Arkansas & Georgia: United Healthcare to Exit Marketplaces
United Healthcare announced it will not sell insurance plans on the Arkansas or Georgia health insurance Marketplaces for the 2017 plan year. The company previously said it may withdraw from Marketplaces after lower-than-expected earnings last year. Arkansas consumers purchasing coverage on the Marketplace will have a choice of four insurers, while Georgia consumers will have eight insurer options. United is the largest health insurer in the country but has a much smaller share of enrollees in the Marketplaces.
California: Marketplace Presses Health Plans to Improve Quality and Value
The Covered California board unanimously approved a series of adjustments to the 2017-2019 Qualified Health Plan (QHP) Model Contract aimed at promoting higher quality and better value for consumers. A wide range of provider, health plan, and consumer stakeholder groups helped craft the new contract provisions, which aim to lower costs, increase access to appropriate and timely care, reduce health disparities, and empower consumer choice. Numerous levers will be used to achieve these goals, including encouraging plans to adopt advanced primary care models such as patient-centered medical homes and accountable care organizations; requiring plans adopt value-based payment methodologies including linking at least 6% of hospital reimbursements to quality performance over time; increasing expectations for network quality; and providing consumer decision-making tools to increase understanding of care options and costs.
California: Marketplace Supports 1332 Waiver to Enroll Undocumented Immigrants
The Covered California board published a report supporting the pursuit of a Section 1332 waiver to allow undocumented immigrants to purchase "non-qualified health plans (QHPs) that 'mirror' Covered California QHPs" through the State-based Marketplace. Undocumented residents are currently only able to purchase full-cost coverage through private insurance brokers. If approved, the waiver could provide access to up to 50,000 undocumented residents to purchase the plans, though they would not be eligible for federal cost sharing or premium subsidies. The change could take effect as early as January 1, 2017 pending State legislation and federal approval.
New York: New SEP Created for Victims of Domestic Violence
New Yorkers who are victims of domestic violence or spousal abandonment may now enroll in insurance plans offered through the NY State of Health, the State-based Marketplace, at any point during the year, Governor Andrew Cuomo (D) announced. The special enrollment period (SEP) applies to any member of a household who is a victim of domestic abuse, including those who are unmarried or are dependents, as well as dependents of victims of spousal abandonment. CMS made the HealthCare.gov SEP for victims of domestic violence permanent in 2015 and several other states, including California and Minnesota, have followed suit.