Health Plan Weekly

Litigation against health plans over alleged mental health parity violations has proliferated in recent years, with judges notably ruling in favor of UnitedHealth Group and against Elevance Health, Inc. Things may get even more complicated with the Biden administration likely to propose more mental health parity regulation this year, according to attorneys from Manatt, Phelps & Phillips, LLP. 

Mental health parity rules, which rely on statutes including the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and the Consolidated Appropriations Act, 2021, require health plans to cover behavioral health and substance use disorder (SUD) treatment at the same level as medical/surgical benefits. 

More than 21.4 million people have signed up or were automatically re-enrolled in Affordable Care Act marketplace coverage during the 2024 open enrollment period, a 31% increase compared to 2023 OEP, according to CMS.

About 16.4 million people enrolled through HealthCare.gov in the 32 states that use that platform, and another 5.1 million enrolled across 18 states and the District of Columbia, which use their own marketplaces. More than 5.2 million people signed up for marketplace coverage for the first time, a 41% increase compared to 3.7 million during the 2023 OEP.

Every state except Maine saw membership growth in 2024, ranging from 0.2% in the District of Columbia to 80.2% in West Virginia. From 2023 to 2024, 44 of the 51 states reported signup increases of at least 10%, and seven states saw surges of more than 50%. Compared to 2021, marketplace enrollment increased over 150% in six states: Georgia, Louisiana, Mississippi, Tennessee, Texas and West Virginia.

HHS and the Labor and the Treasury departments on March 28 released final rules pertaining to short-term, limited-duration (STLDI) health plans. Those plans will be limited to last no more than four months, compared to up to three years under the previous rules. The rules will also require issuers of STLDIs “to include a clear, easy-to-understand consumer notice on marketing, application, enrollment, and reenrollment materials, so that consumers can make informed coverage purchasing decisions.” The departments called STLDI plans “junk insurance” and noted they are not subject to consumer protections enacted in the Affordable Care Act, including guaranteeing coverage for people with preexisting conditions. 

Jamie Raskin (D-Md.), the ranking member of the House Oversight and Accountability Committee, sent a letter on March 25 to UnitedHealth Group CEO Andrew Witty requesting information about the ongoing cyberattack on Change Healthcare, a UnitedHealth subsidiary. Raskin inquired about details such as what data may have been exposed and what policies UnitedHealth has in place to prevent an attack, and he asked Witty to respond to the 12 questions in writing by April 8. Meanwhile, Reuters reported that UnitedHealth said on March 22 that it would start processing its medical claims backlog of more than $14 billion. 

Since 2021, just three consumer operated and oriented plans (CO-OPs) have remained operational out of the original 23 nonprofit insurers created by the Affordable Care Act. Now, one of the three survivors — Common Ground Healthcare Cooperative (CGHC) — is poised to shed its CO-OP identity and combine forces with CareSource, a Medicaid-focused insurer based in Ohio.  

In a Feb. 27 press release, CGHC said it was “financially healthy and on track to repay” all loans that it’s received from the federal government.  

“Even so, it’s challenging as a nonprofit startup to support necessary investments in operations and diversification while keeping premiums affordable for our members,” CEO Cathy Mahaffey said.  

Comprehensive information about appeals of coverage denials by Medicaid managed care organizations is not available, and state and federal officials are far from setting a common, national data standard, according to a March report from the Government Accountability Office (GAO). The report reiterates some of the same conclusions made by another federal watchdog, the HHS Office of Inspector General (OIG), in a July 2023 report about Medicaid MCOs’ prior authorization denials, and experts say they do not expect data reporting to improve in the short term. 

Medicaid MCOs are facing increasing regulatory pressure over prior authorization and other utilization management (UM) practices, particularly at the state level. Federal lawmakers have yet to approach Medicaid UM reforms with the same bipartisan zeal that they have brought to revamping Medicare Advantage practices. But the new GAO report, which was prepared at the request of Sen. Ron Wyden (D-Ore.) and Rep. Frank Pallone (D-N.J.) is an indication that powerful Democratic members of Congress are taking interest in reforming UM in managed Medicaid.