Changes in the Coverage Environment During COVID-19: State Strategies to Support Enrollment
Manatt Health and GMMB
On Friday, October 30, State Health & Value Strategies hosted a webinar during which experts from Manatt Health and GMMB reviewed the trajectory of 2020 Medicaid enrollment growth to date and provide effective strategies related to communication with members and coordination across state Medicaid agencies and Marketplaces to support coverage access and retention in this dynamic environment.
State Medicaid agencies and Marketplaces are facing intense pressure as coverage volatility resulting from the COVID-19 economic downturn continues and the 2021 open enrollment period begins. Millions of people have already lost jobs and in many cases their employer-sponsored insurance, and the number of individuals entering the unemployment ranks for the first time remains high. Additionally, the eventual (and unknown) end to the public health emergency adds to the dynamic of coverage churn in and across Medicaid and the Marketplace, making it more critical than ever that states prepare for increases and shifts in enrollment. The webinar included a question and answer session during which webinar participants can pose their questions to the experts on the line.
SHVS also published Tracking Medicaid Enrollment Growth During COVID-19 Databook, which includes Medicaid enrollment data from over 40 states, and provides a comprehensive, detailed look at 2020 Medicaid enrollment trends to-date. As a companion to the Databook, Manatt Health authored an Overview that summarizes key findings from an analysis of the enrollment data. In addition, as states prepare for OEP in the midst of significant churn between Medicaid and the marketplaces, Collaborating to Connect Consumers to Coverage highlights messages to encourage consumers to check out coverage options during open enrollment and profiles two state examples of coordination to ensure consumers encounter “no wrong door” in their search for coverage.
On October 7, the U.S. Departments of Health and Human Services (HHS), Treasury, and Labor (DOL) and the Office of Personnel Management (OPM) published a third rule implementing the No Surprises Act (NSA), the comprehensive federal law banning balance bills in emergency and certain non-emergency settings beginning January 1, 2022. This third rule, an interim final rule, provides details on the independent dispute resolution process (IDR), good faith estimates for enrollees on the cost of services, the dispute resolution process for uninsured patients, and external review. This expert perspective summarizes the provisions of the IFR and notes particular implications for state regulators.
With the Patient Protection and Affordable Care Act’s (ACA’s) ninth open enrollment period (OEP) set to launch in less than a month, the ACA Marketplaces are seeing record enrollment numbers with more generous subsidies, new carrier competition, and a relatively stable rating environment. At the same time, there is uncertainty with the trajectory of the COVID-19 pandemic and medical costs trending upward as the economy recovers, albeit at an uneven pace. These trends have made for a challenging rate review process in the 47 states plus the District of Columbia (D.C.) that conduct their own ACA rate reviews of carrier-proposed rates using federal review standards. State announcements of 2022 rates have trickled out at a slower pace than in prior years, and it is likely that many states will not publish their approved rates until the beginning of open enrollment. As always, state rate results vary widely and, even within states, there often are substantial variations among carriers and across different regions in geographically diverse states. With these caveats, this expert perspective highlights some observations about the factors that are impacting rate changes this year and the kind of variations that exist among states.