Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), approved section 1115 demonstration amendments that allow, for the first time ever, Medicaid and Children’s Health Insurance Program (CHIP) coverage of traditional health care practices provided by Indian Health Service (IHS) facilities, Tribal facilities, and urban Indian organizations (UIO). Today’s action is expected to improve access to culturally appropriate health care and improve the quality of care and health outcomes for tribal communities in Arizona, California, New Mexico, and Oregon, and will support IHS, Tribal, and UIO facilities in serving their patients.
The good news is that the federal Rate Review database has now posted the preliminary avg. 2025 rate filings for the individual and small group markets for every state. This makes it very easy to plug in the average requested rate changes in 2025 for every carrier participating in both markets.
The bad news is that most of the underlying filing forms are heavily redacted, meaning I can't use the RR database to acquire the other critical data I need in order to run a proper weighted average: The number of people actually enrolled in the policies for each carrier.
This means that in cases where this data isn't available elsewhere (either the state's insurance department website, the SERFF database or otherwise), I'm limited to running an unweighted average. This can make a huge difference...if one carrier is requesting a 10% increase and the other is keeping prices flat, that's a 5.0% unweighted average rate hike...but if the first carrier has 99,000 enrollees and the second only has 1,000, that means the weighted average is actually 9.9%.
February 16: CMS approved coverage expansions in Arizona through an amendmentof two policies, “Parents as Paid Caregivers” (PPCG) and “KidsCare Expansion." Approval of the Parents as Paid Caregivers amendment will allow the state to continue to reimburse legally responsible parents for providing direct care to their minor children, helping to mitigate the direct care worker shortage and improve access to timely, effective care in the home and community.
Additionally, the KidsCare Expansion amendment will allow the state to increase the Children’s Health Insurance Program (CHIP) eligibility thresholds from 200% of the federal poverty level (FPL) to 225% of the FPL. Expanding KidsCare is expected to improve the rate of child health insurance coverage, increase access to affordable health care coverage, decrease costs by addressing health needs earlier, when care is less expensive, and provide financial relief for families. The demonstration will remain in effect until September 30, 2027.
The good news is that the federal Rate Review database has now posted the preliminary avg. 2024 rate filings for the individual and small group markets for every state. This makes it very easy to plug in the average requested rate changes in 2024 for every carrier participating in both markets.
The bad news is that most of the underlying filing forms are heavily redacted, meaning I can't use the RR database to acquire the other critical data I need in order to run a proper weighted average: The number of people actually enrolled in the policies for each carrier.
This means that in cases where this data isn't available elsewhere (either the state's insurance department website, the SERFF database or otherwise), I'm limited to running an unweighted average. This can make a huge difference...if one carrier is requesting a 10% increase and the other is keeping prices flat, that's a 5.0% unweighted average rate hike...but if the first carrier has 99,000 enrollees and the second only has 1,000, that means the weighted average is actually 9.9%.
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.
Arizona became the latest state to extend postpartum coverage for individuals enrolled in Medicaid and the Children’s Health Insurance Program, following CMS’ approval of the state’s postpartum coverage extension state plan amendments (SPAs). The opportunity to extend this coverage was made possible by the American Rescue Plan, and this approval marks 31 states and D.C. that have extended postpartum Medicaid/CHIP coverage to a full year.
I have no idea why the administration hasn't put out a formal standalone press release about this...they've done so for every other state to my knowledge (including Oklahoma just two weeks ago), but whatever; it's still good news!
Arizona Senate Bill 1292 was introduced by Democratic state Representative Rosanna Gabaldon in February. Here's the most relevant portionf of the legislative text:
Title 20, chapter 1, article 1, Arizona Revised Statutes, is amended by adding a new section 20-123, to read:
20-123. Health care insurers; requirements; prohibitions; definitions
A. Notwithstanding any other law, every health care insurer that offers an individual health care plan, short-term limited duration insurance or a small employer group health care plan in this state:
1. Shall:
(a) Ensure that all products sold cover essential health care benefits.
(b) Limit cost sharing for the coverage of essential health care benefits, including deductibles, coinsurance and copayments.
Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), approved Medicaid section 1115 demonstration initiatives in Arizona that will help the state take aim at health-related social needs. Like recently approved demonstrations in Oregon and Massachusetts, Arizona’s demonstration will test innovative interventions that target critical drivers of health outcomes, including housing insecurity.
“Everyone deserves the chance to receive the care they need to live safe and healthy lives,” said HHS Secretary Xavier Becerra. “We are proud to work with Arizona in this groundbreaking effort. We will continue doing all we can to strengthen Medicaid, and urge states to follow Arizona’s lead.”
There's two significant changes this year: One new entrant to the individual market (Imperial Insurance) and one major withdrawl...Bright Health Co., which I wrote about earlier today; they had around 19,700 enrollees in the AZ individual market as of a year ago, though I don't know how many are enrolled at the moment.
In any event, Arizona is looking at a weighted average rate increase of 4.3% on the individual market (for unsubsidized enrollees only), and 8.2% on the small group market:
