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.
SHOP Notices and Appeals Webinar
Sharon Woda, Manatt Health Solutions Adam Block, Manatt Health Solutions Lisa Sbrana, New York Health Benefit Exchange Kelly Smith, New York Health Benefit Exchange
The State Coverage Initiatives program, in coordination with the State Network, hosted a webinar Tuesday, July 23 from 1:30 – 3:00 p.m. EDT to discuss Small Business Health Option Programs (SHOP) notices and appeals. Sharon Woda and Adam Block from Manatt Health Solutions, and Lisa Sbrana and Kelly Smith from the New York Health Benefit Exchange (NYHBE) facilitated this event. The webinar covered various issues, including:
– Federal requirements for SHOP notices;
– Notices that will be used by the NYHBE to communicate with employers and employees served by the SHOP (found here); and
-Discussion of the proposed SHOP appeals regulations and corresponding policy and operational decisions made by the NYHBE in developing their SHOP appeals process.
The webinar slides can be found in the blue “Download” icon and the NYHBE SHOP Notice template can be found here.