Medicare and Medicaid

Datapoint: Puerto Rico Faces Medicaid Funding Crisis

June 18, 2019

Puerto Rico’s temporary Medicaid funding following Hurricanes Irma and Maria is set to run out in September 2019, a problem that could lead to heavy enrollment cuts for the island’s 1,181,525 managed Medicaid beneficiaries. Puerto Rico is also in the midst of revamping its Medicaid delivery system to an entirely managed care-based system. Triple-S Management Corp. currently holds 29.5% of the island’s market share.

Puerto Rico’s temporary Medicaid funding following Hurricanes Irma and Maria is set to run out in September 2019, a problem that could lead to heavy enrollment cuts for the island’s 1,181,525 managed Medicaid beneficiaries. Puerto Rico is also in the midst of revamping its Medicaid delivery system to an entirely managed care-based system. Triple-S Management Corp. currently holds 29.5% of the island’s market share.

Source: AIS’s Directory of Health Plans

California Adds Mandate, Expands Health Care to Some Undocumented Immigrants

June 18, 2019

California created its own state-based individual mandate, added help for middle-income consumers purchasing coverage on the individual market, and agreed to pay for Medi-Cal coverage for undocumented young adults in a $213 billion legislative budget deal.

In the budget pact, approved June 13, California became the first state in the nation to offer subsidies for health coverage for those between 400% and 600% of the federal poverty level.

By Jane Anderson

California created its own state-based individual mandate, added help for middle-income consumers purchasing coverage on the individual market, and agreed to pay for Medi-Cal coverage for undocumented young adults in a $213 billion legislative budget deal.

In the budget pact, approved June 13, California became the first state in the nation to offer subsidies for health coverage for those between 400% and 600% of the federal poverty level.

The penalties paid by those who fail to purchase qualifying health insurance will help pay for those subsidies, according to the state. Beginning in 2020, adults will be charged $695 or 2% of their household income, whichever is more, for failing to purchase health insurance.

The legislation also expands Medi- Cal coverage to undocumented young adults ages 19 through 25 at the state’s expense, which will add approximately 90,000 young adults to the Medicaid program at a cost of around $98 million per year.

“We think for the long-term health of the exchange, having a mandate will help to get lower-risk people into the exchange,” L.A. Care Health Plan CEO John Baackes says. “It also gets the younger cohort used to participating and getting access to care whenever they need it.”

The budget deal left two other top issues for health insurers — a tax on managed care organizations and a new statewide drug purchasing plan — unresolved.

Datapoint: Managed Medicaid Penetration Rose 3% Year Over Year

June 17, 2019

Approximately 54.7 million people are currently enrolled in Medicaid managed care plans, according to the latest update to AIS’s Directory of Health Plans. Of the entire Medicaid landscape, 73.5% of lives are enrolled in managed care, a 3.3% increase from 2018.

Approximately 54.7 million people are currently enrolled in Medicaid managed care plans, according to the latest update to AIS’s Directory of Health Plans. Of the entire Medicaid landscape, 73.5% of lives are enrolled in managed care, a 3.3% increase from 2018.

Source: AIS’s Directory of Health Plans

Snapshot of the Medicare-Medicaid Dual Eligibles Landscape as of May 2019

June 14, 2019

Nearly 3 million Medicare-Medicaid dual eligibles are enrolled in managed care plans designed to serve the duals population, a 13% boost from May 2018, according to the latest update to AIS’s Directory of Health Plans. The market penetration of Dual Eligible Special Needs Plans (D-SNPs) in particular has grown as payers make heavier investments in Medicare Advantage in general, but some states are also pioneering their own duals coordination initiatives in partnership with CMS (Medicare-Medicaid Plans, or duals demonstrations).

by Carina Belles
Nearly 3 million Medicare-Medicaid dual eligibles are enrolled in managed care plans designed to serve the duals population, a 13% boost from May 2018, according to the latest update to AIS’s Directory of Health Plans. The market penetration of Dual Eligible Special Needs Plans (D-SNPs) in particular has grown as payers make heavier investments in Medicare Advantage in general, but some states are also pioneering their own duals coordination initiatives in partnership with CMS (Medicare-Medicaid Plans, or duals demonstrations). The 10 largest duals sponsors have a firm grip on the market, enrolling 2.16 million people (about 73% of all managed duals lives) with UnitedHealthcare alone holding 31.3% of the national market share. See a full breakdown of the current duals landscape plus the top 10 duals sponsors with their enrollment changes from 2018 below.

NOTE: AIS’s dual eligibles data reflect current enrollment in Dual Eligible Special Needs Plans (D-SNPs), Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs), Medicare-Medicaid Plans (MMPs,) or duals demonstration plans, and the Program of All-Inclusive Care for the Elderly (PACE).

SOURCE: CMS, AIS’s Directory of Health Plans (DHP). Visit https://aishealthdata.com/dhp for more information.

Datapoint: South Carolina Seeks Work Requirements Waiver

June 13, 2019

South Carolina this week became the latest state to ask the Trump administration for a Medicaid work requirements waiver. The state wants to ask nondisabled adults to show they have worked 80 hours per month, on average, but unlike other ‘community engagement’ programs, South Carolina will not disenroll people from Medicaid if they fail to meet the requirements, and will instead impose a 3-month suspension of benefits. South Carolina currently serves 1,223,680 Medicaid beneficiaries, with 64.7% enrolled in managed care plans.

South Carolina this week became the latest state to ask the Trump administration for a Medicaid work requirements waiver. The state wants to ask nondisabled adults to show they have worked 80 hours per month, on average, but unlike other ‘community engagement’ programs, South Carolina will not disenroll people from Medicaid if they fail to meet the requirements, and will instead impose a 3-month suspension of benefits. South Carolina currently serves 1,223,680 Medicaid beneficiaries, with 64.7% enrolled in managed care plans.

Source: AIS’s Directory of Health Plans

Idaho Is First State to Seek ‘Empowerment Waiver’ for Medicaid/HIX

June 11, 2019

Nearly eight months ago, CMS issued guidance loosening rules on individual-market exchanges for states seeking Section 1332 waivers under the Affordable Care Act (ACA). Yet despite CMS’s efforts to change states’ strategy, this year Idaho is soon to become the first, and likely one of only two states, to seek what morphed from “state innovation waiver” to “state empowerment and relief waiver” for its controversial Medicaid expansion plan. Idaho will do so by going beyond CMS’s four initial templates, and with the endorsement of two major health insurance carriers in the state.

By Judy Packer-Tursman

Nearly eight months ago, CMS issued guidance loosening rules on individual-market exchanges for states seeking Section 1332 waivers under the Affordable Care Act (ACA). Yet despite CMS’s efforts to change states’ strategy, this year Idaho is soon to become the first, and likely one of only two states, to seek what morphed from “state innovation waiver” to “state empowerment and relief waiver” for its controversial Medicaid expansion plan. Idaho will do so by going beyond CMS’s four initial templates, and with the endorsement of two major health insurance carriers in the state.

Under Idaho’s “Coverage Choice Waiver,” Idahoans making between 100% and 138% of the FPL could opt to get health insurance coverage either through Medicaid or via the Your Health Idaho state exchange.

An estimated 18,000 Idahoans falling into this income group are currently covered by exchange plans. If CMS were to approve the waiver, these individuals would be able to keep the federal tax credits they get now for exchange policies and retain private coverage.

But an expert sees such waiver proposals as problematic. Almost every state’s legislative session is ended for 2019, “and we’re almost past the deadline for anyone to do anything adventurous for 2020 [ACA exchange] enrollment…so the writing is on the wall” for state empowerment waivers, says Joel Ario, a managing director of Manatt Health who previously served as director of HHS’s Office of Health Insurance Exchanges.

While CMS’s Verma is urging states to try more transformative strategies, Ario asserts that “would come at the cost of hurting people in the larger risk pool.” Yet states’ pursuit of Section 1332 reinsurance programs to cut premium rates by perhaps 5% to 10% “is a solid step forward,” he says.