Analysis of HHS Final Rules On Reinsurance, Risk Corridors And Risk Adjustment
Wakely Consulting Group – Ross Winkelman, FSA, MAAA, Julie Peper, FSA, MAAA, Patrick Holland, Syed Mehmud, ASA, MAAA, James Woolman
Under the Affordable Care Act (ACA) much of the expanded coverage will be provided through health insurers offering products on the new health benefit exchanges (exchanges). By compensating issuers for the risks related to the individuals they enroll, provisions related to reinsurance, risk corridors and risk adjustment are designed to lessen the financial risk issuers and exchanges will face under the ACA. These programs will mitigate the impact of adverse selection and encourage issuers to compete based on cost and quality, rather than attracting the healthiest, lowest-cost enrollees. On March 16, 2012, the U.S. Department of Health and Human Services (HHS) issued final rules, titled “Patient Protection and Affordable Care Act; Standards Related to Reinsurance, Risk Corridors and Risk Adjustment.” This research brief prepared by Wakely Consulting Group summarizes the final rules, highlights the changes from the proposed rules of July 11, 2011, and provides Wakely’s perspective on the implications. It is intended for policymakers and state officials familiar with the complexities underlying these issues.
Wakely Consulting Group has also prepared a Work Plan that serves as an outline for state officials on the decisions and actions necessary to implement the risk adjustment and reinsurance provisions of the ACA.
Medicaid enrollment has increased by over 10 million (or 15 percent) from February 2020 through February 2021 across all states since the outbreak of the COVID-19 pandemic. States have a clear imperative to center health equity as they plan for the end of the public health emergency (PHE) given that Black, Latino/a, and other people of color are most at risk of coverage loss. This expert perspective highlights strategies states can implement to ensure that the end of the PHE does not exacerbate already widespread racial and ethnic disparities in our health care system.
COVID-19 vaccines are now widely accessible in the United States and free to everyone over the age of 12. Given the spread of the Delta variant, there is an urgent need to increase vaccination rates, particularly among Medicaid enrollees. States across the country continue to report Medicaid enrollees are getting vaccinated at lower rates than the general population. This expert perspective explores how state Medicaid managed care programs and health plans can work collaboratively to increase COVID-19 vaccination rates for the more than 55 million Medicaid enrollees in comprehensive managed care plans.
Many states are looking to fill gaps in race and ethnicity data for Medicaid and related agencies. Working with the State Health Access Data Assistance Center (SHADAC) at the University of Minnesota, with support from the State Health and Value Strategies (SHVS) program, New York tested multiple strategies aimed at encouraging applicants to answer the optional race and ethnicity questions. This expert perspective highlights an effort by New York’s official state-based marketplace, NY State of Health, to improve the completeness of race and ethnicity data that applicants share when applying for Medicaid; Child Health Plus, the state’s Children’s Health Insurance Program (CHIP); the Essential Plan, New York’s Basic Health Program (BHP); or Qualified Health Plan (QHP) coverage through its Marketplace.
