has increased by 22,110,705 individuals (34.7%).
CHIP enrollment has increased by 247,301 individuals (3.6%).
The Medicaid enrollment increases are likely driven by COVID-19 and the continuous enrollment condition in the Families First Coronavirus Response Act (FFCRA).
