The start of the 2021 rate review process for the Affordable Care Act (ACA) Marketplaces coincided with the initial outbreak of COVID-19 cases, and early forecasts were ominous, with rate increases projected as high as 40 percent. There was also widespread concern about how to set rates when insurers’ COVID-related costs looked anything but predictable. In short, it looked like, after a period of relative stability in Marketplace rates, enrollees might be in for a rollercoaster ride. This expert perspective provides a brief overview of how the rate review process has developed since the first ACA OEP in 2013 and how those developments came together this year to enable regulators and insurers to manage uncertainty and achieve more stable rates for the 2021 plan year.
Medicaid Fiscal Accountability Rule
In November, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule making significant changes affecting Medicaid supplemental payments and financing mechanisms, including provider taxes and intergovernmental transfers (IGTs). On Tuesday, January 14, 2020 at 4:00 pm EST, State Health and Value Strategies hosted a webinar on the proposed rule, facilitated by experts at Manatt Health.
The proposed fiscal accountability rule would, if finalized, sharply limit states’ abilities to use IGTs to fund their Medicaid programs and require many states to redesign aspects of their provider taxes, with resulting serious ramifications for many states’ Medicaid budgets. Additionally, the proposed rule would impose various reporting and approval requirements on supplemental payments. Further, many of the provisions in the proposed rule would provide CMS with considerable discretion to approve or disapprove payments or financing structures, leaving states uncertain of whether their programs comply with federal requirements. The webinar provided an overview of the proposed rule, highlighting the provisions with the most significant implications for states, and also discussed how the rulemaking process may unfold over the next several months and what states can do to prepare. The experts at Manatt Health published an analysis of the proposed rule and potential implications for states which you may find helpful.