New Mexico: CHRISTUS is OUT, True Health is IN, approved 2020 premium hikes PLUMMET

Back in June, the New Mexico Insurance Dept. posted the preliminary 2020 rate change filings for the ACA individual and small group markets. At the time, the vcarriers were requesting the highest average premium increase in the country for next year: An increase of 13.0%.

The main source of this double-digit hike was New Mexico Health Connections, one of just a handful of original ACA Co-Op carriers to survive. They were requesting a whopping 30% average rate hike for 2020, and with over 1/3 of the market share, this was more than enough to drag the statewide average up. A second carrier, Presbyterian, only sells off-exchange but was requesting a 16.3% increase which also pushed the average up.

Well, today the approved rate filings have been released, and there's several eyebrow-raising developments.

First of all, there's this (first noted by Sabrina Corlette):

CHRISTUS HEALTH PLAN LOSES QUALIFIED HEALTH PLAN STATUS

Inability to Fulfill Compliance Requirements Bars Individual Market Participation Santa Fe, NM – Under the Affordable Care Act, New Mexico’s Office of Superintendent of Insurance (“OSI”) must certify health insurance plans that health insurance carriers wish to offer as qualified health plans (“QHPs”) prior to their sale to consumers in New Mexico’s individual and small-group markets. To be certified as a QHP, a health insurance carrier must submit regulatory filings evidencing compliance with state and federal consumer protection laws and coverage mandates. OSI’s regulatory compliance staff reviews these filings each year and works with carriers to resolve compliance gaps before the QHP certification deadline for the upcoming plan year. This year, the qualified health plan certification deadline was August 16, 2019.

“CHRISTUS Health Plan failed to achieve compliance with requirements for certification as a qualified health plan,” announced New Mexico Superintendent of Insurance John G. Franchini, on Monday, August 19th. “The term ‘qualified health plan’ signifies a high standard. It indicates that a health insurance plan is compliant with federal and state requirements and is therefore eligible to participate on the New Mexico health insurance exchange. Four other carriers in the state were able to meet the requirements, and we are disappointed that this year, CHRISTUS was not.” said Superintendent Franchini. The Superintendent added that the determination would not affect the ability of CHRISTUS to continue the sale and service of its Medicare Advantage products in the state.

CHRISTUS Health Plan currently offers coverage to approximately 1,100 of the over 56,000 New Mexicans in the individual market. Pursuant to state law, OSI will require CHRISTUS to alert its New Mexico members that their plans will terminate on December 31, 2019. Individuals who need to select new coverage can shop for a plan or find enrollment assistance through New Mexico’s Health Insurance Marketplace, either online at www.bewellnm.com or by calling 1-833-862-3935 toll-free. Open enrollment for individual health insurance coverage in the 2020 plan year runs from November 1 through December 15, 2019.

The Office of Superintendent of Insurance offers consumer assistance with individual and smallgroup health insurance coverage, including benefit denials, through its Managed Health Care Bureau. New Mexico consumers may contact the Managed Health Care Bureau by calling 1-855- 4ASK-OSI (1-855-427-5674) toll-free or may file a complaint.

Wow. As Corlette noted, this is the first time she's heard of a carrier being de-certified. OK, so around 1,100 New Mexicans are gonna have to shop around for a different carrier this fall.

The second big change is that it looks like there's a new carrier jumping into the New Mexico market (True Health New Mexico)...although they're only kind of new, as Greg Fann called to my attention:

In late 2017, New Mexico Health Connections – one of the few remaining health plan CO-OPs in the nation out of the original 24 – signed an expanded agreement with Evolent Health to assume NMHC’s small-group and large-group members and launch a new health plan, True Health New Mexico. The majority of our Senior Leadership Team (SLT) has been with NMHC for years before this change – some of them since the very beginning. All SLT members have been instrumental in guiding NMHC and Evolent Health toward and through this evolution to True Health New Mexico.

I'm not sure I understand exactly what's going on here...this makes it sound like NMHC simply offloaded their group plans to True, but now True will be offering individual market plans as well. NMHC is still around as well, so I'm not sure if they're offering plans under both names, or if True is starting to muscle in on NMHC's territory or what.

The third major development is that all four of the other current carriers had their requested 2020 rate filings slashed down significantly:

  • Blue Cross Blue Shield asked for flat rates...but were approved for a 6% reduction
  • Molina Healthcare asked for a 0.8% increases...but was approved for a 1.8% reduction.
  • New Mexico Health Connections requested a whopping 30% increase...but was only approved for 1.9%.
  • Presbyterian asked for a 16.3% hike...but was approved for 9.4%.

As a result, New Mexico just saw their average unsubsidized 2020 premiums plummet from a 13% increase to just 0.9%.