Radar on Medicare Advantage

✦CMS at press time said it had approved more than 200 requests for state relief in response to the COVID-19 pandemic, including recent approvals for Alaska, Iowa, Hawaii, New Jersey, North Carolina, Pennsylvania, Rhode Island, Utah and Virginia. CMS in March released a toolkit to speed the application and review of states’ requests for flexibilities, which include making temporary changes to Medicaid eligibility and benefit requirements and relaxing rules to ensure that individuals with disabilities and the elderly can be effectively served at home. Meanwhile, as part of the Trump administration’s “Opening Up America Again” plan, CMS on May 18 released guidance for nursing homes, including that they “remain in the current state of highest restriction even when a community begins to relax restrictions for other businesses.” Visit http://cms.gov/newsroom.

✦strong>Newlight Partners LP and its affiliates have made a significant equity investment in Zing Health Holdings, Inc., a physician-led Medicare Advantage HMO plan that launched last year in the Chicago area. With a focus on “populations underserved by traditional health insurance models,” the HMO was co-founded by physician and entrepreneur Eric Whitaker and Health 2047, the innovation lab of the American Medical Association. Contact Taryn Williams Clark for Zing Health at twilliams@purposebrand.com.

Previous research has suggested that disabled adults who rely on services such as home health and nursing home care are more likely to switch from Medicare Advantage to traditional, fee-for-service (FFS) Medicare. Now, a new study appearing in Health Affairs confirms researchers’ assumptions that such switching is more prevalent among MA beneficiaries who are nonwhite and/or from vulnerable sociodemographic groups.

Researchers from the Icahn School of Medicine at Mount Sinai in New York City and the University of California San Francisco examined five years of data from the National Health and Aging Trends Study, a longitudinal, nationally representative survey of aging, to assess switching between MA and traditional Medicare 12 months before and after the onset of a disability. The study asked respondents to identify the specific month when they began requiring help with activities of daily living, and includes characteristics such as age, race, region and marital status.

Despite the acceleration of U.S. COVID-19 cases in March — the third and final month of the Medicare Open Enrollment Period — switching rates among Medicare Advantage beneficiaries during the 2020 OEP were similar to last year’s at 5%, according to new survey results from Deft Research. But with CMS extending certain enrollment flexibilities and the pandemic’s potential impact on in-person interactions, industry experts advise MA plans to have a strong communications strategy in place with existing members while preparing for a more digitally based Annual Election Period (AEP) than the industry has ever seen.

The three-month OEP, reinstated in 2019 after a long hiatus, is available only to MA enrollees who want to make a one-time coverage change from what they selected during the AEP. Its return created enough uncertainty among insurers that “carriers and agencies took it seriously” in their responses both this year and last, observed Deft’s senior vice president of client services, George Dippel, in an executive brief released earlier this month on the firm’s 2020 Medicare Open Enrollment Study.

While some cities and states make moves to safely “reopen” as new COVID-19 cases taper off, New York City remains very much the epicenter of the pandemic in the U.S. And as health plans around the country have pivoted to serve vulnerable members via telehealth and other remote options, some members still require home-based visits and personal interactions to assist with activities of daily living.

VNSNY CHOICE Health Plans is on the front lines of this crisis. Established in the 1990s by the Visiting Nurse Service of New York — the largest home- and community-based care management organization in the New York metropolitan area — VNSNY CHOICE coordinates care for about 26,000 Medicare-Medicaid beneficiaries in the five boroughs of New York City and Nassau, Suffolk and Westchester counties, where the death toll as of mid-May had surpassed 20,000. Its product lines include a Fully Integrated Dual Eligible Special Needs Plan, a statewide managed long-term care plan for dual-eligible enrollees who are chronically ill or disabled and who wish stay in their homes and communities, and a special needs plan for Medicaid recipients living with HIV.

House Democrats’ latest pandemic-relief package, the Heroes Act (H.R. 6800), has been noted in the mainstream media for its $3 trillion price tag, the uphill battle it faces in the Senate, and a string of items it contains that appear to be unrelated to the COVID-19 outbreak. But it also includes some key provisions aimed at strengthening the Medicare and Medicaid programs that could impact insurers.

Introduced by House Democrats on May 12 and passed largely along party lines by a vote of 208-199 on May 15, the Heroes Act seeks another temporary increase to the Federal Medical Assistance Percentages (FMAP) and support for home- and community-based services (HCBS) that are often the target of Medicaid budget cuts. The Families First Coronavirus Response Act enacted in March already raised the FMAP by 6.2% for non-expansion beneficiaries for the duration of the public health emergency, and the Heroes Act seeks to raise that by another 7.8% for a combined 14% increase for each quarter through June 2021.