CMS concludes no QHPs can be certified as comparable to CHIP coverage; California's Marketplace plans to connect consumers to vision coverage issuers; and states react to CMS's proposed HealthCare.gov user fee.
FEDERAL & STATE MARKETPLACE ACTIVITY:
CMS Report Finds No QHPs With CHIP-Comparable Coverage for Children
CMS has completed its review comparing benefits and cost sharing in qualified health plans (QHPs) to those offered through the Children's Health Insurance Program (CHIP), in an effort to certify any QHP with CHIP-comparable coverage. The Affordable Care Act requires the Secretary to certify QHPs with CHIP-comparable coverage in the event that a federal funding shortfall requires CHIP children to transition to the Marketplace. Based on the agency's findings, the Secretary did not certify any QHP as having CHIP-comparable coverage. To conduct its comparative analysis, CMS reviewed the benefit package for "child-specific services" and associated cost sharing for the second lowest cost silver plan (SLCSP) in the largest rating area in each state. The report concludes that while coverage of "core" benefits (such as physician and laboratory services) are similar between the two programs, "child-specific services" (such as dental and habilitation) and services for children with special health care needs are more comprehensive in CHIP. The report also found that the actuarial value of CHIP exceeds the actuarial value of the SLCSP in every state except Utah, where the two programs were equivalent. However, when premiums are included in total out-of-pocket spending estimates, Utah's QHP was more expensive than CHIP.
New Report Counters Dire Media Predictions for 2016 Marketplace Premiums
Average premiums for the lowest cost silver plan increased 4.3% from 2015 to 2016, according to a new report by the Urban Institute. The report found that the average premium of the lowest cost silver plan decreased in six states, increased by less than 5% in five states, increased 5%-10% in five states, and increased by more than 10% in four states. The states with the largest increases tended to be those with premiums below the 2015 national average of $264 per month. These modest increases counter early media reports anticipating double-digit premium rate increases for 2016 based on requested—not approved—rates. This report reviewed the final approved premiums for the three largest rating areas in 20 states and the District of Columbia.
States React to Proposed User Fee for HealthCare.gov Platform
Bruce Gilbert, executive director of Nevada's Silver State Health Insurance Exchange, said a proposed 3% user fee on issuers selling qualified health plans in a State-based Exchange on the federal platform (SBE-FP) may be too costly for the Exchange, leading it to seek services from a private sector contractor, according to InsideHealthPolicy.com. Joel Ario of Manatt Health, a former insurance commissioner and CMS official, noted that the 3% fee was a surprise, higher than the mid-2% figure stakeholders had anticipated, and that the cost may deter states from using the federal platform. The director of Oregon's Exchange, also currently an SBE-FP, noted that it plans to consider other vendors and will issue a Request for Proposals in mid-December. The new rule was proposed in the Department of Health and Human Services' Notice of Benefit and Payment Parameters for 2017.
California: Marketplace to Highlight Select Vision Plans on Website
The Covered California board announced that the Marketplace will provide links from its website to select vision plan websites starting in 2016 in order to help consumers connect with and obtain vision coverage. While the Marketplace will not sell vision coverage directly, the new initiative will enable vision plans to sell standalone coverage to Marketplace consumers, including outside of open enrollment periods. The board released a Request for Proposals to evaluate and select vision plan partners for 2016, which will be announced during the week of December 21.
STATE MEDICAID ACTIVITY:
71 Million Individuals Are Enrolled in Medicaid and CHIP
According to CMS's monthly Medicaid/CHIP eligibility and enrollment report, 71.6 million individuals were enrolled in Medicaid and CHIP in September 2015. Nearly 13.3 million additional individuals have enrolled in Medicaid and CHIP since October 2013, an increase of 23.3% over the average monthly enrollment for July 2013 through September 2013. Compared to that same 2013 timeframe, Medicaid expansion states have seen an average 30.6% increase in enrollment, while states that have not expanded report an average increase of 10%.
West Virginia: Medicaid Agency Settles Lawsuit, Will Implement Competitive Bidding
The Department of Health and Human Resources (DHHR) has agreed to use a competitive bidding process for the State's Medicaid program beginning in 2017, settling a lawsuit brought against DHHR and several other State agencies by five West Virginia residents. The change is expected to save the State's $1 billion Medicaid program approximately $100 million annually. The settlement also instructs the State's Medicaid managed care contracts not to exceed 48 months and to require a medical loss ratio of at least 85%, up from the current medical loss ratio of 70%-75%. DHHR's Deputy Secretary Jeremiah Samples said that the State agreed to the settlement to save West Virginia taxpayers further litigation expenses and to eliminate the uncertainty that the lawsuit had created for Medicaid patients and providers. West Virginia Medicaid currently contracts with four managed care companies.