On January 15, 2022, health insurers will be subject to new federal requirements to cover and waive cost-sharing for over-the-counter diagnostic tests for COVID-19 for the duration of the federal public health emergency. Past federal guidance required insurers to fully cover COVID-19 tests, but allowed them to require enrollees to first obtain a health professional’s determination that a test is medically necessary. The new requirements, published January 10, enable consumers to obtain the tests directly from pharmacies or online retailers without being seen by a health professional. With case rates surging and the costs of over-the-counter COVID-19 tests ranging from $14 to $34, this new benefit should provide significant financial relief to privately insured individuals. This expert perspective focuses on key provisions of the new coverage requirements as well as health equity considerations and implications for state insurance regulators.
Medicaid Managed Care: How States’ Experience Can Inform Exchange Qualified Health Plan Standards
Manatt Health Solutions – Deborah Bachrach, Patricia Boozang and Allison Garcimonde
State Affordable Insurance Exchanges (exchanges) are at the core of the coverage reform in the Affordable Care Act (ACA). The exchanges establish a marketplace in which individuals and small employers can compare and select among affordable, quality health insurance options. In this policy brief, supported by the State Network and published by the Center for Health Care Strategies, authors from Manatt Health Solutions examine lessons from Medicaid managed care contracts in six states. The brief notes opportunities for exchanges to “borrow” from and align qualified health plan standards with Medicaid managed care requirements, as well as areas where managed care requirements may need to be modified for adoption in exchanges.