On April 28, 2022, the Centers for Medicare & Medicaid Services released its final Notice of Benefit & Payment Parameters for plan year 2023. This annual regulation governs core provisions of the Affordable Care Act, including operation of the health insurance marketplaces, standards for insurers, and the risk adjustment program. This expert perspective focuses on provisions of the final rule that are of particular import to the state-based marketplaces and state insurance regulators.

On April 5, 2022, the Treasury Department and the Internal Revenue Service (IRS) released proposed regulations to address the so-called “family glitch” under the premium tax credit (PTC). The family glitch prevents certain dependents of employees from qualifying for PTC, and by extension for advance payments of PTC and cost-sharing reductions, through the Affordable Care Act’s Marketplaces. Addressing the family glitch is an important step towards making affordable health insurance universally available. While fixing it has long been a key priority of state health officials and other stakeholders, the change will also create new work for states with little time to prepare for its rollout. This expert perspective reviews the proposed regulations and discusses the potential implications for states.

As state insurance regulators and marketplace officials prepare for the substantial transitions in coverage that will occur in the wake of the eventual expiration of the public health emergency, they will want to ensure that brokers and enrollment assisters are doing all they can to help new marketplace consumers understand their coverage options and enroll in a plan that suits them. This expert perspective reviews the options available to state marketplaces and insurance regulators to protect consumers and take action to prevent carriers from implementing compensation schemes for brokers that discourage mid-year enrollment. The ability of brokers and assisters to facilitate smooth transitions from Medicaid to the marketplaces will have direct consequences for the well-being and security of the transitioning population and significant ramifications for health equity.

State health updates as of April 29, 2022.

State health updates as of April 22, 2022.

On February 17, 2022, the Centers for Medicare & Medicaid Services (CMS) released a request for information (RFI) seeking feedback on topics related to healthcare access. The RFI presents an important opportunity for states to share with federal partners input and creative ideas to achieve substantial reforms on access to coverage–namely, the processes for enrollment and eligibility redeterminations–as well as the standards for defining and monitoring enrollee access to care. This expert perspective provides model comments developed to inform and support state responses to the RFI. We encourage states to submit comments, including by leveraging and building on any of the below language that reflects state priorities. States must submit all comments by Monday, April 18, 2022, via the online portal.

State health updates as of April 15, 2022.

State health updates as of April 8, 2022.

New state reporting templates and guidance released by the Centers for Medicare & Medicaid Services (CMS) on March 22, 2022, build upon a State Health Official letter released on March 3. The resources specify both the data and the metrics that states will be required to submit to monitor enrollment and renewal efforts as they resume routine Medicaid and CHIP operations following the end of the COVID-19 PHE. This expert perspective summarizes the new reporting requirements and presents a set of considerations for states as they begin implementing new unwinding policies, procedures, and reporting.

State health updates as of April 1, 2022.