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The Scoop: health insurance news – February 24, 2021

February 24, 2021

In this edition

  • Idaho is final state to open COVID-related enrollment window
  • Bills under consideration in California, Maryland would connect unemployment applicants with health coverage
  • DOJ asks Supreme Court to cancel hearing in Medicaid work requirement case
  • Virginia lawmakers head to conference committee over reinsurance funding
  • Iowa, Kentucky Houses approve bills limiting insulin cost-sharing; other states consider similar bills
  • South Dakota becomes fifth state to allow non-insurance Farm Bureau health plans
  • Oscar Health to become publicly traded company, with 31 million shares for sale next week
  • Senate committee hearings focus on HHS Secretary nominee Xavier Becerra

Idaho is final state to open COVID-related enrollment window

Before we delve into this week’s news, a reminder that enrollment is now open for 2021 individual/family health insurance in every state except Idaho – but Idaho’s enrollment period will start on Monday. Uninsured people have another opportunity to sign up for coverage, and in most states, people who already have coverage can use this window as an opportunity to switch to a different plan if it would better meet their needs.

The Biden administration and the states that run their own exchanges are also pouring a great deal of money into marketing and outreach during this period, in an effort to reach the millions of uninsured Americans who don’t yet know about the coverage and financial assistance available to them via the marketplace or Medicaid. In most states, the enrollment window continues through May 15, but there are several states with different deadlines.

Bills under consideration in Maryland, California would connect unemployment applicants with health coverage

California S.B. 644, introduced last week, would help to connect unemployed California residents with health coverage resources, starting in July 2022. Under the terms of the legislation, the California Employment Development Department (EDD) would provide Covered California (the state-run exchange) with contact information for people who apply for programs administered by the EDD, including unemployment benefits, state disability, paid family leave, etc. Covered California would then reach out to these individuals, determine whether they’re eligible for Medi-Cal or premium subsidies, and help them get enrolled in coverage if they choose to do so.

In Maryland, a similar bill (H.B. 1002) would allow people seeking unemployment benefits to consent to having their contact information and other relevant information shared with Maryland Health Connection (the state-run exchange) and the Maryland Department of Health. These agencies could then determine whether the resident would be eligible for financial assistance with their health insurance, and help them enroll in coverage. Maryland already has an “easy enrollment” program that connects residents with the health insurance exchange via their tax returns; H.B.1002 would expand the outreach to include people dealing with the loss of a job.

DOJ asks Supreme Court to cancel hearing in Medicaid work requirement case

On Monday, the Department of Justice asked the Supreme Court to scrap the oral arguments that are scheduled to be heard next month in a case to determine the legality of Medicaid work requirements. The case focuses on the work requirements in Arkansas and New Hampshire, but it would have ramifications for work requirements that the Trump administration approved in several other states as well.

Work requirements are not currently in effect in any state, and would not be compatible with the current rules that allow states to receive additional COVID-related federal Medicaid funding, on the condition that enrollees’ coverage not be terminated during the pandemic emergency period. But some states, including Arkansas, hope to eventually reimpose a Medicaid work requirement.

The Biden administration notified states earlier this month that the Medicaid work requirements that were approved over the last few years are now being reconsidered. Arkansas, which had the previous administration’s support in the work requirement lawsuit, filed a brief asking the Supreme Court to ignore the Department of Justice’s request and continue with the scheduled oral arguments next month. But Arkansas officials have also said that they will not seek reapproval for the work requirement when the current waiver expires at the end of this year, and are instead considering a work incentive program that would provide private coverage to people who participate in the program, and traditional Medicaid to those who don’t.

Virginia lawmakers head to conference committee over reinsurance funding

Virginia lawmakers have been working on a bill to create a reinsurance program in the state. But as has been the case in some other states that have considered reinsurance programs, there’s disagreement over how to cover the state’s portion of the funding.

The measure passed by Virginia’s House of Delegates earlier this month called for an assessment on individual/family and large group health plans in the state (but not small-group plans), set at 1% of the prior year’s premium revenue. But the Senate has proposed funding the state’s share of the reinsurance program – estimated at $40 to $60 million – from general fund revenues, without the need for an assessment on health insurers.

The two chambers are taking the measure into a conference committee, and have until March 1 to come to an agreement. Assuming they do reach an agreement, the reinsurance program is slated to take effect in 2023 – but it’s possible that the conference committee could work out an arrangement that allows it to take effect in 2022 instead. (Most other states that have established reinsurance programs have had them up and running by the plan year immediately following the enactment of legislation to start the program.)

Iowa, Kentucky Houses approve bills limiting insulin cost-sharing; other states consider similar bills

Yesterday, Kentucky’s House of Representatives voted unanimously to pass H.B. 95, which would require state-regulated health plans to cap cost-sharing for insulin at $30/month, starting in 2022. The measure now heads to Kentucky’s Senate for further consideration. A similar bill – but with a cost-sharing limit of $100/month – passed in Iowa’s House of Representatives earlier this month.

A bill that would cap insulin cost-sharing at $50/month was introduced in California’s Senate last week. And although Illinois was one of the states that enacted legislation last year to cap insulin cost-sharing at $100/month, a new bill was introduced in the Illinois House last week that would lower that cap to $30/month. West Virginia also enacted a $100/month cap last year, but a new bill was introduced this month in West Virginia’s Senate that would lower the cap to $25/month.

In 2019, Colorado became the first state to enact legislation to limit cost-sharing for insulin. Several other states enacted similar legislation last year, and several more had already begun considering bills to limit cost-sharing for insulin earlier this year.

South Dakota becomes fifth state to allow non-insurance Farm Bureau health plans

South Dakota Gov. Kristi Noem signed a bill last week that will allow the South Dakota Farm Bureau to offer health plans that will not be considered health insurance, and that will be specifically exempt from state and federal insurance laws and regulations. Tennessee, Kansas, Iowa, and Indiana already allow this type of plan to be sold.

South Dakota Farm Bureau noted that its plans to partner with a third-party administrator to offer the new plans. SDFB does intend to cover the Affordable Care Act’s essential health benefits, but it’s expected that that plan will use medical underwriting as a mechanism to keep costs down.

Oscar Health to become publicly traded company, with 31 million shares for sale next week

Oscar Health has filed to become a publicly traded company, with stock sales expected to begin next week. Oscar plans to offer 31 million shares, priced at $32 – $34 per share, potentially raising a billion dollars in the initial public offering. Shares will trade on the NY Stock Exchange under the ticker symbol OSCR.

Oscar offers health plans in 18 states this year. They have more than half a million members, most of whom are enrolled in individual/family plans obtained via the health insurance marketplaces. Although most insurers in the individual market struggled with losses in the early years of ACA implementation, many of them have since become profitable. But Oscar’s losses have continued to mount, despite steady expansion into new states and expansion into the Medicare Advantage market last year.

Senate committee hearings focus on HHS Secretary nominee Xavier Becerra

The Senate Health Committee held a hearing yesterday with California Attorney General Xavier Becerra, President Biden’s nominee to lead the Department of Health and Human Services. Another hearing takes place today, with the Senate Committee on Finance. The committees will then make a recommendation to the rest of the Senate, and the nomination will be sent to the full Senate for debate and a confirmation vote. If Becerra is confirmed, he would be the first Latino Secretary of Health and Human Services.

Becerra was previously in the U.S. House of Representatives from 1993 to 2017. He voted for the Affordable Care Act in 2009/10 and then voted to protect it numerous times over the ensuing years. Becerra became California’s Attorney General in 2017, taking over from Kamala Harris when she was elected to the Senate. He led numerous legal battles against the Trump administration, and some Senate Republicans have expressed opposition to his nomination.

Democrats and the White House have expressed confidence that Becerra will be confirmed. With the 50-50 split in the Senate, Becerra could be confirmed on a party-line vote, with Vice President Kamala Harris casting the tie-breaking vote. But moderate West Virginia Democrat Joe Manchin has indicated that he’s undecided on Becerra’s nomination. There are, however, moderate Republicans who may support Becerra’s confirmation.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

The post The Scoop: health insurance news – February 24, 2021 appeared first on healthinsurance.org.

https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance.png 512 512 wpmaddoxins https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.png wpmaddoxins2021-02-24 13:17:252021-02-24 14:05:59The Scoop: health insurance news – February 24, 2021

The Scoop: health insurance news – February 17, 2021

February 17, 2021

In this edition

  • COVID-related enrollment window starts in most states
  • CMS notifies states that Medicaid work requirements are being reconsidered
  • South Dakota legislature passes bill to allow sale of Farm Bureau plans
  • Kansas Senate legislation would allow short-term health plans in Kansas to follow federal rules
  • Aetna plans to rejoin exchanges for 2022
  • Washington state Senate approves legislation to ensure coverage of gender-affirming healthcare
  • Rhode Island legislation would create commission to consider single-payer health program
  • Medicaid buy-in legislation introduced in West Virginia

COVID-related enrollment window starts in most states

Although open enrollment ended two months ago in most of the country, a new one-time enrollment opportunity is available for 2021 coverage. Uninsured Americans nationwide have access to this enrollment window, and in most states, it can also be used by people who want to pick a different plan or switch from off-exchange to on-exchange coverage.

This enrollment window – a response to the ongoing COVID emergency – is now underway nationwide, with the exception of Idaho, which announced on Monday that a special enrollment period would begin March 1. In almost every state, the enrollment period continues through May 15, although there are seven state-run exchanges that have – for now – different end dates:

  • Connecticut – through March 15
  • Washington, DC – through the end of the pandemic emergency period
  • Idaho – March 1 to March 31
  • Massachusetts – through May 23
  • Minnesota – through May 17
  • New York – through March 31
  • Vermont – February 16 to May 14

If you’re not yet enrolled in health coverage for 2021, or if you’re enrolled in something like a short-term plan, Farm Bureau plan, or health care sharing ministry plan, this enrollment window – which does not require a qualifying event – is an opportunity to secure real health insurance coverage for the rest of the year.

And keep an eye on the COVID relief legislation that Congress is considering. It could end up providing enrollees with much larger and more widely available premium subsidies, making it particularly important that people get enrolled in on-exchange coverage before the end of this enrollment window.

CMS notifies states that Medicaid work requirements are being reconsidered

Last week, the Biden administration began notifying states with approved Medicaid work requirements that CMS is considering withdrawing the approval for these programs. The letters were sent to Arizona, Arkansas, Georgia, Indiana, Nebraska, New Hampshire, Ohio, South Carolina, Utah, and Wisconsin, and clarify that CMS “has preliminarily determined that allowing work and other community engagement requirements to take effect … would not promote the objectives of the Medicaid program.”

There are currently no Medicaid work requirements in effect. Some have been overturned by the courts, some have been postponed voluntarily by the states, and others have been suspended or postponed due to the COVID pandemic and the ban on coverage terminations that states are required to adhere to in order to receive enhanced federal Medicaid funding during the pandemic. The Supreme Court will hear oral arguments next month in Arkansas v. Gresham, to determine whether the Trump administration’s approval of a Medicaid work requirement in Arkansas was lawful.

CMS also sent a letter (see Michigan’s here) last week to states that currently operate 1115 waivers, rescinding a previous letter that former CMS Administrator Seema Verma sent to states in early January. Verma’s letter had stated that if CMS were to terminate or withdraw approval for part or all of a state’s 1115 waiver, there would be a nine-month delay before the changes took effect.

South Dakota legislature passes bill to allow sale of Farm Bureau plans

Last week, we told you about a bill in South Dakota that would allow the state to join Tennessee, Kansas, Iowa, and Indiana in allowing Farm Bureau (or other agricultural organizations domiciled in the state for at least 25 years) to sell medically underwritten health plans that would specifically not be considered health insurance and thus would be exempt from insurance laws and regulations, including state laws as well as the Affordable Care Act’s rules.

The bill had already passed the Senate at that point, and has since passed in the South Dakota House as well. It’s now under consideration by GOP Gov. Kristi Noem, who consistently voted against the Affordable Care Act during her time in Congress.

There are other states where Farm Bureau partners with health insurers to offer ACA-compliant health insurance (Michigan is an example), and the Nebraska Farm Bureau partners with Medica to offer guaranteed-issue short-term health insurance during a limited annual enrollment period. But these approaches are not the same as allowing an agricultural organization to offer products that are specifically not considered health insurance.

Kansas Senate legislation would allow short-term health plans in Kansas to follow federal rules

Kansas is one of the states where the rules for short-term health plans are more restrictive than the current federal rules. But S.B. 199, introduced last week in the Kansas Senate, would change that. Kansas currently limits short-term health plans to a single renewal, which means their total duration cannot exceed 24 months. S.B. 199 would allow short-term health plans in Kansas to have total durations of up to 36 months – in line with current federal rules. The Biden administration may roll back the Trump-era rules for short-term plans, however, which would eventually make more relaxed state rules moot.

Aetna plans to rejoin exchanges for 2022

CVS Health/Aetna plans to offer health coverage in at least some health insurance exchanges during the open enrollment period that starts this November, although the insurer has not yet provided details in terms of where it will participate. Aetna had previously offered coverage in some exchanges, but had exited all of them by the end of 2017, and has not participated since. CVS/Aetna opting back into the exchanges would continue the trend that has been ongoing in 2019, 2020, and 2021, with insurers joining or rejoining the exchanges, after numerous insurers – including Aetna – left the exchanges in 2017 and 2018.

Aetna’s previous exit from the health insurance exchanges happened before the company was acquired by CVS. But the exit was controversial, and linked to the Department of Justice’s decision to block a merger between Humana and Aetna. Here’s what David Anderson wrote about this in 2016, and Charles Gaba has put together a timeline of Aetna’s 2016 decision-making process.

Washington state Senate committee approves legislation to ensure coverage of gender-affirming healthcare

Washington state lawmakers are considering S.B. 5313, which would require state-regulated health plans to provide non-discriminatory coverage for medically necessary gender-affirming care. Insurers would not, for example, be able to deny coverage for services needed by transgender members, such as facial feminization, breast reductions, breast implants, etc. by classifying them as cosmetic procedures.

The bill was overwhelmingly approved last week by the Washington Senate’s Committee on Health and Long Term Care.

Rhode Island legislation would create commission to consider single-payer health program

Legislation was introduced in Rhode Island last week that calls for the creation of a special legislative committee tasked with “a comprehensive study to determine the pros and cons of implementing a single-payer (health coverage) program in Rhode Island.” The legislation notes that an “improved Medicare-for-all type single-payer program” would be in the state’s best interest. There are not currently any states that have single-payer health coverage systems, although there are others that are considering similar studies.

Medicaid buy-in legislation introduced in West Virginia

Legislation has been introduced in several states this year that would create Medicaid buy-in programs. With the introduction of H.B. 2241, West Virginia is the latest state where lawmakers are considering this possibility. The idea is to create a public option program by allowing residents – who would not otherwise be eligible for Medicaid – to purchase Medicaid coverage as an alternative to purchasing private health insurance. There are not yet any states where Medicaid buy-in programs have been enacted; Nevada has come the closest, but the Medicaid buy-in legislation that lawmakers passed in 2017 was vetoed by Nevada’s governor.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

The post The Scoop: health insurance news – February 17, 2021 appeared first on healthinsurance.org.

https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance.png 512 512 wpmaddoxins https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.png wpmaddoxins2021-02-17 12:04:482021-02-17 14:15:34The Scoop: health insurance news – February 17, 2021

The Scoop: health insurance news – January 20, 2021

January 20, 2021

In this edition

  • President Biden’s American Recovery Plan calls for additional premium subsidies and COBRA subsidies
  • Open enrollment for 2021 coverage ends Saturday in Massachusetts and Rhode Island
  • Partial 2022 health insurance rules finalized by outgoing Trump administration
  • Lawsuit filed to block Georgia’s plan to eliminate its health insurance exchange
  • Bills introduced in Virginia to eliminate current ban on abortion coverage on marketplace plans, and study infertility coverage mandate
  • Legislation introduced in Maryland and Rhode Island to create universal health care commissions
  • Legislation introduced in Missouri calls for a Medicaid work requirement as of 2022
  • Uncompensated care funding in Florida and Texas extended through 2030

President Biden’s American Recovery Plan calls for additional premium subsidies and COBRA subsidies

Newly inaugurated President Joe Biden outlined his American Recovery Plan last week, and it includes some important provisions aimed at improving access to health coverage. The wide-ranging $1.9 trillion proposal, which would have to be approved by Congress, calls for premium tax credits to be increased “to lower or eliminate health insurance premiums” and to cap any enrollee’s after-subsidy premium at no more than 8.5 percent of their income. This second provision would primarily help people with income near or a little above 400 percent of the poverty level, and could make a substantial difference in the affordability of coverage for some households that currently have to pay full-price for their coverage — sometimes amounting to well over a quarter of their income.

The plan also calls for government subsidies of COBRA premiums through the end of September 2021. In 2009, the American Recovery and Reinvestment Act provided COBRA subsidies, which could serve as a model for how a new round of COBRA subsidies might work.

Biden’s American Recovery Plan encompasses far more than just health coverage. But if you’re curious about how health care reform might proceed under the new administration and the new Congress, check out this two-part series from Andrew Sprung, this piece from Charles Gaba, and this piece from Katie Keith.

Open enrollment ends Saturday in Massachusetts and Rhode Island

Open enrollment for 2021 health coverage is still ongoing in five states and Washington, DC (plus a COVID-related special enrollment period for uninsured residents in Maryland). But the enrollment window ends this Saturday, January 23, in Massachusetts and Rhode Island. After Saturday, residents in those states will need a qualifying event in order to enroll or make changes to their 2021 coverage.

As of this week, confirmed marketplace enrollment totals for 2021 coverage have surpassed 11.6 million nationwide.

Partial 2022 health insurance rules finalized by outgoing Trump administration

Last fall, the Trump administration published the proposed Notice of Benefit and Payment Parameters for 2022. This annual rulemaking document is wide-ranging and typically addresses a variety of issues related to the health insurance exchanges, special enrollment periods, risk adjustment, etc. At the time, we summarized several of the proposed rule changes that were most likely to directly affect people with individual market health plans.

Last week, the Trump administration announced that it was finalizing some aspects of the proposal — including the most controversial ones — but that the rest of the proposed rule changes would be finalized in an additional rule that will be issued “at a later date.” That will be under the Biden administration, which is also likely to delay the rule the Trump administration finalized last week (currently slated to take effect March 15) and reissue a new proposed rule, with a new comment period.

A total of 542 comments were submitted to CMS regarding the proposed rule changes for 2022. The comments that pertain to the rule changes that CMS finalized last week are summarized in the final rule, along with the responses from CMS. Notably:

  • Although CMS noted that “nearly all commenters on this rulemaking cautioned about potential harmful impacts to consumers” of allowing states to abandon their exchanges and rely entirely on brokers, agents, and insurers for health plan enrollment, the proposed rule change that would allow this was finalized. There would still be a role for an official exchange website in states that choose this option, but it would be minimal. And there are ongoing concerns that a switch to relying on brokers, agents, and insurers, instead of exchanges, will make it harder for Medicaid-eligible enrollees to understand the assistance and coverage that’s available to them.
  • The Trump administration’s 2018 guidance on 1332 waivers, which sharply relaxed the “guardrails” that apply to these waivers, is being officially incorporated into federal regulations.
  • The fee that insurers pay HealthCare.gov (and pass on to consumers via premiums) will be reduced in 2022. In states that rely fully on HealthCare.gov, it will be 2.25 percent of premiums; in states that run their own exchanges but use HealthCare.gov for enrollment, it will be 1.75 percent of premiums (down from a current 3 percent and 2.5 percent, respectively).

Many of the proposed rule changes are still under consideration and were not finalized last week, including the premium adjustment percentage (which would affect maximum out-of-pocket amounts and the affordability threshold for catastrophic plan eligibility), special enrollment periods when employer COBRA subsidies cease or a person loses eligibility for premium subsidies, and a rule change that would permanently allow insurers to issue MLR rebates earlier in the year.

At Health Affairs, Katie Keith has an excellent in-depth analysis of the partial final rule.

Lawsuit filed to block Georgia’s plan to eliminate its health insurance exchange

Last fall, the Trump administration approved Georgia’s 1332 waiver proposal to transition away from HealthCare.gov and instead utilize a system that relies on brokers, agents, and insurers to get people enrolled, without a centralized exchange (the finalized rule change that allows a similar approach nationwide is very reminiscent of Georgia’s 1332 waiver).

Last week, Planned Parenthood Southeast and Feminist Women’s Health Center filed a lawsuit against HHS, CMS, the Department of the Treasury, and their respective leaders, alleging that the waiver was unlawfully approved and should be vacated. Democracy Forward, which is representing the plaintiffs in the case, explained that Georgia’s 1332 waiver “will do immense damage to Georgia’s health insurance market, force Georgians to shop for insurance through private brokers and insurance companies, lead more residents to enroll in junk plans, and increase premiums.”

Bills introduced in Virginia to eliminate state ban on abortion coverage under marketplace plans; study impact of mandating coverage for infertility

Virginia is one of 26 states where health insurance plans sold in the marketplace/exchange are not allowed to provide coverage for abortions. (Virginia’s ban includes exceptions for abortion coverage in cases of rape, incest, or the mother’s life being in danger.) Legislation was introduced last week in Virginia’s Senate that would eliminate this ban, allowing insurers to offer abortion coverage if they choose to do so.

Legislation has also been introduced in Virginia that would direct the Virginia Health Insurance Reform Commission to conduct a study on the impacts of requiring health insurance plans in the state to cover infertility treatment. There are currently 19 states that mandate at least some coverage for infertility treatment.

Legislation introduced in Maryland and Rhode Island to create universal healthcare commissions

Legislation was introduced in Maryland last week that calls for the state to create a Commission on Universal Health Care. The Commission would be tasked with developing a plan for the state to establish a single-payer universal coverage system by 2024.

Legislation was also introduced in Rhode Island last week that calls for the creation of a special legislative commission that would study how the state might go about implementing a single-payer Medicare-for-All type of health coverage program in Rhode Island.

Legislation introduced in Missouri to create a Medicaid work requirement

Missouri has not yet expanded Medicaid eligibility under the ACA, but that will change this summer, thanks to a ballot initiative that voters in the state passed last year. Legislation was introduced this month in Missouri’s Senate that calls for a Medicaid work requirement in the state, effective as of January 2022. Under the terms of the bill, non-exempt Medicaid enrollees would have to work (or participate in various other community engagement activities, including volunteering, school, job training, etc.) at least 80 hours per week in order to maintain eligibility for Medicaid.

The Trump administration approved numerous work requirement waivers over the last few years, but due to lawsuits and the COVID pandemic, none are currently in effect. And the Biden administration is very unlikely to approve any additional waivers, meaning that Missouri’s legislation is likely a non-starter for the time being, even if it’s enacted.

Uncompensated care funding in Florida and Texas extended through 2030

Last Friday, the Trump administration renewed 1115 waivers in Texas and Florida, both of which are now valid through mid-2030. These waivers are for Medicaid managed care, and also provide federal funding for uncompensated care – which is more of a problem in states like Texas and Florida, due to their failure to expand Medicaid and the resulting coverage gap for low-income residents.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

The post The Scoop: health insurance news – January 20, 2021 appeared first on healthinsurance.org.

https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance.png 512 512 wpmaddoxins https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.png wpmaddoxins2021-01-20 12:58:272021-01-20 14:26:31The Scoop: health insurance news – January 20, 2021

The Scoop: health insurance news – December 9, 2020

December 9, 2020

In this edition

  • In most states, open enrollment ends in six days
  • Biden selects California AG, ACA defender, to lead HHS
  • SCOTUS will hear arguments on the legality of Medicaid work requirements
  • Trump administration’s public charge rule changes blocked in DC and 18 states
  • California lawmakers introduce bills to provide Medicaid to undocumented immigrants
  • Massachusetts attorney general sues insurer for misleading consumers

In most states, open enrollment ends in six days

Open enrollment for individual health plans is drawing to a close in most of the country. The deadline has been extended in 10 states and Washington, DC (although in most of those states, people still have to enroll by December 15 to have coverage that starts on January 1). But in the rest of the country, December 15 is the last day to enroll in an individual/family health plan for 2021. This is true regardless of whether you’re shopping in the exchange/marketplace or outside the exchange.

open enrollment 2021

Our 2021 Open Enrollment Guide: Everything you need to know to enroll in an affordable individual-market health plan.

A handful of states – Connecticut, Idaho, Maryland, and Vermont – run their own exchange platforms (and thus have the option to extend open enrollment) but have thus-far opted to keep the December 15 enrollment deadline for people buying 2021 plans. Any of those four states could still issue an extension, and we’ll update our deadlines page and our open enrollment guide if they decide to do so.

In the rest of the country, an extended deadline is only possible if the federal government agrees to allow it via HealthCare.gov. Some states have specifically asked for this, but HHS has not yet given any indication that they plan to offer an extension.

CMS announced last Thursday that a total of 2.9 million people had enrolled in 2021 coverage through HealthCare.gov during the first four weeks of open enrollment (through November 28), which is still trending higher than last year’s enrollment numbers. That accounts for 36 states; the other 14 states and Washington, DC, have their own enrollment platforms, and some of them have not yet publicized their enrollment data. But as of late November/early December, there were about 4 million confirmed enrollments nationwide – plus the enrollments in states that haven’t yet reported any data.

Biden selects California attorney general, ACA defender, to lead HHS

President-elect Joe Biden has chosen California Attorney General Xavier Becerra to be the secretary of Health and Human Services (a position currently held by Alex Azar). Becerra has spent years defending the Affordable Care Act from judicial attacks and pushing back against various health care measures implemented by the Trump administration.

California, led by Becerra’s office, has been the lead state in defense of the ACA in the California v. Texas (formerly Texas v. U.S.) lawsuit, which was argued at the Supreme Court last month.

The Kaiser Family Foundation has put together an extensive list of administrative changes the Biden administration can make in terms of healthcare reform. Assuming Becerra is confirmed by the Senate, we can expect that he’ll be leading the effort to implement many of those changes.

SCOTUS will hear arguments on legality of Medicaid work requirements

Last Friday, the Supreme Court agreed to take two cases (which are being combined) that are centered around the legality of Medicaid work requirements, with oral arguments expected to be set for late winter or early spring next year. These cases focus on the Medicaid work requirements that the Trump administration approved for New Hampshire and Arkansas, which were subsequently overturned by a federal judge.

Although work requirements have been approved in several states, none are currently in effect, due to a combination of court rulings and the COVID-19 pandemic. The Biden administration is unlikely to approve any of the pending work requirement waiver proposals, and could eventually rescind already-approved waivers, including the ones at the heart of the cases the Supreme Court has agreed to hear.

But the Court is the most conservative it’s been in several generations; if it rules that Medicaid work requirements are legal, that could come into play once a Republication administration is again in the White House.

Trump administration’s public charge rule changes blocked in DC and 18 states

There has been a lot of back and forth on the Trump administration’s changes to the “public charge” rule in recent weeks. Last month, the administration’s changes to the public charge rule were briefly vacated, nationwide, by a federal judge, but an appeals court stayed that decision just two days later, allowing the rule changes to continue to be implemented.

Then last week, the Ninth Circuit Court of Appeals blocked the implementation, but only in 18 states and Washington, DC. In the rest of the country, the Trump administration’s changes to the public charge rule – which adds Medicaid (and several other low-income assistance programs) to the list of benefits that can classify a person as a “public charge” – can continue to be implemented while additional lawsuits proceed in the court system.

California lawmakers introduce bills to provide Medicaid to undocumented immigrants

California already provides Medicaid (Medi-Cal) coverage, regardless of immigration status, to low-income residents under the age of 26. But as the 2021 legislative session got underway in the state this week, a pair of bills were introduced that would extend Medi-Cal eligibility to more low-income adults, regardless of their immigration status.

Senate Bill 56 would allow people age 65 or older to enroll in Medi-Cal if they meet the rest of the eligibility requirements other than immigration status. Assembly Bill 4 would go further, granting Medi-Cal benefits to any California resident, of any age, who would otherwise be eligible except for their immigration status.

The lawmakers who sponsored these bills noted that the COVID pandemic has been particularly brutal for undocumented immigrants – many of whom work in jobs that don’t allow for social distancing and that are essential for keeping the economy and food supply on track. They point out that providing health coverage for these essential workers is the right thing to do, especially given the state’s budget surplus.

Massachusetts AG sues insurer for misleading consumers

Massachusetts Attorney General Maura Healey announced this week that her office is suing HealthMarkets and two of its subsidiaries for misleading consumers. The lawsuit alleges that the insurers’ recent deceptive marketing practices are in violation of state laws, but also in violation also a court order from 2009, when HealthMarkets and two different subsidiaries had to pay more than $15 million after engaging in similar deceptive practices.

Healey’s office noted an extensive list of violations that stem from the companies’ efforts to essentially trick people into buying “supplemental health insurance products of very limited value” when the consumer wanted or needed major medical coverage instead. According to the lawsuit, more than 15,000 Massachusetts residents have been affected since 2011, and the companies have collected more than $43.5 million in premiums for the low-quality plans, while spending less than 20 percent of revenue on members’ claims.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

The post The Scoop: health insurance news – December 9, 2020 appeared first on healthinsurance.org.

https://www.maddoxinsured.com/wp-content/uploads/2021/01/open-enrollment-2021-400x203-1.jpg 203 400 wpmaddoxins https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.png wpmaddoxins2020-12-09 06:36:092021-01-22 14:19:44The Scoop: health insurance news – December 9, 2020

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