CMS restores Affordable Care Act risk-adjustment transfers for 2017 benefit year

Yesterday, the Centers for Medicare and Medicaid Services (CMS) released a final rule designed to allow and reissue payments under the Affordable Act risk-adjustment program to balance the insurance market. According to CMS Administrator Seema Verma, “This rule will restore operation of the risk adjustment program and mitigate some of the uncertainty caused by the New Mexico litigation.”  

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Overview of the CMS 2018 Enrollment Manual

On June 25, 2018, the Centers for Medicare and Medicaid Services (CMS) released its 2018 Enrollment Manual. The manual offers 15 key highlights relating to several processes including auto reenrollment and non-renewal, reports such as the Batch Auto-Reenrollment (BAR) Progress Report, as well as updates on Enhanced Direct Enrollment (EDE), Marketplace premiums, and Medicaid.

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The ACA’s vision of a reformed small-group market

Although the political controversy surrounding the Affordable Care Act has focused primarily on its extension of coverage through the individual market and Medicaid expansions, Congress also intended the ACA to reform extensively reform the small-group market. In the decade preceding the ACA, small-group health insurance premiums had more than doubled while the percentage of small firms offering coverage dropped from 66 to 59 percent. Administrative costs and employee cost sharing charges were high and benefits offered by some employers were skimpy. 

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NMHIX: New Mexico State Health Insurance Exchange 2018 and beyond

New Mexico (beWellNM) is one of only five states that operates a state-based marketplace on the federal platform, more commonly known as SBM-FP. While this platform has proven to be successful for the last 5 years, the state has recently started looking to revitalize its exchange.

On December 13, 2012, New Mexico submitted a technical implementation letter to CMS to become a state-based health insurance exchange and was approved by CMS on January 3, 2013 to begin to follow and comply with state-based regulations. In an effort to grow into the healthcare era, NMHIX Centennial Care, New Mexico requested an extension on its current 1115 waiver, which is set to expire by December 31, 2018. The waiver, which will renew the state’s Medicaid managed care program, was sent to CMS on December 6, 2017. CMS has acknowledged the letter and confirmed that New Mexico’s extension application has met the requirements.

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