On September 17, 2021, the U.S. Departments of Health and Human Services and Treasury finalized the 2022 Notice of Benefit and Payment Parameters (NBPP) rule and announced a significant expansion of their oversight of health plans’ provider networks. This expert perspective reviews provisions of the rule of particular import to the state-based marketplaces (SBMs) and state insurance regulators.
Why Per Capita Caps Aren’t Just Managed Care for States
Deborah Bachrach, Patricia Boozang, and Anne Karl, Manatt Health
The American Health Care Act (AHCA), as passed by the House of Representatives on May 4, 2016, would overhaul federal financing of state Medicaid programs, and for the first time, would cap federal Medicaid funding. As policymakers debate the potential implications of per capita caps, it has been suggested that per capita caps are really no different than Medicaid managed care—a concept with which states are fully familiar and well able to manage. This Manatt Health policy brief tests that hypothesis by examining the similarities and differences between the federal per capita cap and a state’s per capita “cap” in Medicaid managed care spending.