Health Plan Weekly

In comments submitted to CMS about two new proposals aimed at improving the Medicaid program, health insurers and their lobbying groups told the agency in no uncertain terms that implementing the regulations could require more resources than health plans currently have — especially since they’re also trying to navigate the recently resumed Medicaid redetermination process. 

The regulations in question are both notices of proposed rulemaking (NPRM) that CMS introduced in May — the “Medicaid and Children's Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality” NPRM, and the “Ensuring Access to Medicaid Services” NPRM. Together, the two proposals represent the first significant regulatory update to Medicaid managed care since 2020. 

Executives from a health plan and hospital say that payer-provider alignment and value-based payment have existential stakes — if independent, regional-scale payers and providers can’t find a way to work together through joint ventures and new payment models, they say, national firms’ acquisitions of small payers and providers will accelerate. 

That’s according to Greg Sweat, M.D., a senior vice president and chief health officer at Blue Cross and Blue Shield of Kansas City (Blue KC), and Stephen L. Reintjes, Sr., M.D., president and CEO of North Kanas City Hospital, who spoke during a June 13 session of the 2023 AHIP Conference in Portland, Oregon.  

Here’s how major health insurers’ stock performed in June 2023. UnitedHealth Group had the highest closing stock price among major commercial insurers as of June 30, 2023, at $480.64. Humana Inc. had the highest closing stock price among major Medicare insurers at $447.13.

CMS on July 7 unveiled a long-awaited regulation that would crack down on short-term, limited-duration insurance (STLDI), which some consumer advocates — and the Biden administration — refer to as “junk plans.” Designed to fill a temporary gap in insurance coverage, STLDI plans are exempt from the Affordable Care Act’s rules for comprehensive coverage, allowing them, for example, to deny coverage for preexisting conditions and set lifetime and annual dollar limits on coverage. The Obama administration capped the duration of such plans at three months and limited their renewability, but a 2018 rule from the Trump administration allowed STLDI plans to cover individuals for up to 364 days and be renewed for up to 36 months. If finalized, the Biden administration’s notice of proposed rulemaking would return to the Obama-era three-month limit for SLTDI plans’ initial contract period, and it would set the maximum coverage period at four months, taking into account any renewals or extensions.  

Friday Health Plans Management Services Company, Inc. is in the death throes of its life as an Affordable Care Act exchange insurer — regulators are stepping in to take over its operations, and it’s laying off all employees in its home state of Colorado. Meanwhile, Bright Health Group, Inc., which has already exited every ACA exchange in which it operated, reached a deal to sell its California Medicare Advantage plans to Molina Healthcare, Inc. in order to satisfy Bright’s creditors. 

Experts tell AIS Health, a division of MMIT, that both insurers largely followed the same playbook: raising massive amounts of funding from venture capital (VC) investors and promising to delight customers with tech-driven, differentiated products. But those big plans fell apart when faced with the realities of an industry that is especially challenging to disrupt, and then capital infusions dried up when interest rates rose.