The growth of Medicaid Managed Care Organizations (MCOs) in the United States

Enrollment in Medicaid and Managed Care Organization (MCO) plans in the United States has reached an all-time high of 74 million recipients. According to Health Affairs, “an estimated 71 percent of Medicaid recipients are receiving their care via private health plans, both investor-owned and nonprofit.” In 2016, research behind the shift showed that managed care plans can provide services that state Medicaid agencies cannot fulfill. For example, network contracting, information technology, and use of management systems to display low-value care can vastly improve the health of beneficiaries. 

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New Jersey becomes second state to institute an individual mandate for health coverage

Shortly after announcing that the state will manage its own health insurance exchange for the 2019 Open Enrollment, New Jersey Governor Phil Murphy signed into law a bill enacting an individual mandate.

The bill, signed yesterday, requires all New Jersey residents to have health insurance coverage or pay a penalty. Democratic lawmakers drafted the bill in response to Congress’ decision to appeal the federal mandate established in the Affordable Care Act.

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The single risk pool at risk

The Affordable Care Act’s coverage expansions in the individual and small group markets were based on a key idea—as of 2014, all who had coverage in the individual market would be part of single, state- and insurer-wide, risk pools, with separate small group single risk pools.  Indeed, the risk adjustment program would spread risk among all insurers in the individual and small group markets creating, in a sense, a single statewide risk pool in each market. The individual responsibility requirement would drive individuals into the market, while premium tax credits for moderate income individuals would pull them in.  The healthy would help cover the costs of the sick, and all would find affordable premiums.

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Connecticut: Another State to make mid-year rate reductions

On January 22nd H.R 195 was signed into law, suspending the collection of health insurance provider fees in the 2019 calendar year. The bill was originally introduced on January 3, 2017 to resolve differences throughout the year from House actions and Senate actions. From this new law, States were mandated to pass on requirements for each health insurance Issuers within their state to submit updates to rates.  

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Enhanced direct enrollment eliminates ‘double redirect’, establishes new policy management strategy

In June 2018, the Federally-Facilitated-Marketplace (FFM) is expected to launch new technology known as Enhanced Direct Enrollment (EDE) – which will allow consumers and agent/brokers to shop, enroll, and manage policy changes to Marketplace health products, without ever having to create an application on Healthcare.gov or contact Marketplace Customer Service. 

EDE is a unified enrollment experience that contains an updated, easy-to-use, portal for Marketplace members. EDE will eliminate the current “double redirect” to HealthCare.gov, using a series of CMS-based APIs to process eligibility and changes behind the scenes. This new portal will allow issuers and agent/brokers to establish and maintain relationships with members from initial enrollment, through mid-year changes, and into renewal. The goal of EDE is to provide consumers and health insurance brokers with alternatives to shop for and enroll in coverage, providing the data and tools needed to effectuate and maintain policies.  

In our new whitepaper former Executive Director for Aetna’s Exchange program and Founder, JGood Advisors, Jane Good discusses Enhanced Direct Enrollment (EDE) and this new policy strategy.

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New York SHOP program removes online enrollment & premium billing

Starting this month, NY State of Health (NYSOH) made several changes to the state’s SHOP program in an effort to give the federal tax credit to as many small businesses as possible.   

In New York, 98% of businesses have fewer than 100 employees and over 40% of the workforce is employed in these small businesses. The recent changes impacting these businesses were allowed through the November 2017 rule that allows small employers to enroll directly through issuers and brokers and still receive the small business tax credits.  

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States look to protect brokers on Healthcare.gov from commission cuts

Georgia legislation passed a bill that will create guidelines for insurance carriers to pay commission to brokers. House Bill 64 states: 

  • A carrier that issues a benefit plan in this state will pay a commission consistent with the amount proposed in the rates filed with the department 
  • No compensation is required for any individual health plan sold during a Special Enrollment Period (SEP) 

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Iowa Governor signs bill allowing non-ACA health plans

Iowa’s Republican Gov. Kimberly Reynolds signed a state law Monday that lets some insurers skirt Obamacare regulations. The law would let the Iowa Farm Bureau and Wellmark Blue Cross Blue Shield sell health plans to the farm bureau’s members that ignore the mandates. 

The mandates require insurers to cover essential health benefits such as maternity care or hospitalization and prevents insurers from charging sick people higher prices. Gov. Reynolds said the state’s market is collapsing because of the high cost of Obamacare, with many citizens choosing to go without insurance because the law is pricing them out of the market. 

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Iowa gov. expected to sign off on legislation allowing some health plans to avoid Affordable Care Act mandates

This week, Iowa senators approved controversial legislation that would make certain health plans exempt from Affordable Care Act mandates. If signed into law, the bill would have a significant impact on the way many Iowans receive health coverage.

The legislation, approved in a 37-11 vote, combines two proposals that would do the following:

  • Allow the Iowa Farm Bureau Federation to partner with Wellmark Blue Cross/Blue Shield to offer an association health plan to qualifying participants
  • Allow multiple small businesses to band together to provide health coverage for their employees under plans that would not be regulated by the state insurance commissioner or subject to ACA rules and regulations.

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