On this version
- 5 states prolong SEPs created in response to COVID-19; federal authorities guarantees to cowl therapy for uninsured
- Utah suspends Medicaid work requirement throughout COVID-19 disaster
- Kentucky affords short-term Medicaid protection for uninsured
- Web site forecasts extra enrollment throughout pandemic disaster
- Louisiana Affiliation of Well being Plans challenges emergency COVID-19 insurance coverage mandates
- Colorado infertility protection laws signed into regulation
- South Dakota enacts regulation to impose limits on prescription drug step remedy
- Utah regulation caps insulin prices for residents with state-regulated well being plans
5 states prolong SEPs created in response to COVID-19
Learn the way your state is taking motion to develop entry to well being protection and therapy of COVID-19.
The COVID-19 pandemic has, understandably, overshadowed nearly every little thing else in current weeks. There have been quite a few coronavirus-related well being coverage updates at each the state and federal ranges, and we’re retaining monitor of them right here.
Notably, a number of state-run exchanges have prolonged their COVID-19 particular enrollment intervals for uninsured residents: Colorado, Connecticut, Maryland, Massachusetts, and Washington have all added extra time to their COVID-19 particular enrollment intervals.
These enrollment home windows for uninsured residents are ongoing – till not less than April 15 and in lots of circumstances a lot later – in 11 states. And the District of Columbia additionally has a particular enrollment window for uninsured residents, which is tied to the tax submitting season.
Though the federal authorities has declined to open a COVID-19 particular enrollment interval on HealthCare.gov (the change utilized by residents in 38 states), HHS Secretary Alex Azar has mentioned that the federal authorities will cowl the price of COVID-19 therapy for uninsured People. However there’s nonetheless some uncertainty by way of how it will work, and it’s not completely clear that each one uninsured People can have zero prices stemming from COVID-19 therapy in the event that they grow to be sick.
Utah suspends Medicaid work requirement throughout COVID-19 emergency
Utah applied Medicaid enlargement in January, albeit with a requirement that enrollees be working, going to high school, or collaborating in job coaching or job search actions. However amid the COVID-19 pandemic, the state has suspended the work requirement.
Though Medicaid work necessities in a number of states have acquired federal approval, they had been in impact in solely Michigan and Utah as of the beginning of 2022. Michigan’s work requirement was blocked by a choose final month, so Utah’s resolution to droop its work requirement in gentle of the COVID-19 scenario implies that there are presently no states with energetic Medicaid work necessities.
Kentucky affords short-term Medicaid protection for uninsured
Kentucky makes use of HealthCare.gov (as a federally supported state-run change), so the state is unable to supply a particular enrollment interval for uninsured residents. However the state is opening up its Medicaid program to supply short-term protection to individuals who don’t have medical health insurance. The protection will final by way of June 30, and is accessible no matter earnings. Particulars can be found on the Kentucky Division for Medicaid Companies web site.
Particular person medical health insurance enrollments are rising as folks lose employer-sponsored protection
At ACA Signups, Charles Gaba is monitoring the variety of People gaining protection within the exchanges throughout this pandemic. Though HealthCare.gov doesn’t have a COVID-19 particular enrollment interval for uninsured folks, the traditional particular enrollment interval guidelines nonetheless apply. Meaning people who find themselves dropping their present well being protection are capable of enroll in a plan within the particular person market (on- or off-exchange) – an possibility that’s all the time out there, nationwide, when an individual loses protection. And 12 of the 13 absolutely state-run exchanges are permitting anybody with out well being protection to enroll proper now, with none explicit qualifying occasion.
The widespread job losses associated to COVID-19 – and the accompanying lack of insurance coverage protection – are driving enrollment numbers larger than they might in any other case be within the particular person market. And it’s a superb reminder of how essential the Inexpensive Care Act (Obamacare) is. With out it, most of the newly unemployed would have had a way more difficult time sustaining protection. They’d have needed to depend on COBRA or state continuation (neither of that are universally out there, and each of that are very costly), or cross the medical underwriting necessities that had been used within the particular person market in almost each state pre-ACA.
However because of the ACA, folks can enroll in particular person market protection – with premium subsidies and cost-sharing reductions in the event that they’re eligible – no matter their medical historical past. And Medicaid enlargement, which can be a part of the ACA, is offering a a lot wanted security internet for a lot of newly unemployed People.
Louisiana Affiliation of Well being Plans challenges emergency COVID-19 insurance coverage mandates
Nationwide, quite a few insurers have voluntarily waived value sharing for COVID-19, and insurance coverage departments throughout the nation are implementing quite a lot of emergency mandates to deal with the pandemic. However not all insurers are on board with the brand new necessities. The Louisiana Affiliation of Well being Plans plans to problem the Louisiana Division of Insurance coverage in court docket over the COVID-19 mandates the Division has applied, together with short-term bans on prescription step remedy and coverage cancellations for non-payment of premiums. Louisiana Insurance coverage Commissioner Jim Donelon has famous that the insurers will be capable to recoup prices with their 2022 charges, declaring that his workplace doesn’t have the authority to reject premium proposals from insurers. (Insurance coverage commissioners in lots of states do have that authority, however Louisiana is just not amongst them.)
Colorado infertility protection laws signed into regulation
Final week, we advised you about Colorado lawmakers’ efforts to make sure that residents with state-regulated plans would have protection for infertility therapy. Colorado Gov. Jared Polis has since signed the invoice into regulation. All state-regulated well being plans in Colorado which might be issued or renewed on or after January 1, 2022 should cowl infertility therapy, with the identical cost-sharing that applies to different medical circumstances.
South Dakota enacts regulation to impose limits on prescription step remedy
Step remedy is a course of by which well being insurers require members to first strive lower-cost drugs earlier than a plan will cowl dearer choices. It’s a cost-saving measure, but it surely’s additionally controversial. Final week, South Dakota Gov. Kristi Noem signed SB155 into regulation, after it handed unanimously in each chambers of the state’s legislature. The regulation imposes varied limits on step remedy, together with necessities that any step remedy guidelines be proof based mostly, and comply with a transparent, consumer-friendly exceptions course of. SB155 applies to state-regulated well being plans which might be issued or renewed in 2022 or later.
Utah regulation caps insulin prices for residents with state-regulated well being plans
Utah has enacted HB207, which is able to cap out-of-pocket prices for insulin at $30/month on state-regulated well being plans. The regulation, which takes impact for plans issued or renewed on or after January 1, 2022, doesn’t apply to self-insured employer-sponsored plans (which cowl the vast majority of employees who’ve employer-sponsored insurance coverage), as these plans are regulated by the federal authorities as a substitute. Colorado applied a $100/month out-of-pocket cap on insulin this 12 months, and a number of other different states have enacted comparable laws over the previous few months.
