CMS Proposes New Rule for Medicaid and CHIP Managed Care Plans

CMS released the first major update to Medicaid and CHIP managed care rules in more than a decade this week. The proposed rule focuses on aligning Medicaid managed care and CHIP with other forms of insurance coverage, including private coverage and Medicare Advantage; allows states to require participation in information technology reform such as health information exchanges; establishes a quality ratings requirement; and emphasizes consumer protections including new network adequacy provisions. The rule also requires plans to spend at least 85% of their revenue on medical care beginning in 2017, a medical loss ratio similar to that required of Marketplace plans but with one key difference—Medicaid managed care plans are not required to rebate the difference to consumers. The deadline to submit comments is July 27, 2015.

Senate Republicans Offer King v. Burwell Contingency Bill

Thirty-one senators, including Majority Leader McConnell (R), have signed onto a King v. Burwell contingency bill that would extend subsidies through September 2017 for enrollees in the Federally-facilitated Marketplace in the event of a Supreme Court ruling for the plaintiffs, reports Politico. The bill also would repeal the ACA’s individual mandate, employer mandate, and insurance coverage requirements. Meanwhile, Republican members of the House are developing a plan independent of the Senate, which is likely not to offer an extension; and Congressional Democrats are expected to offer a one-page legislative solution that eliminates the four words at issue in the litigation (“established by the State”) and thereby restores subsidies to residents of all states.

High Plan Satisfaction Reported Among Marketplace Enrollees

Nearly three-quarters of Marketplace enrollees rate their coverage as excellent or good, according to a report by The Kaiser Family Foundation, and the majority of enrollees are "very" or "somewhat" satisfied with specific features of their plan, including: provider and hospital availability, out-of-pocket expenses for doctor visits, prescription drugs, annual deductible, and monthly premiums. Despite the high marks overall, the survey revealed some affordability concerns. While 57% of those in ACA-compliant plans feel financially protected by their insurance, nearly four in ten feel vulnerable to high medical bills. Almost half of those with both ACA-compliant and non-compliant plans say it is very or somewhat difficult for them to afford their monthly health insurance premium.