Expert Perspectives

Aug 21, 2020 

Partial Win for Insurers in Cost-sharing Reduction Litigation: Implications for State Insurance Regulation

On August 14, 2020, the Court of Appeals for the Federal Circuit affirmed a lower court ruling that the federal government is liable to insurers selling marketplace health plans for the loss of cost-sharing reduction (CSR) reimbursements mandated under the Affordable Care Act (ACA). However, the court determined that the federal government could reduce the damages it owes to insurers because most successfully mitigated their losses through a practice called silver loading. This expert perspective highlights implications for state insurance regulators of the recent federal Court of Appeals’ ruling on CSR reimbursement mandated under the ACA.

Aug 14, 2020 

CMS Premium Rebate Guidance – Implications for States and Other Stakeholders

On August 4, 2020, CMS released guidance permitting health insurance issuers to provide certain premium rebates for 2020. The guidance explains the conditions rebates must meet and clarifies the impact of individual market rebates on ACA provisions like the premium tax credit. The guidance provides welcome news about the impact of rebates on consumers, but it may pose challenges for issuers that have already been providing rebates. This piece summarizes the guidance, explains how it affects key stakeholders, and notes some questions that remain unanswered.

Aug 7, 2020 

More States Looking to Section 1332 Waivers

In the absence of federal legislation, states are actively seeking tools to reform their health care systems. While 1115 waivers rightly get a lot of attention, because of their ability to reshape state Medicaid programs, the Affordable Care Act’s Section 1332 waivers continue to be a promising avenue for states to stabilize their health insurance marketplace. SHVS is tracking state activity and has many resources, including a template, for states interested in pursuing a Section 1332 waiver.

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Aug 6, 2020 

Considerations for State Medicaid and CHIP Agencies As they Prepare to Unwind Eligibility and Enrollment Flexibilities Obtained During the COVID-19 Public Health Emergency

As a condition of receiving enhanced federal funding under the Families First Coronavirus Response Act (FFCRA), states are prohibited from terminating individuals enrolled in Medicaid as of March 18, 2020, or determined eligible on or after that date. These continuous coverage requirements run through the end of the month of the public health emergency (PHE), which was recently extended to October 22, 2020. Absent a further extension of the PHE, states have three months to implement a plan for unwinding the FCCRA continuous coverage requirements which are otherwise set to terminate on October 31, 2020. States will also need to identify which newly obtained eligibility and enrollment flexibilities they would like to make permanent beyond the termination of the PHE–especially in the context of emerging information that suggests that the duration of COVID-19 pandemic may extend well into 2021.

Jul 31, 2020 

State Budget Actions in Response to COVID-19 and the Impact on State Health Programs

The COVID-19 pandemic is a public health crisis that has triggered an economic crisis. While the federal government acted to provide financial relief, states have faced significant growth in expenditures in response to the pandemic, as well as simultaneous and severe drops in revenue. This expert perspective provides a snapshot of how states are navigating the known and unknown fiscal challenges of the COVID-19 pandemic, given declining revenues and rising spending demands in the context of balanced budget requirements. The strategies that states employ to address the fiscal fallout of COVID-19, will have significant and long-lasting implications for critical health care and safety net programs.

Jul 27, 2020 

Ensuring Medicaid MCO Enrollees Receive Necessary Care During COVID-19

COVID-19 has significantly reduced health care utilization in the United States. Of great concern to states is that Medicaid beneficiaries safely access medically needed services. There are already worrisome indications that many beneficiaries are not receiving such care and it is incumbent on states to take steps with their Medicaid plans to make sure needed services are delivered during the course of the pandemic. This expert perspective recommends three categories of state Medicaid program activities to facilitate the delivery of needed services.