(LANSING, MICH) The Michigan Department of Insurance and Financial Services (DIFS) is reminding consumers that they have the right to appeal a denial of a health insurance claim to DIFS after attempting resolution through the insurer’s appeal process. To assist Michiganders with these appeals, the state has launched a newly updated consumer website that offers more information and answers to frequently asked questions.
New Jersey Department of Banking and Insurance Issues Guidance to Insurance Carriers to Ensure Nondiscriminatory Health Coverage to Transgender Individuals
Addresses obligation to follow laws against discrimination based on gender identity, gender expression or on the basis that an individual is a transgender person
TRENTON — Department of Banking and Insurance Acting Commissioner Justin Zimmerman today issued a bulletin providing guidance to insurance carriers concerning health coverage for transgender individuals to ensure all New Jersey residents have equal access to health coverage and health care.
The guidance follows Executive Order No. 326 signed by Governor Phil Murphy in April protecting gender-affirming health care in New Jersey.
State Agencies Work Together to Keep Nevadans Insured
Nevada Health Link, Nevada Medicaid and Division of Welfare and Supportive Services (DWSS) continue to engage Nevadans whose health coverage may be impacted by the Public Health Emergency ending
(CARSON CITY, Nev.) – Nevada Health Link, Nevada Medicaid and the Division of Welfare and Supportive Services (DWSS) are working together to ensure Nevadans enrolled on Medicaid are informed about the Medicaid renewal process that has resumed as a result of the Public Health Emergency (PHE) ending. The state agencies are working to keep Nevadans insured by encouraging them to fill out their redetermination packets in the mail and if they are no longer eligible for Medicaid, to seek affordable health insurance coverage through the state marketplace, Nevada Health Link.
"Work requirements" is as old a saw for Republican politicians as "selling insurance across state lines," and it's just as ineffective and counterproductive (as well as simply being cruel). This debate has been held numerous times before, and the upside of such requirements has been debunked repeatedly, but here he go again:
The summary table below provides an overview of the proposed average rate changes from 2023 in the individual health insurance market, as reported by the insurers.
These rate changes do not reflect the impact of federal premium tax credits that are available to eligible Minnesotans who purchase their coverage through MNsure.
It is important to note these are the initial rates proposed by the insurers and filed with the Departments. Rates are subject to review and approval by the Departments and the final approved rates may vary from these proposed rates for many reasons.
Additionally, the actual rate change a consumer will experience in 2024 can vary from the average – with factors such as specific plan, geographic rating area, age, and federal premium tax credits playing a major role.
Each year insurers that sell Individual and Small Group plans in Maine's pooled risk market must submit their proposed forms and rates to the Bureau of Insurance, using the System for Electronic Rate and Form Filing (SERFF). Details of the filings submitted to the state since June 10, 2010 can be viewed in the system.
To see details of a filing, click on the Search Public Filings button below and paste or type in the relevant SERFF Tracking Number listed in the table (no need to complete the rest of the form).
Note: The rule below actually doesn't apply to health insurance carriers, who I presume are bound by other federal and state transparency provisions in the ACA and other laws/regulations; it's primarily focused on auto and homeowner's insurance policies. I found it noteworthy enough to include here regardless, given my annual ACA rate filing project.
Rule adopted requiring insurers to tell you why your premium is going up
OLYMPIA, Wash. — Washington state Insurance Commissioner Mike Kreidler has adopted a rule that requires insurance companies to explain premium increases to their policyholders in language they can understand.
An individual coverage health reimbursement arrangement (ICHRA) is a new type of health reimbursement arrangement in which employers of any size can reimburse employees for some or all of the premiums that the employees pay for health insurance that they purchase on their own...ICHRAs represent a departure from previous ACA implementation rules that forbid employers from reimbursing employees for individual market premiums....
A few weeks ago, I reported that both Nevada and Oklahoma had placed insolvent insurance carrier Friday Health Plans under receivership, leaving just two states left to do so (North Carolina and Colorado, which happens to also be the home to Friday's corporate headquarters).
It turned out that I was correct about Oklahoma, but had jumped the gun slightly re. Nevada; the insurance commissioner had petitioned the court to put Friday into receivership, but hadn't actually done so yet.
via the North Carolina Dept. of Insurance (email; no link yet):
Insurance Commissioner Causey places Friday Health Plans of North Carolina Inc. into receivership
RALEIGH – North Carolina Insurance Commissioner Mike Causey announced today that Friday Health Plans of North Carolina Inc. (FHP-NC) has consented to being placed into receivership to protect North Carolina policyholders due to its reported insolvency and inability to raise additional funds from outside investors.
The petition for receivership is expected to be filed with the Wake County Superior Court today and the receivership order will be posted on the North Carolina Department of Insurance website after the order is signed.
Under the President’s leadership, the Biden-Harris Administration has continued its work to invest in America, lower costs for families, combat climate change, and grow the economy from the bottom up and middle out. The Administration is using every available tool to improve Americans’ lives, including Federal regulations that my office—the Office of Information and Regulatory Review (OIRA)—reviews.
Today, OIRA is releasing its Spring Regulatory Agenda , which details additional actions that Federal agencies are considering over the coming months. These actions build on and accelerate this Administration’s progress in delivering for the American people.
The Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary released projections of National Health Expenditures (NHE) and health insurance enrollment for the years 2022-2031. The report contains expected impacts from the Inflation Reduction Act (IRA), including that people with Medicare prescription drug coverage (Part D) are projected to experience lower out-of-pocket spending on prescription drugs for 2024 and beyond as several provisions from the law begin to take effect.
Individual Coverage Health Reimbursement Arrangements, or the unfortunate-soundingICHRA for short, are a type of health insurance arrangements which were created via Trump administration-era regulations back in 2019.
An individual coverage health reimbursement arrangement (ICHRA) is a new type of health reimbursement arrangement in which employers of any size can reimburse employees for some or all of the premiums that the employees pay for health insurance that they purchase on their own...ICHRAs represent a departure from previous ACA implementation rules that forbid employers from reimbursing employees for individual market premiums....
...data is only available for 8 states so far; for another, the data from those states is a mish-mash, clearly broken out in some but only partial in others, and some only include percentages instead of hard numbers.
Even so, you can already see that at least 258,000 people have lost Medicaid coverage due to paperwork/clerical issues in just Arkansas and Florida alone...in just the first two months of the unwinding process.
Thanks to the Biden-Harris Administration’s efforts to strengthen maternal health, an estimated 509,000 Americans annually are now eligible for essential care for a full year after pregnancy.
Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced New York’s extension of comprehensive coverage after pregnancy through Medicaid and the Children’s Health Insurance Program (CHIP) for postpartum individuals for a full 12 months.
Last week Amy Lotven of Inside Health Policy noted that the 5th Circuit Court panel was trying to come up with some sort of stopgap solution to the ongoing Braidwood v. Becerra lawsuit until such time as the case winds its way up to the U.S. Supreme Court.
One judge on the federal appeals court panel considering whether an order blocking HHS from enforcing the Affordable Care Act preventive services coverage mandate should continue to be partially stayed through its appeal is urging the parties to pursue a workable resolution, and legal expert Tim Jost says the panel appeared open to the government’s suggestion the court issue a narrow solution that only applies to insurers in Texas.
The list includes 9 major items (some of which actually include a lot more than one provision within them). It really should include ten, since I forgot about implementing a Basic Health Plan program like New York and Minnesota have (and as Oregon is ramping up to do soon as well), but it's still a pretty full plate.
Health Carriers Propose Affordable Care Act (ACA) Premium Rates for 2024
Public Invited to Submit Comments
BALTIMORE – The Maryland Insurance Administration has received the rate filings containing the proposed 2024 premium rates for Affordable Care Act (ACA) products offered by health and dental carriers in the Individual, Non-Medigap and Small Group markets, which impact approximately 471,000 Marylanders.
The Connecticut Insurance Department has received a total of 10 rate filings from 9 health insurers for plans that will be available on the individual and small group market, both on and off the state-sponsored exchange, Access Health CT. As part of our regulatory responsibilities, we will conduct a thorough examination of these filings to ensure that the requested rates comply with state laws and regulations.
The review process will delve deeply into each submission, requiring insurers to provide justifications and supporting evidence. As always, the rate reviews will be comprehensive, continuing our ongoing efforts to promote transparency and accountability. By utilizing various tools, such as benchmarking and other industry best practices, we strive to maintain a fair and competitive insurance market while prioritizing the interests of consumers.
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.
Erie, PA - Pennsylvania Department of Human Services (DHS) Acting Secretary Dr. Val Arkoosh and Pennie® Director of External Affairs Chachi Angelo joined representatives from Community Health Net today to highlight how the Shapiro Administration, Pennie, and local health centers are collaborating to support Pennsylvanians through federal changes to Medicaid and CHIP renewal requirements so they can protect their health and stay covered.
“Everyone deserves the dignity and peace of mind of having access to affordable, high-quality, local health care and knowing they can go to the doctor when they need it. DHS’ goal throughout the renewal process is to make sure that all Pennsylvanians stay covered,” said Acting Secretary Arkoosh. “I urge all Pennsylvanians who get their health coverage through the state Medicaid program to be on the lookout for communications from DHS about your renewal, and to make sure you complete it on time when it’s your turn to renew.”
Colorado’s Marketplace Offers Free Enrollment Help and Low-Cost Health Plans
DENVER— For the first time in more than three years, Coloradans who are no longer eligible for Health First Colorado (Colorado’s Medicaid program) or Child Health Plan Plus (CHP+) will start to lose their coverage.
Why Coloradans Might Lose Health First Colorado (Colorado’s Medicaid Program)
This change was the result of federal legislation passed in winter of 2022: the Omnibus bill, otherwise known as the Consolidated Appropriations Act. It included a provision to end the requirement for states to keep individuals covered by Medicaid during the COVID-19 Public Health Emergency.
The Department of Health Care Policy & Financing (HCPF) estimates that more than 325,000 current members will no longer be eligible for Health First Colorado coverage following their annual eligibility review. These eligibility reviews will be done in the anniversary month of when the person enrolled.
While numerous other states have already done the same thing (and several more are in the process of doing so as well), Georgia's move to their own enrollment platform was especially noteworthy for two reasons:
First, because it represents as complete 180-degree turn from their prior attempts (over the course of several years) to eliminate any formal ACA exchange (federal or state-based) in favor of outsourcing it to private insurance carriers & 3rd-party web brokers.
When we last checked in on the Braidwood v. Becerra federal lawsuit, there was a lot of confusion as to exactly which preventative services mandated by the Affordable Care Act to be covered at no out-of-pocket (OOP) charge to enrollees were supposed to be stricken and which weren't.
In February 2023, 93,373,794 individuals were enrolled in Medicaid and CHIP.
86,174,094 individuals were enrolled in Medicaid in January 2023, an increase of 291,095 individuals from January 2023.
7,199,700 individuals were enrolled in CHIP in February 2023, an increase of 111,838 individuals from January 2023.
Since February 2020, enrollment in Medicaid and CHIP has increased by 22,723,554 individuals (32.2%).
Medicaid enrollment has increased by 22,369,004 individuals (35.1%).
CHIP enrollment has increased by 354,550 individuals (5.2%).
The Medicaid enrollment increases are likely driven by COVID-19 and the continuous enrollment condition in the Families First Coronavirus Response Act (FFCRA).
One of the most important provisions of the Inflation Reduction Act, passed with only Democratic votes in the U.S. House last summer, was this one: After decades of prior attempts, it finally allows the Centers for Medicare & Medicaid Services (CMS) to actively negotiate the price of at least some prescription drugs. As explained by the Kaiser Family Foundation:
The Inflation Reduction Act of 2022 (the Act), signed into law by President Biden in August 2022, includes several provisions to lower prescription drug costs for people with Medicare and reduce drug spending by the federal government. One of the Act’s key drug-related policies is a requirement for the Secretary of Health and Human Services (HHS) to negotiate prices with drug companies for certain drugs covered under Medicare Part D (starting in 2026) and Part B (starting in 2028). This new requirement is the culmination of years of debate among lawmakers over whether to grant the federal government the authority to negotiate drug prices in Medicare.
SIOUX FALLS, S.D. (Dakota News Now) - Although Medicaid expansion in the state of South Dakota doesn’t take effect for another month, the window to apply opened on Thursday. A kickoff event was held for advocates and patients to review the benefits for those who qualify.
“Today has been long overdue. No one should have to choose between bankrupting their family and getting the health coverage they need,” said Dr. Dan Johnson from the American Cancer Society.
After the hard work of gathering petition signatures and talking to voters, Medicaid expansion advocates are celebrating enrollment opening for South Dakota residents.
...Over 50,000 people will be eligible for Medicaid, as voters approved Constitutional Amendment D last November. Erik Nelson, an advocate with AARP, has had positive conversations with the state handling the logistics of enrollment.
...Even if applicants don’t have their application completed by the July 1 effective date, a plan is in place.
The Michigan Dept. of Financial Services hasn't issued any press release yet, but nearly all 2024 preliminary rate filings for the MI individual and small group markets are available via the SERFF database.
The only one missing as of today is UnitedHealthcare Community Plan, Inc.; they have most of their 2024 forms on record but there's no Actuarial Memo or URRT form included for the individual market, so I can't seem to find their actual requested rate changes or their enrollment as of March 2023.
In any event, I'm not seeing anything too odd here. Unlike other states with preliminary filings so far this year, Michigan carriers are seeking a fairly reasonable 5.6% average rate hike on the individual market and 7.0% for the small group market.
It's worth noting that two of the three indy market carriers asking for double-digit rate hikes (Alliance and HAP) both only offer off-exchange policies. The third, MacLaren, is also pulling out of the small group market entirely. It's also possible that Humana is dropping out of the small group market, although I'm not sure about that one.
Ouch. Via the New York Dept. of Financial Services, the preliminary, weighted average rate increases being requested for individual market health insurance policies for 2024 are looking pretty ugly indeed: 20.9% overall according to DIFS. I get a slightly lower weighted average of 20.7%, but it still ain't pretty.
Two of the highest increases are for carriers which are only offering policies off-exchange next year and which have fewer than 100 enrollees each anyway; I assume they're both winding down their operations in the state. There are also two carriers which appear to be leaving the NY individual market entirely this year.
As for the rest, they range from requested average increases of "only" 13.3% for MVP to a stunning 52.7% rate hike by Emblem (HIP). The justification summaries are below the table.
It's important to remember that these are not final rate increases--New York in particular has a tendency to slash the requested rate hikes down significantly before approving them:
Friday Health Plans, Inc., the parent company of Friday Health Plan of Colorado, ,Inc. (HMO), has announced that it will begin to wind down its business activities throughout the country, working in close conjunction with state regulators, including the Colorado Division of Insurance.
In recent months, it became apparent that the parent company would need to raise substantial capital to continue. Friday was ultimately unable to raise that capital and on June 1, Friday Health Plans, Inc. (Parent) stated publicly that they would begin to wind down.
This post has a long intro, but please bear with me...
Back in 2018, after the then-Republican controlled Congress zeroed out the ACA's federal "individual mandate penalty" (officially the "shared responsibility penalty"), I posted both a video and slideshow explainer about what this penalty was and why it was included in the ACA in the first place.
...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:
And its confirmed. Email received from Friday. Buckle up folks! Individual OEP in Texas is going to be a bumpy ride! https://t.co/AMNJ4rPyr3
