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.
Ensuring Access to LTSS During COVID-19: Exploring a State Resource Guide Produced by Manatt Health and The SCAN Foundation
On Friday, July 10, State Health and Value Strategies hosted a webinar during which experts from Manatt Health presented key findings from a new COVID-19 state resource guide, funded by The SCAN Foundation. People who use long-term services and supports (LTSS), including individuals dually-eligible for Medicare and Medicaid, are particularly vulnerable to contracting COVID-19 and experiencing severe symptoms. We have seen COVID-19 have a devastating impact on people with complex care needs receiving care in nursing homes and other congregate care settings, in particular. To date, over 50,000 nursing home residents have died from COVID-19, representing up to 40 percent of U.S. COVID-19 deaths. Although there is less transparency on the impact of COVID-19 on people receiving LTSS in the community, we know that care has been disrupted due to caregivers being subject to stay-at-home orders, having no access to child care, lacking access to PPE to provide care safely, or quarantining after being sick or exposed to COVID-19.
In the resource guide, Manatt Health identifies federal and state Medicaid flexibilities available to state officials and other stakeholders and how those flexibilities are being deployed during COVID-19 to help ensure access to LTSS. The resource guide highlights examples of how states are ensuring continued access to LTSS by expanding the types of settings in which services can be delivered, bolstering pay and other supports for LTSS providers, and addressing barriers to care created by the COVID-19 pandemic. Several states are turning their attention to considering which flexibilities they want to “unwind,” which they want to retain to respond to future COVID-19 outbreaks or other public health emergencies, and which they want to make permanent to strengthen and improve LTSS care delivery. The webinar provided examples of how states are approaching answering these questions.