…(in addition to $4 million obtained from the company itself for submitting Medicaid claims for mental health services by unlicensed and unqualified staff). Preventing consolidation Finally, both federal and state regulators have the potential to better monitor, and when necessary stop PE-driven mergers and acquisitions activity in the health care space. Indeed, the Federal Trade Commission (FTC) was able to…
…Perspective for the State Health & Value Strategies project, CHIR’s Justin Giovannelli looks at the consequences of cutting commissions for special enrollment periods (SEP). Reducing or eliminating broker commissions for SEPs puts consumers at risk of coverage loss after the PHE, and may weaken the individual market risk pool. Additionally, this marketing practice likely violates federal nondiscrimination rules. States should…
…young adults (ages 19-34) would experience the largest coverage losses should the PTCs expire, estimating a 1.5 million or 14.1 percent increase in the number of uninsured young adults relative to extending the PTCs. Researchers find that non-Hispanic Black populations will also be disproportionately harmed by the PTCs expiring, potentially facing a 17.7 percent increase in the uninsured population. While…
…like issuing cease and desist orders for Salvasen/Triada to stop the sale of their plans. Takeaway Salvasen Health will not be the first or last company to target vulnerable consumers with false claims that they are selling comprehensive health insurance. The multi-state effort to uncover Salvasen as an unlicensed actor and exert pressure to get these products removed from the…
…depend largely on marketplace officials. In a new post for the Commonwealth Fund’s To the Point blog, CHIR’s Sabrina Corlette and Maanasa Kona discuss the important role that ACA marketplaces will play in mitigating coverage losses. Their piece identifies basic as well as more innovative strategies marketplaces can adopt to help consumers make a smooth transition to affordable, comprehensive coverage….
…the pandemic, in exchange for enhanced federal funding. Separately, CHIR has highlighted states’ daunting task of processing redeterminations for an estimated 86 million people and limiting coverage losses. But Medicaid is not the only program affected by pandemic relief policies that expire at the end of the PHE. Additional policies mandate coverage of COVID-19 tests and related care, lower barriers…
…between early 2019 and early 2021. What it Finds The health insurance safety net, augmented by the Medicaid continuous coverage requirement in the Families First Coronavirus Response Act and the American Rescue Plan’s (ARP) temporary enhancements to marketplace subsidies, did its job of preventing “catastrophic coverage losses” during the pandemic. All three surveys showed statistically insignificant increases in the uninsurance…
…which they are working to overcome several challenges, including lack of lead time, workload and staffing challenges, lack of data, technology glitches, and market instability. Several states are pursuing innovative strategies to mitigate coverage loss and ease consumers’ transitions into alternative sources of coverage. You can read the full brief here. Medicaid and CHIP Eligibility and Enrollment Policies as of…
…also proposed giving SBMs greater flexibility on pre-enrollment verification for SEPs, and only requiring such verification on HealthCare.gov for the loss of minimum essential coverage (MEC) SEP. Comments on this proposal unanimously supported the additional flexibility for SBMs. Nevada suggested the “consumer friendly approach” CMS proposed will help prevent adverse selection by removing barriers to enrollment for young and healthy…
…incentives for insurers to select for risk and offer less generous benefits. In contrast, Molina offered its strong support. Medical Loss Ratio (MLR) Requirements CMS has found that insurers are abusing the MLR reporting mechanism by labeling bonus payments to providers as quality improvement activities. Insurers offered a variety of recommendations for CMS’ proposals to establish stricter accounting and reporting…
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