On this version
- Open enrollment is usually over; tax season has begun
- Oklahoma governor plans to pursue new Medicaid block grant alternative
- HHS proposes federal medical health insurance guidelines for 2022
- HHS points one other extension for grandmothered plans
- Virginia Senate passes laws that may require preventive advantages on short-term plans
- Laws launched in Washington State would create state-based premium subsidies
- New Mexico laws would create a healthcare affordability fund
- Virginia Senate passes laws to develop affiliation well being plans
- Two extra states take into account laws to cap out-of-pocket prices for insulin
- Missouri activity pressure recommends reinsurance, expanded entry to catastrophic plans
Welcome to this week’s round-up of state-level well being reform information, together with:
Open enrollment is usually over; tax season has begun
Open enrollment in particular person market well being plans for 2022 has ended nationwide, until you’re in New York or Washington, DC. Residents in DC have till the tip of the day as we speak to pick out a plan for 2022, and residents in New York have till Friday, February 7.
However tax season is upon us, and though there’s not a federal penalty for being with out medical health insurance, individuals who purchase their very own medical health insurance within the alternate nonetheless want to concentrate to the tax varieties they’re receiving and submitting. Type 1095-A is used to reconcile your premium subsidy or to say it should you paid full value for a plan within the alternate and ended up being eligible for a subsidy.
Residents in DC, New Jersey, and Massachusetts who had been uninsured in 2022 will see penalties once they file their 2022 state tax returns, until they’re exempt. (Penalties will begin to present up subsequent yr for residents in Rhode Island and California, as particular person mandates simply took impact in these states final month.)
Oklahoma governor plans to pursue new Medicaid block grant alternative
Medicaid growth proponents in Oklahoma gathered sufficient signatures to make sure that an growth initiative will likely be on the state poll this yr. However Gov. Kevin Stitt opposes Medicaid growth and the poll initiative, and has been engaged on a special strategy.
Quickly after the Trump administration unveiled its controversial “Wholesome Grownup Alternative” Medicaid waiver program final week, Gov. Stitt introduced his plan for Oklahoma to be among the many first states to hunt a waiver underneath this system. Stitt’s administration remains to be understanding the main points, however its proposal, dubbed “SoonerCare 2.0” is predicted to request further federal funding to cowl extra adults within the state’s Medicaid program, albeit with a piece program and a cap on the federal funding.
HHS proposes federal medical health insurance guidelines for 2022
Final week, the Division of Well being and Human Companies printed the proposed Discover of Profit and Fee Parameters for 2022 (abstract accessible right here, and Well being Affairs evaluation accessible right here, right here, and right here). HHS makes use of this doc annually to make numerous changes and updates to guidelines pertaining to the Reasonably priced Care Act.
As we famous earlier this week, the proposal consists of increased out-of-pocket caps for medical health insurance plans, and a proposal to forestall protection from auto-renewing with premium subsidies if the subsidies cowl the whole premium. HHS can also be proposing a rule change to remove the requirement that folks with most particular enrollment durations join by the fifteenth of the month to get protection efficient the primary day of the next month. HHS is accepting feedback on the proposed guidelines till March 2.
HHS points one other extension for grandmothered plans
As anticipated, the federal authorities has issued one other extension for grandmothered (transitional) well being plans. Underneath the newest steering, these plans can renew as late as October 1, 2022, and might stay in pressure till the tip of 2022. As was the case in prior years, HHS is letting states determine whether or not to permit grandmothered plans to be renewed; the bulk have accomplished so in prior years. However even in states that permit these plans to resume, the choice is in the end as much as the insurers, as they’ll select as an alternative to terminate their grandmothered plans and transition enrollees to ACA-compliant plans. Over the approaching weeks, we’ll monitor states’ responses to the newest announcement.
Virginia Senate passes laws that may require preventive advantages on short-term plans
Virginia is a state to observe this yr by way of new laws that is likely to be applied for short-term well being plans. However Virginia’s Senate has already handed a invoice that may require state-regulated well being plans – together with short-term plans – to cowl preventive care with no copays, coinsurance, or deductibles. Preventive care can be outlined in the identical means it’s at present outlined by the federal authorities by way of compliance with the Reasonably priced Care Act. However in contrast to the ACA, the laws in Virginia would lengthen the preventive care mandate to incorporate short-term well being plans.
Laws launched in Washington State would create state-based premium subsidies
Final yr, Washington enacted laws calling for the state to give you a plan to create state-based premium subsidies. Washington’s medical health insurance alternate is engaged on a report that will likely be submitted to the state legislature by November 15, 2022, in order that lawmakers can work on associated laws in 2022.
However laws was additionally launched in Washington’s Home final week that may create state-based subsidies as of 2022. The invoice requires subsidies to increase to folks incomes as much as 500 % of the poverty stage, which is identical threshold referred to as for in final yr’s laws. Nevertheless it additionally addresses funding, as it could impose a tax on insurers equal to 1 % of claims from the prior yr. The primary evaluation can be in early 2022, based mostly on 2022 claims, and can be used to fund sliding-scale subsidies in 2022.
New Mexico laws would create a healthcare affordability fund
The ACA’s medical health insurance tax received’t be assessed after the tip of this yr. So lawmakers in New Mexico launched laws final week that may enhance an current state tax on medical health insurance premiums and use the cash to make protection and healthcare extra reasonably priced within the state.
The measure has robust help from well being care client advocates within the state, and as Well being Motion New Mexico’s Colin Baillio explains, the quantity that well being insurers would pay underneath the proposed state tax enhance would nonetheless be lower than they pay underneath the ACA.
Virginia Senate passes laws to develop affiliation well being plans
In 2021, the Trump administration finalized new guidelines for affiliation well being plans (AHPs) that may permit sole proprietors to affix AHPs that function underneath large-group guidelines, assuming the affiliation has a minimum of 51 members. (Giant-group guidelines are extra lenient than the principles that apply to particular person and small-group medical health insurance.) The 2021 federal AHP rule has since been blocked by a federal decide.
However Virginia’s Senate has unanimously handed laws that requires the state to hunt a 1332 waiver that may permit sole proprietors to enroll in AHPs. (A companion invoice has acquired unanimous committee approval within the Home.)
It’s price noting, nevertheless, that the Virginia Bureau of Insurance coverage has knowledgeable lawmakers that the provisions within the laws can’t be applied with a 1332 waiver, as 1332 waivers can’t be used to waive provisions of ERISA. And the crux of the argument to permit sole proprietors to enroll in affiliation well being plans entails altering the definition of “employer” underneath ERISA.
Two extra states take into account laws to cap out-of-pocket prices for insulin
Colorado enacted laws final yr to cap out-of-pocket insulin prices on state-regulated well being plans, and quite a few states are working to do one thing comparable this yr.
Virginia’s Home handed a invoice this week, by a vote of 98-1, that may cap the insured’s share of the price of a 30-day provide of insulin at $30. And New Mexico lawmakers have launched laws to cap out-of-pocket insulin prices at $50 per thirty days. Many of the payments into consideration in different states name for a $100 cap.
Missouri activity pressure recommends reinsurance, expanded entry to catastrophic plans
Missouri’s Well being Insurance coverage Innovation Process Drive was created final yr and tasked with “figuring out improvements to enhance entry to reasonably priced insurance coverage choices and entry to well being care providers, notably in rural areas of Missouri.” The duty pressure has accomplished its evaluation and submitted a report back to Governor Parson. The duty pressure recommends that Missouri submit 1332 waiver proposals to CMS, in search of to determine a reinsurance program and develop entry to catastrophic well being plans.
Although Missouri is amongst a dwindling minority of states that also haven’t expanded Medicaid underneath the ACA, the duty pressure didn’t point out Medicaid growth, which is a confirmed means to enhance entry to reasonably priced well being protection and well being care providers. (The duty pressure was instructed to solely take into account proposals that may be impartial or optimistic with reference to state income; ten % of the price of Medicaid growth is roofed by the state, however quite a few research point out that Medicaid growth remains to be a web monetary optimistic for states.)
