The Scoop: Health Insurance News – February 10, 2021 Edition

COVID’s enrollment window opens in most states on Monday

COVID enrollment windows will be available in all states except Idaho by next week. In a few states, these are already open. Connecticut opened a COVID enrollment window following the publication of this week’s Scoop, leaving Idaho to be the only state without one. These enrollment windows allow customers to enroll in ACA-compliant health insurance without any qualifying event.

Most states allow anyone to enroll in the marketplace, including those who are already enrolled but need to change their plan. Some state-run exchanges limit eligibility to those who are currently uninsured or who have not already enrolled through the change. Some states also extend the COVID enrollment window to plans purchased off-exchange, although financial assistance is rare outside the exchange.

If you are uninsured, or know someone who is, now’s your chance to get coverage for the rest of 2021. The effective date can be as early as 1 March. Uninsured Individuals are eligible for substantial premium subsidies that can cover the entire cost of at least some plans on the market. Congress is also considering COVID assistance measures that would make protection more affordable.

The COVID package should include medical health insurance, according to the home committees

This week, the Home Methods and Means Committee released a list of nine COVID assistance proposals. The sub-title G, titled “Selling Financial Safety,” includes a number essential provisions on medical health insurance:

  • In 2021 and 2022 the guidelines for the percentage of income that an individual will be expected to pay towards medical insurance on the exchange could be changed to be more generous. The benchmark plan would be free for individuals with incomes up to 150 percent of the federal poverty level. No one would pay more than 8.5 percent of their income, including those who earn 400 percent of poverty level (and are not eligible to receive a tax credit score for premiums, regardless of how much they pay for health insurance).
  • The extra premium tax credit would not be required to be repaid by 2020. Before President Biden took office, a number insurance commissioners across the country urged him to do this. The premium subsidy reconciliation process can be a surprise, even at the best of times. And 2020 was one of those years.
  • In 2021, those receiving unemployment benefits will receive a credit for premiums that will cover the cost of the benchmark insurance plan.

This week, the Home Power and Commerce Committee also revealed its COVID assistance measures. Included in this was a provision which would provide additional monetary incentives to the states if they hadn’t done so already. Twelve states have not yet expanded Medicaid.

Under the current guidelines, states that develop Medicaid will receive a federal match of 90 percent of their Medicaid costs. The state can continue to fund the rest of its Medicaid program at the regular state matching rate (which varies between 50 and 76 percent, depending on the state). In the legislative proposal of the committee relating to Medicaid, newly developed Medicaid states would receive a 5 percent federal match for their entire Medicaid program for the first two years.

These proposals will be marked up by the committees this week. A vote on the final COVID support laws in the House is planned for later this month.

Virginia Home bill will implement a reinsurance program by 2023

Virginia passed laws last month to establish a state-wide reinsurance program. Last week, Virginia’s House of Delegates passed the bill by a wide margin. A Virginia Senate Committee unanimously agreed that the bill would be discussed during a special session starting today.

The law, if it is passed and signed, requires that the state submit a waiver proposal 1332 to federal authorities by the end of January 2022 and the reinsurance program be implemented by the end of January 2023. It’s a long timeline. Over the past couple of years we’ve seen several states implement reinsurance programs. Usually, this system is in place the year following the passing of the law that authorized it.

Montana Home adopts a bill to ban abortion protections for change plans

Last week, we told you about a bill in Montana’s House that would prohibit health plans on exchange from covering abortion services in Montana. The bill was passed in the House on Friday by a wide margin and mostly along party lines. Four Democrats voted yes, while one Republican voted against. The bill is now in the hands of the Montana Senate Judiciary Committee to be further reviewed. Montana is currently among the minority of states where abortion coverage will be available under on-exchange policies and at least some plans provide this protection.

South Dakota Senate passes law allowing non-insurance Farm Bureau Well being Plans

Last week, the South Dakota Senate passed S.B.87, allowing a nonprofit group of farmers, residing in South Dakota for at least 25 years, to offer non-insurance health benefits to their members. South Dakota Farm Bureau proposed the law, which would exempt these health plans from insurance laws or oversight. Tennessee, Kansas Iowa and Indiana allow Farm Bureau health plans to be sold with the related guidelines. The plans are not considered medical insurance, and therefore not subject to insurance laws or guidelines.

The bill is now before the South Dakota House of Representatives. This week the Agriculture and Pure Assets Committee approved it by a vote of 11-1, sending it for a vote in the Home. The American Cancer Society has strongly opposed the bill, noting that non-insurance health plans ” could segment the insurance market, drive up premiums, and make it harder for South Dakotans with serious or persistent illnesses to find medical insurance.”

State lawmakers introduce Medicaid buy-in laws

Since many years, the idea of Medicaid purchase as a way to build a public option has been discussed. Nevada legislators passed a Medicaid Buy-in bill in 2017 but it was vetoed. New Mexico considered similar legislation in 2019 but it didn’t pass. United States of Care provides a comprehensive list of actions that various states considered in 2019 related to Medicaid buy-in programs.

In the past year, a variety of states introduced different types of Medicaid Buy-In laws.

  • Georgia: S.B. 83/H.B. 214 would establish a Medicaid Buy-In Program that is accessible to anyone who does not qualify for Medicaid, Medicare or PeachCare for Children, Georgia’s CHIP.
  • Iowa: S.F. S.F. 220 would establish a Hawk-i (Iowa’s CHIP) buy-in program. This program would allow families to purchase coverage for their children (and young adults up to age 26) if they earn too much to meet the standard eligibility criteria. (At present, 302 percent of the federal poverty level.) Iowa’s marketplace will offer the plan, which can be used in conjunction with a premium tax credit or cost-sharing reductions.
  • Oklahoma: H.B. The state would have a Medicaid Buy-In Program if H.B. 1808 was passed. The bill would amend the Oklahoma statute which directs the state, if funding becomes available, to create a Medicaid Buy-in Program for people with disabilities. Oklahoma still hasn’t created a Medicaid Buy-in Program for people with disabilities. Last week in Oklahoma, a new bill was introduced that called for the removal of the language “if funds become accessible” from the current statute.
  • South Carolina : H.3573 would create a Medicaid Buy-In Program that is accessible to those who are not eligible for the premium tax credit under the ACA or Medicaid, Medicare or reasonably priced employer sponsored protection.
  • Tennessee: S.B. 418/H.B. 602 would establish a Medicaid Buy-In Program that is accessible to those who are not eligible for the premium tax credit or employer-sponsored coverage at a reasonable price, Medicaid or Medicare. The Tennessee law is very similar to South Carolina’s.

Biden administration maintains Trump’s affiliation health plan rule appeal on hold

In 2018, the Trump Administration relaxed the foundations of affiliation health plans (AHPS), allowing self-insured individuals to join AHPs as well as small groups that share only a common geographical location. These foundations could have even allowed the formation of these associations with the sole purpose of offering medical insurance. These rules have been challenged quickly in courtroom, and were vacated in 2019 by a judge. The Trump administration appealed this choice and the D.C. Circuit Court heard oral arguments in the appeal. Circuit Court docket in November 2019.

The court granted this request last week. As a result, the appeal is on hold while the new management at the Department of Labor reviews the case. The court granted this request last week. As a result, the appeal is now on hold while the new administration at the Department of Labor reviews the case. Standing reviews are due every two months.