Health Plan Weekly

Health insurers are conducting outreach to people who may have been left without coverage as a result of the COVID-19 crisis, but experts say they may be partially stymied in their efforts to get people enrolled in new plans by the difficulties of operating within a pandemic environment.

AmeriHealth Caritas, which is run by Independence Blue Cross in partnership with Blue Cross Blue Shield of Michigan, says it has launched a series of videos designed to help potential Medicaid enrollees learn how they can apply.

Health insurers that sued to recoup halted cost-sharing reduction (CSR) payments scored a key victory on Aug. 14 when a federal appeals court confirmed that the government must reimburse them for providing subsidies to low-income Affordable Care Act exchange enrollees. But that win came with a significant catch, as the three-judge panel said insurers can collect only the monetary damages that they didn’t already recoup from silver loading — the process by which they raise benchmark silver-plan premiums to compensate for lost CSR payments.

Health policy experts who spoke to AIS Health say they don’t expect the court’s decisions will cause much to change about CSRs or silver loading, as the current setup is working well for nearly all stakeholders. Still, insurers probably won’t file any more lawsuits seeking CSR reimbursement from the 2018 plan years and beyond, since they aren’t likely to collect any damages.

✦ Molina Healthcare Inc. and two of its subsidiaries have been accused of providing subpar care and overbilling the government for children’s behavioral health services by $20 million, Axios reported on Aug. 13. A recently unsealed lawsuit obtained by the news outlet — which was first filed in 2018 — alleges that Molina billed for some care as though it was provided by a professional even when it wasn’t, failed to give some providers proper training, provided care for some children who weren’t eligible to receive it and fired an employee who complained about such practices. Axios’ article noted that Molina did not respond to a request for comment. Visit https://bit.ly/2PSrqIB to learn more.

✦ New Mexico Health Connections, a consumer operated and oriented plan (CO-OP) that offered health plans on the state’s individual insurance exchange, will shut down on Jan. 1, 2021, according to an Aug. 10 press release. “With continued high claims costs and limited opportunities for new investment, it has become clear that the amount of growth required to provide quality care at reasonable rates will be unlikely in the next plan year,” said Marlene Baca, the CO-OP’s president and CEO. New Mexico Health Connections previously filed a lawsuit challenging the formula used to calculate payments in the Affordable Care Act risk adjustment program, arguing it disadvantages smaller and newer health plans. New Mexico Health Connections is the latest in a long string of CO-OPs that have folded amid challenging market conditions on the ACA exchanges. Read more at https://bit.ly/343Tyk2.