I've been following this bill for awhile now but never got around to writing about it until after it passed through both chambers of the Illinois legislature. That's a shame, because it's a pretty Big F*cking Deal for Illinois residents.
The Illinois House passed the Healthcare Protection Act Saturday to help curb predatory insurance practices and protect consumers.
Gov. JB Pritzker's monumental plan could make Illinois the first state to ban prior authorization for in-patient adult and children's mental healthcare. The legislation also bans step therapy, or the fail first method, where insurers force people to receive less effective treatment before moving to options initially recommended by doctors.
...The measure requires prior approval from the Department of Insurance before large group insurance plans can increase rates and states premiums must align with the actual cost of providing care as well.
Pennie Has Issued a New Request for Proposal (RFP) for an Enrollment Assister Contract to Expand Support Across Pennsylvania Communities
Pennie is seeking an organization to build grassroots awareness and provide direct enrollment assistance to Pennsylvanians seeking health coverage. Proposals due at 1 pm on June 27th.
Harrisburg, PA – May 2024 – Pennie, PA’s official health insurance marketplace, has issued a Request for Proposal for Assister Services. The awardee will collaboratively drive statewide activities to increase awareness of the financial help and health coverage available through Pennie, and work directly with community organizations to provide local, in-person enrollment assistance.
CMS Approves State Plan Amendments Extending Postpartum Coverage in Nevada
May 3: CMS marked another important maternal health milestone by approving Medicaid and Children’s Health Insurance Program (CHIP) postpartum coverage extensions in Nevada, an opportunity made possible through the American Rescue Plan (ARP). Nationally, people across 46 states, the District of Columbia, and U.S.V.I. now have access to Medicaid and CHIP coverage for a full 12 months following pregnancy — up from just 60 days before the ARP.
Today, U.S. Health and Human Services Secretary Xavier Becerra released the following statement after the Centers for Disease Control and Prevention (CDC) released new data - PDF showing the uninsurance rate holding steady at 7.7 percent:
“Under President Biden’s leadership more people have health coverage than under any previous president. Even more encouraging, the data released today does not reflect the record-breaking open enrollment period that saw over 21 million people sign up for insurance. The Biden-Harris Administration will redouble our efforts to make sure tax breaks for working families stay in place so that every single person in America can go to the doctor and afford the care that will keep them and their families healthy.”
Wyomingites may be skeptical of Obamacare, but many use it for health insurance
(sigh)
Wyoming leaders have repeatedly rejected Medicaid expansion, but a new study shows many residents here rely on another component of the Affordable Care Act: the health insurance marketplace.
Among 10 states with the highest share of farmers, Wyoming uses the federal health insurance marketplace the most, according to a new analysis by the Robert Wood Johnson Foundation. That marketplace is a virtual space for comparing plans and finding insurance that’s often more affordable than elsewhere thanks to federal subsidies.
Last month I noted that North Carolina's ACA Medicaid expansion initiative, which started in December 2023, had officially enrolled more than 400,000 of the estimated 600,000 NC residents eligible for the program.
The data comes from the Centers for Medicare & Medicaid Services quarterly Medicaid Budget & Expenditure System reports. Unfortunately, the MBES reports only ran through June of last year, so it was missing the last half of the year...which is pretty important since that's when the drop in Medicaid coverage due to the ongoing Unwinding process really started to kick in.
Fortunately, CMS recently updated the MBES data to include the third quarter of 2023, bringing Medicaid enrollment *up through September. It's still 8 months out of date but it's better than nothing.
Note: Medicaid expansion enrollment actually peaked in May 2023 at just shy of 24.8 million, but the graph below only includes 6-month increments (January/June).
As of September 2023, MBES put Medicaid expansion enrollment at 23,225,220 nationally.
No further analysis or comment here; I just think this is a pretty cool graphic...and keep in mind that most of the people represented here would have been utterly screwed from early 2020 - early 2023 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 (also note that Guam, Puerto Rico and the U.S. Virgin Islands also have a number of ACA expansion enrollees shown):
As I've written about several times before, starting April 1st, New York State expanded their wildly popular Essential Plan program (NY's name for the ACA's Basic Health Plan program) up the household income scale from 200% of the federal poverty level (FPL) to 250% FPL:
On March 1, 2024, the U.S. Department of Health and Human Services (HHS) and U.S. Department of Treasury approved New York's Section 1332 State Innovation Waiver application to expand the Essential Plan. Section 1332 State Innovation Waivers allow states to pursue innovative strategies for providing residents with access to high quality, affordable health insurance. The waiver was approved for five years, from 2024 through 2028.
...Key Components of the Waiver
This approved State Innovation waiver expands health insurance and covers health-related social needs, improving health care and advancing health equity. The waiver includes the following key components:
TRENTON — New Jersey Department of Banking and Insurance Acting Commissioner Justin Zimmerman today announced the department will continue and extend a previously announced Special Enrollment Period (SEP) to make it easier for qualified individuals who are no longer eligible for NJ FamilyCare coverage to enroll with Get Covered New Jersey.
As required by federal law, the Department of Human Services restarted eligibility reviews for NJ FamilyCare on April 1, 2023. Those who no longer qualify for NJ FamilyCare because their income is too high may be eligible to obtain health coverage through Get Covered New Jersey and may be able to get help paying for premiums.
The end date of this SEP will be extended from July 31, 2024, to November 30, 2024, which will help more individuals leaving NJ FamilyCare to find quality, affordable health insurance through the start of the next Open Enrollment Period. Any eligible consumer who attests to losing NJ FamilyCare (Medicaid/CHIP) coverage between that same time period will be eligible for the SEP.
Nursing home minimum staffing standards promote resident care and safety
Medicaid and CHIP to have historic access standards, advance fair compensation for direct care workers
The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), today issued three final rules to fulfill President Biden’s commitment to support family caregivers, boost compensation and job quality for care workers, expand and improve care options, and improve the safety and quality of care in federally-funded nursing homes. The actions, announced during Care Workers Recognition Month and the Month of Action on Care, represent a transformational investment to support America’s families and workers.
In response, a couple of weeks later the Centers for Medicare & Medicaid Services (CMS) issued a statement about the actions they're taking to resolve the issue.
Regular readers may have noticed that while I've written plenty about non-ACA compliant Short-Term, Limited Duration (STLD) healthcare policies (the "Short" part of my #ShortAssPlans hashtag), I've written far less about the "Ass" part...namely, Association Health Plans (AHPs)
The main reason for this is that I simply don't understand AHPs as well and don't want to misinform people about them. The other reason is that they sort of have one foot each in the worlds of the Individual and Small Group markets, and I write mostly about the Individual market.
But these health plans, created for small businesses, have a darker side: They have a long history of fraud and abuse that have left employers and employees with hundreds of millions of dollars in unpaid medical bills.
The problems are described in dozens of court cases and enforcement actions taken over more than a decade by federal and state officials who regulate the type of plans Mr. Trump is encouraging, known as association health plans.
HHS Releases New Data Showing Over 10 Million People with Medicare Received a Free Vaccine Because of the President’s Inflation Reduction Act; Releases Draft Guidance for the Second Cycle of Medicare Drug Price Negotiation Program
Over 10 million people with Part D Medicare received a free vaccine in 2023 thanks to the Inflation Reduction Act, up from just 3 million in 2021.
President Biden’s lower cost prescription drug law, the Inflation Reduction Act, is helping millions of seniors and families save money on health care costs and prescription drugs. The law took on Big Pharma to finally allow Medicare to directly negotiate with participating drug companies for the prices of covered prescription drugs, caps the cost of insulin at $35 for seniors, and makes recommended vaccines free for Medicare Part D enrollees. Today, the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) published a new report showing that in 2023 more than 10 million people with Medicare Part D received a free vaccine thanks to the law – an increase from just 3.4 million people receiving covered vaccines in 2021.
I strongly suspect that at least one of the remaining holdout states will join the expansion crowd this year, most likely Georgia, Mississippi or Alabama...but it likely will be some state-specific variant as described above. Stay tuned...
...As I noted, however, in all three [states] it's pretty likely they'll go with at least a partially privatized version as Arkansas has instead of a "clean" expansion of Medicaid proper.
February 28th:
BREAKING: The Mississippi House just passed Medicaid expansion by a 96-20 vote.
That's more than enough to overcome a veto from Gov. Tate Reeves.
It now heads to the Senate.
President Joe Biden is set to announce that his administration is expanding eligibility for Medicaid and the Affordable Care Act’s health insurance exchanges to hundreds of thousands of immigrants brought to the U.S. illegally as children, according to two U.S. officials briefed on the matter.
The action will allow participants in the Obama-era Deferred Action for Childhood Arrivals program, or DACA, to access government-funded health insurance programs. The officials spoke on the condition of anonymity to discuss the matter before the formal announcement on Thursday.
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.
Normally, states will review (or "redetermine") whether people enrolled in Medicaid or the CHIP program are still eligible to be covered by it on a monthly (or in some cases, quarterly, I believe) basis.
However, the federal Families First Coronavirus Response Act (FFCRA), passed by Congress at the start of the COVID-19 pandemic in March 2020, included a provision requiring state Medicaid programs to keep people enrolled through the end of the Public Health Emergency (PHE). In return, states received higher federal funding to the tune of billions of dollars.
As a result, there are tens of millions of Medicaid/CHIP enrollees who didn't have their eligibility status redetermined for as long as three years.
• In January 2024, 84,041,447 individuals were enrolled in Medicaid and CHIP, a decrease of 1,056,384 individuals (1.2%) from December 2023.
76,930,368 individuals were enrolled in Medicaid in January 2024, a decrease of 983,655 individuals (1.3%) from December 2023.
7,111,079 individuals were enrolled in CHIP in January 2024, a decrease of 72,729 individuals (1.0%) from December 2023.
As of January 2024, enrollment in Medicaid and CHIP has decreased by 9,826,559 individuals (10.5%) since March 2023, the final month of the Medicaid continuous enrollment condition under the Families First Coronavirus Response Act (FFCRA) and amended by the Consolidated Appropriations Act, 2023.
Medicaid enrollment has decreased by 9,800,191 individuals (11.3%).
CHIP enrollment has decreased by 26,368 individuals (0.4%).
Between February 2020 and March 2023, enrollment in Medicaid and CHIP increased by 22,992,937 individuals (32.4%) to 93,868,006.
Medicaid enrollment increased by 22,650,766 individuals (35.3%).
CHIP enrollment increased by 342,171 individuals (5.0%).
