START OF 2018 OPEN ENROLLMENT PERIOD

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Ohio: Ah, crud; strike one more Co-Op...InHealth Mutual taken over by state

(sigh) Once upon a time, there were 24 ACA-created Co-Ops. Then, after one of them failed to even make it through the 2nd open enrollment period, a variety of factors (culminating in the infamous Risk Corridor Massacre) caused another dozen or so to curl up & die, falling like dominoes throughout last September/October.

When the dust settled, there were 11 Co-Ops left standing, but most of them were still on pretty shaky ground, with all but a handful placed under "enhanced oversight" by their states (and I have to admit that the term sounds an awful lot like a euphamism, a la "enhanced interrogation technique").

Anyway, things looked dicey going into Year Three of open enrollment, but then some positive news started popping up over the past few weeks. First, about a month ago it was announced that at least 3 of the remaining Co-Ops (in Maryland, New Mexico and Massachusetts) had actually pulled off small profits in Q1 of 2016. Then, a couple of weeks ago, the CMS division of the HHS Dept. announced that they're finally going to allow the Co-Ops to seek outside investment/funding to help shore up their financing, something which some had been asking for since the beginning.

Unfortunately, moments ago, healthcare reporters Paul Demko and Sabrina Corlette noticed that the state of Ohio is officially pulling the plug on their Co-Op as well, InHealth Mutual:

5/26/2016
InHealth Mutual Failing Ohio Insurance Department Takes Control

COLUMBUS - Lt. Gov. Mary Taylor was appointed receiver for Coordinated Health Mutual, Inc. today following the Ohio Department of Insurance (ODI) request to liquidate the company which provides health insurance to nearly 22,000 Ohioans under its InHealth Mutual brand. The action allows ODI to assure that claims of policy holders, providers and vendors are provided for in an orderly manner while it winds down company operations.

Franklin County Common Pleas Judge Kim Brown granted the ODI request to operate the company, pay policy holder claims, and control the cash reserve held by the company.

Under the order, InHealth policy holders must continue to pay their premiums; providers must continue to honor their contract for service to InHealth policy holders; and, vendors must work with Taylor to continue to provide necessary services to the company.

“Our examination of the company’s financials made it clear that the company’s losses would prevent it from paying future claims should its operations continue,” Lt. Gov. Mary Taylor, also Ohio Director of Insurance, said.

“Under Ohio law, we acted with certainty to protect the consumers,” she said, adding: “Now, policy holders should learn their options by visiting the special page on the Ohio Department of Insurance web site or calling our consumer services division.”

ODI’s action triggers the availability of the Ohio Life & Health Insurance Guaranty Association made up of companies who engage in life and health insurance business in the state. Should the reserve and receipts of Coordinated Health Mutual not be sufficient to operate InHealth during this process, the law provides that the Ohio Life & Health Insurance Guaranty Association support up to $500,000 of a policy holder’s claims.

That's 22,000 people currently enrolled in effectuated InHealth policies. I don't know how many of these are enrolled via the ACA exchange vs. off-exchange, nor do I know the breakout between individual and small group policies, but it doesn't really matter that much; they're all gonna have to shop around.

One part of the press release really caught my eye:

Current InHealth policy holders who want to keep their federal health care subsidy should visit the federal health insurance exchange within the next sixty days to replace their InHealth policy with a policy offered by another company on the federal exchange.

Last year, every one of the Co-Op liquidations was structured so that they'd still be operational through the end of the year (12/31/15). The one exception to this was Health Republic of New York, which was originally supposed to stay afloat through New Year's Eve, but suddenly announced that they were shutting down effective November 30th, which casued utter chaos for thousands of enrollees and providers.

The Ohio/InHealth press release is a bit confusing on the cut-off date, since it states that enrollees "must continue to pay their premiums" (which makes it sound like they'll be operational for several months at least) but then states that enrollees are eligible to utilize the 60-day "Lost Coverage" Special Enrollment Period clause of the ACA to switch to a different policy starting right now. This suggests that they're "losing their coverage" effective immediately, which contradicts the "keep paying your premiums" statement.

In any event, this also means that the big scare about InHealth Mutual pulling an "in network" bait & switch from earlier this year, which they backed off from, is now a moot point.

Coordinated Health Mutual, Inc. was licensed by ODI in October 2013. It is organized as a Consumer Operated and Oriented Plan (CO-OP) under the Affordable Care Act. The Act sought to create CO-OP companies to compete with private sector companies that traditionally marketed health insurance plans. Fully operational since January 2014, the company sold its InHealth products for both individual and group health coverage.

The company has policy holders throughout the state with the largest concentrations in central Ohio followed by concentrations in the Cincinnati and Dayton areas.

Consumers with questions may call the insurance department’s help line at 1-800-686-1526. Consumers, providers and vendors will find information at http://insurance.ohio.gov/liq/Pages/LIQTab1.aspx.