The Scoop: February 5, 2020 Version

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 2020 has ended nationwide, unless you’re in New York or Washington, DC. Residents in DC have till the top of the day at present to pick out a plan for 2020, 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 forms they’re receiving and filing. Kind 1095-A is used to reconcile your premium subsidy or to claim it if you paid full price for a plan within the alternate and ended up being eligible for a subsidy.

Residents in DC, New Jersey, and Massachusetts who have been uninsured in 2019 will see penalties once they file their 2019 state tax returns, except they’re exempt. (Penalties will begin to present up subsequent 12 months 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 enlargement proponents in Oklahoma gathered sufficient signatures to make sure that an expansion initiative will be on the state ballot this 12 months. However Gov. Kevin Stitt opposes Medicaid enlargement and the poll initiative, and has been engaged on a distinct method.

Quickly after the Trump administration unveiled its controversial “Healthy Adult Opportunity” Medicaid waiver program final week, Gov. Stitt announced his plan for Oklahoma to be among the many first states to hunt a waiver underneath this system. Stitt’s administration continues to be figuring out the main points, however its proposal, dubbed “SoonerCare 2.0” is anticipated to request extra 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 2021

Final week, the Division of Well being and Human Companies printed the proposed Notice of Benefit and Payment Parameters for 2021 (summary available here, and Well being Affairs evaluation accessible right here, right here, and here). HHS makes use of this doc every year to make varied changes and updates to guidelines pertaining to the Affordable Care Act.

As we noted earlier this week, the proposal contains greater out-of-pocket caps for medical health insurance plans, and a proposal to stop protection from auto-renewing with premium subsidies if the subsidies cowl your complete premium. HHS can be proposing a rule change to remove the requirement that individuals with most particular enrollment intervals sign up by the 15th 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) health plans. Beneath the most recent steering, these plans can renew as late as October 1, 2021, and might stay in drive till the top of 2021. As was the case in prior years, HHS is letting states resolve whether or not to permit grandmothered plans to be renewed; the bulk have achieved so in prior years. However even in states that enable these plans to resume, the choice is in the end as much as the insurers, as they will select as an alternative to terminate their grandmothered plans and transition enrollees to ACA-compliant plans. Over the approaching weeks, we’ll track states’ responses to the latest announcement.

Virginia Senate passes laws that may require preventive advantages on short-term plans

Virginia is a state to observe this 12 months when it comes to new regulations that might be implemented for short-term health plans. However Virginia’s Senate has already passed a bill 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 manner it’s currently defined by the federal government when it comes to compliance with the Inexpensive Care Act. However not like the ACA, the laws in Virginia would prolong the preventive care mandate to incorporate short-term well being plans.

Laws launched in Washington State would create state-based premium subsidies

Final 12 months, Washington enacted laws calling for the state to provide you with a plan to create state-based premium subsidies. Washington’s medical health insurance alternate is working on a report that will probably be submitted to the state legislature by November 15, 2020, in order that lawmakers can work on associated laws in 2021.

However legislation was also introduced in Washington’s Home final week that may create state-based subsidies as of 2022. The invoice requires subsidies to increase to individuals incomes as much as 500 p.c of the poverty degree, which is identical threshold referred to as for in final 12 months’s laws. But it surely additionally addresses funding, as it could impose a tax on insurers equal to 1 p.c of claims from the prior 12 months. The primary evaluation can be in early 2021, based mostly on 2020 claims, and can be used to fund sliding-scale subsidies in 2022.

New Mexico laws would create a healthcare affordability fund

The ACA’s health insurance tax received’t be assessed after the end of this year. So lawmakers in New Mexico introduced legislation final week that may enhance an present state tax on medical health insurance premiums and use the money to make coverage and healthcare more affordable in the state.

The measure has strong support from well being care shopper 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 2018, the Trump administration finalized new guidelines for association health plans (AHPs) that may enable 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 foundations that apply to particular person and small-group medical health insurance.) The 2018 federal AHP rule has since been blocked by a federal decide.

However Virginia’s Senate has unanimously passed legislation that requires the state to hunt a 1332 waiver that may enable sole proprietors to enroll in AHPs. (A companion bill has acquired unanimous committee approval within the Home.)

It’s value noting, nonetheless, that the Virginia Bureau of Insurance coverage has informed lawmakers that the provisions within the laws can’t be carried out 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 changing the definition of “employer” underneath ERISA.

Two extra states think about laws to cap out-of-pocket prices for insulin

Colorado enacted laws final 12 months to cap out-of-pocket insulin prices on state-regulated well being plans, and numerous states are working to do one thing related this 12 months.

Virginia’s Home passed a bill 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 introduced legislation to cap out-of-pocket insulin prices at $50 per thirty days. Many of the payments into account in different states name for a $100 cap.

Missouri job drive recommends reinsurance, expanded entry to catastrophic plans

Missouri’s Well being Insurance coverage Innovation Job Pressure was created last year and tasked with “figuring out improvements to enhance entry to inexpensive insurance coverage choices and entry to well being care providers, notably in rural areas of Missouri.” The duty drive has accomplished its evaluation and submitted a report to Governor Parson. The duty drive recommends that Missouri submit 1332 waiver proposals to CMS, looking for to determine a reinsurance program and develop entry to catastrophic health plans.

Even supposing Missouri is amongst a dwindling minority of states that also have not expanded Medicaid underneath the ACA, the duty drive didn’t point out Medicaid enlargement, which is a proven way to improve access to affordable health coverage and health care services. (The duty drive was instructed to solely think about proposals that may be impartial or optimistic almost about state income; ten p.c of the price of Medicaid enlargement is roofed by the state, however numerous studies point out that Medicaid enlargement continues to be a web monetary optimistic for states.)

Louise Norris is an individual health insurance dealer who has been writing about medical health insurance and well being reform since 2006. She has written dozens of opinions and academic items in regards to the Affordable Care Act for Her state health exchange updates are frequently cited by media who cowl well being reform and by different medical health insurance specialists.

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