Health Plan Weekly

  • California MCOs, Public Health Depts. Discover Benefits of Collaboration

    Data sharing and staff contacts are the keys to improving collaboration between Medicaid managed care organizations and public health departments, according to California officials and plan staffers. Leaders from managed care plans say that close collaboration improves outcomes for high-needs populations who struggle with one or more social barriers to health. 

    “When you're looking at claims data, we're obviously not going to see a claim for homelessness. We’re not going to be able to capture that. But when we take our data and bump it against data that's available to some of the public health jurisdictions, and we find out that some of our members are facing housing instability, then that also gives us the ability to understand that maybe their health outcomes are directly being affected by these social determinants of health,” said Nishtha Patel, manager of care transformation at Inland Empire Health Plan (IEHP), during a March 21 Manatt LLP webinar. “No matter what we do intervention-wise, if we're not addressing those, their health outcomes are not ever going to improve.”  

  • As ACA Exchanges Turn 10, New HHS Reports Show How Far They’ve Come

    Over the first 10 years of the Affordable Care Act marketplaces, enrollment nationwide has almost tripled, from 8 million individuals in 2014 to 21.4 million in 2024, according to an HHS report.

    While the ACA initially envisioned the marketplaces to be developed by states, it also provided states with the option to participate in the federally facilitated marketplace, In 2014, 14 states and the District of Columbia chose to operate their own state-based marketplaces (SBMs). In 2024, there are 19 SBMs.

  • News Briefs: CMS Finalizes 2025 ACA Exchange Plan Rule

    CMS on April 2 finalized the 2025 Notice of Benefit and Payment Parameters for Affordable Care Act exchange plans. The rule extended the special enrollment period for people with household incomes up to 150% of the federal poverty level to enroll in coverage any month during the year. CMS also attempted to prevent coverage gaps for people switching plans by allowing people to enroll on the first day of the month after they select a plan. In addition, the rule streamlined the process for enrollment on federally facilitated and state-based marketplaces. And beginning in 2027, it will allow states for the first time can add routine adult dental care as an essential health benefit. More than 21 million people enrolled in ACA exchange plans this year.  
  • No Surprises Act Arbitration Drives Up Health Care Prices, Report Says

    A new report by Brookings Institution researchers concludes that the No Surprises Act, the 2020 law that banned surprise medical billing, may cause prices — and consequently premiums — to increase, even though policymakers hoped the law would slow or reverse price growth. The report also concludes that a small group of providers, particularly physician staffing groups owned by private equity entities, are responsible for most of the price increases. 

    This unintended consequence raises the stakes of ongoing litigation between the Texas Medical Association (TMA) and the Biden administration. Those lawsuits challenge regulations governing the NSA-created, HHS-backed arbitration process, called Independent Dispute Resolution (IDR), which resolves balance billing disputes between payers and providers when patients unintentionally receive out-of-network care. The TMA and other provider groups have successfully sued multiple times to block IDR rulemaking that many experts believe would have kept price growth in check. 

  • Health Plans Welcome CMS Moves to Curtail Medicaid Coverage Losses

    As it marked the 14th anniversary of the Affordable Care Act, the Biden administration in recent days announced several new steps that aim to build on the Medicaid coverage gains achieved by the ACA — and reduce the coverage losses due to Medicaid redeterminations.  

    On March 27, CMS finalized a rule that aims to streamline eligibility and enrollment processes for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries. Among other provisions, the rule prohibits states from conducting coverage eligibility renewals any more frequently than 12 months apart.  

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