On January 27, 2023, the Centers for Medicare & Medicaid Services released a State Health Official (SHO) letter, “Medicaid Continuous Enrollment Condition Changes, Conditions for Receiving the FFCRA Temporary FMAP Increase, Reporting Requirements, and Enforcement Provisions in the Consolidated Appropriations Act, 2023.” The SHO letter is the second in a series of guidance related to section 5131 of the Consolidated Appropriations Act, 2023 (CAA), which established a fixed end date for the Medicaid continuous coverage requirement, a gradual phase-down for the enhanced federal match, and new guardrails for mitigating coverage loss for individuals who continue to be eligible. This expert perspective reviews the additional detail and operational expectations of states during the unwinding of Medicaid continuous coverage as laid out in the SHO letter.
Qualified Health Plan Selection: Considerations for Consumers Webinar
Deborah Bachrach, Manatt Health Solutions Melinda Dutton, Manatt Health Solutions
As part of their series on “Helping Consumers Understand the Marketplaces,” Manatt Health Solutions, with support from the State Health Reform Assistance Network, led a webinar reviewing factors states will want to call out for consumers seeking guidance on how to choose among plans, especially young adults who may be choosing between catastrophic coverage and other options. This presentation reviewed the interplay between premiums and cost-sharing across the metal levels and catastrophic coverage generally and with respect to specific services, noting among other things the range of preventive services which must be provided without any cost-sharing in all options. Specific examples demonstrated the implications of different premium and cost-sharing options for consumers of different ages and with different incomes and health care needs. Finally, the webinar examined at non-financial considerations such as provider networks and formulary designs.
A recording of the webinar can be found here.