Health Plan Weekly

Amid an ongoing mental health crisis that has seen a near 40% increase in patients grappling with mental health conditions since 2020, Centene Corp.’s WellCare of Kentucky launched a pilot program to address two conditions — panic attacks and post-traumatic stress disorder (PTSD) — that are often overlooked.

Working with digital therapeutics company Freespira Inc., the pilot program takes an innovative approach to managing conditions at home with supportive technology and personalized coaching. AIS Health, a division of MMIT, connected with leaders of the two organizations, Timothy Houchin, M.D., a board-certified adult, child and forensic psychiatrist and senior medical director for WellCare Kentucky, and Joseph Perekupka, CEO of Freespira, to discuss the collaboration and learn about the early outcomes.

Extending enhanced premium tax credits for the Affordable Care Act individual marketplace would cost the federal government $134 billion if extended from 2025 to 2029 and $383 billion if extended from 2025 to 2034, according to a new projection from the Congressional Budget Office (CBO). The federal agency’s projection also predicts that “an average of 3.8 million more people” per year would have health insurance than if the premium tax credits were allowed to expire. A more in-depth CBO “score” of extending the tax credits is also in the works following a request by Republican leadership in the House of Representatives — who seem poised to oppose any move to extend the tax credits.

Congress must extend the enhanced tax credits — called advance premium tax credits (APTCs) — which were initially passed as part of the 2021 American Rescue Plan Act (ARPA) and extended as part of the 2022 Inflation Reduction Act (IRA). If Congress doesn’t act, the credits will expire at the end of the 2025 plan year.

Medicaid managed care plans are going to invest significant money and time in making sure they comply with CMS’s recently released final rule pertaining to access, finance and quality, according to executives from consulting firm Sellers Dorsey who spoke during a May 20 webinar. Karen Brach, a Sellers Dorsey managing director and former health insurer executive, said “plans have quite a lift ahead of them,” although she added the rule presents a “tremendous opportunity for collaboration” among state Medicaid programs, plans and providers.

The final rule, which was published in the Federal Register on May 10, updates access and quality standards that were established in 2016 and 2020. It was released on the same day as another final rule addressing broader access issues, including requirements for home- and community-based services and fee-for-service Medicaid programs. Earlier this year, CMS announced a final rule on prior authorization and interoperability in Medicaid and a final rule on Medicaid eligibility and enrollment.

Under the Biden administration’s new regulations — which will allow Deferred Action for Childhood Arrivals recipients to receive federal health care coverage — more than 100,000 uninsured DACA recipients are expected to enroll in Affordable Care Act (ACA) marketplace plans next year, according to CMS.

As of Dec. 31, 2022, there were 580,000 active DACA recipients and almost 28% of them resided in California. A KFF survey showed that most people who were likely eligible for DACA lived in a family with at least one full-time worker and over half of them worked full time themselves. However, they were much less likely than U.S.-born individuals in their age group to receive health care coverage.