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.
Public Charge Rule
On August 14, 2019, the Department of Homeland Security (DHS) published a final rule, Inadmissibility on Public Charge Grounds. The rule makes significant changes to the standards DHS will use to determine whether an immigrant is likely to become a “public charge”—a person dependent on the government for support—which will make it more difficult for certain immigrants to obtain lawful permanent residence (a green card) in the US. Although the rule was originally scheduled to take effect in October 2019, multiple preliminary injunctions issued by federal courts across the country temporarily blocked the rule. As a result of decisions by the Supreme Court, the rule went into effect nationwide on February 24, 2020. Because litigation is ongoing, the status of the rule could change once again in the months ahead. Individuals whose application for a visa or green card is processed outside the U.S. are subject to Department of State (DOS) public charge rules, which DOS has aligned with the new DHS standards. Individuals with questions about their specific situation should consult an immigration attorney.
State Health and Value Strategies, in partnership with Manatt Health, has developed a variety of resources for states regarding the revised public charge rule and implications for states. We will continue to update this page with new resources as they become available. If you have materials you are willing to share with other states through this page, please contact Sally Mabon firstname.lastname@example.org.
State Health and Value Strategies Resources
Public Charge Final Rule: Frequently Asked Questions. This document provides answers to frequently asked questions about whom the rule will impact, what benefits are implicated by the rule, and how the rule might be administered.
The Department of Homeland Security Begins Implementing Its Public Charge Rule on February 24, 2020. In this Expert Perspective, our colleagues at Manatt Health review the Supreme Court’s decisions granting the Administration’s requests to stay preliminary injunctions that had blocked the Department of Homeland Security public charge final rule from taking effect in October 2019.
Talking Points on Public Charge for State Health Officials. This document, developed by communications experts at GMMB, provides talking points for marketplaces and other state health officials to use in communicating with consumers about the changes to public charge.
Final Public Charge Rule: Analysis and Potential Implications. On September 3, the Robert Wood Johnson Foundation’s State Health and Value Strategies program hosted a webinar on the public charge final rule, facilitated by experts at Manatt Health. The webinar reviewed the final rule, highlighted changes from the proposed rule, and explored the rule’s potential impacts on consumers, states and providers. Speakers identified the key ways the proposed rule departs from current guidance, with a particular focus on the implications for Medicaid and other health-related public benefits, as well as communications and messaging.
Families USA report: analysis of Census Bureau data documenting recent health insurance changes for U.S.-citizen children with immigrant parents.
Protecting Immigrant Families Letter to State Officials Regarding I-944 Form: the letter highlights the information state officials will need to provide and best practices for responding to requests for information.