[ad_1]
Private health plans may take the lead in reminding individuals of their insurance options once Medicaid redetermination begins, raising concerns among patient advocates about payer competition and patient impact.
As part of the pandemic relief effort, states have suspended removing people from Medicaid during the public health crisis because they are no longer eligible. As a result, Medicaid enrollment has ballooned to an all-time high amid an influx of enrollees due to unprecedented rapid unemployment during the pandemic.
Once the Biden administration ends the federal emergency, states will have 12 months to review eligibility information for the nearly 78 million people enrolled in public health programs. The public health emergency is scheduled to end on April 16, although the Biden administration is expected to extend it for at least another 90 days.
depending on 16 million people According to the Urban Institute, Medicaid coverage could be lost. According to a Kaiser Family Foundation survey released earlier this month, only half of states have a plan for how to reassess an individual’s Medicaid eligibility when the emergency ends.
Heather Korbulic, former executive director of Medicaid, said a lack of coordination, outdated technology systems, staffing constraints and the politics of Medicaid will make private insurers and the Affordable Care Act market do the heavy lifting, To ensure Medicaid members maintain continuity of coverage. Nevada Health Insurance Exchange joined GetInsured in February as Senior Policy and Strategy Lead for IT Platforms.
“Medicaid typically doesn’t, and hasn’t historically, put time, energy and resources into marketing and outreach,” she said. “Inevitably there will be a lot of outreach and marketing that will come from state communications and managed care organizations. .”
Korbulic added: “No one is more incentivized right now than insurance companies.”
Insurance companies expand ACA employment scope
The Urban Institute report said many people who are no longer eligible for Medicaid will turn to the ACA in exchange for health insurance, with about a third of those eligible for the subsidy. Another 65 percent of adults will be eligible for insurance through work, the report said.
Over the last year, the big Medicaid insurers have been expanding their ACA offerings and making their products more attractive to employers, in part to attract people who are no longer eligible for Medicaid.
Centene, the largest Medicaid operator in the U.S. with 15 million participants, expanded its exchange footprint to five additional states earlier this year, making its Ambetter ACA program available in 25 of its 29 Medicaid states. The insurer built a platform between its swap program and Medicaid, Chief Operating Officer Brett Leighton said on the company’s fourth-quarter earnings call.
“Whether it’s networking, communications, or planning, we’re preparing for that,” he said.
Anthem, the second-largest Medicaid insurer in the U.S. with 10.6 million enrollees, spent last year Access to local Medicaid programs Chief Financial Officer John Gallina said on the insurer’s third-quarter 2021 earnings call that enrollees who are no longer eligible for public health programs are expected to Insurance companies create financial “tailwinds.” Of individuals who are no longer eligible, Anthem expects 20% will be eligible for subsidized coverage from the ACA Exchange and 45% will receive coverage through their employer.
“We have a product for every American under any circumstances,” Gallina said on the conference call. “Young, old, rich, poor, sick, healthy, we have something for everyone. Right now, we have a large number of members in our Medicaid program. Medicaid may shrink a little bit after the reset, but This means that there are indeed some significant growth opportunities in other areas of the business.”
The insurer recently announced a plan to rebrand it as Elevance Health, which analysts said at the time was a way to grow its business. Employer business is stagnant. The number of lives Anthem manages through its commercial business increased 0.8% year over year to 30.3 million in 2021.
Centene and Anthem did not make executives available for interviews about how they prepared for the re-decision.
At the beginning of the year, AmeriHealth Caritas Also invested in ACA: The insurer entered the exchange market with an ACA product that mimicked its Medicaid product. South Carolina Marketing President Courtnay Thompson said AmeriHealth is working with its providers, homeless shelters and church partners to help its 2.5 million Medicaid plan participants understand the redefinition process.
“It’s really important for us to know these numbers ahead of time because that way we can help work with the state,” Thompson said.
Meanwhile, Highmark Health, which has about 500,000 Medicaid enrollees in three states, expects to drop as many as 75,000 members from its roster once redetermination begins, said Karen Hanlon, executive vice president and chief operating officer. Hanlon said the integrated health system is expected to convert a “trivial” portion into ACA coverage, with most transitioning to employer-sponsored health plans.
“It all depends on what you think is happening in the job market,” she said.
Competitive, patient selection questions
Since the publication of the KFF study, more states — including Texas, which has the nation’s highest uninsured rate — have announced plans for how they will proceed with retrials. In late March, the Centers for Medicare and Medicaid Services released strategies some states can use to guide the process.
However, each state has its own program. It is their choice how much time, effort and money the state Medicaid department will invest in making this work.
Some states have begun mailing renewal notices to members and updating their technology systems to assess membership, said Jack Rollins, director of federal policy for the Medicaid Directors Association.
“Not every state has to stop doing re-adjudication and send out notifications and outreach to members during this time,” Rollins said. “That’s not to say we have to start from scratch.”
GetInsured’s Korbulic said states that operate their own ACA exchanges will have an easier time dealing with retrials than states that operate on the federal Healthcare.gov marketplace, because they are often closely integrated with local Medicaid departments.
“We haven’t really heard a lot from Healthcare.gov about what they’re going to do to deal with the huge amount of work that’s coming,” she said.
CMS did not directly answer questions about how it plans to handle large account transfers. The agency regularly tests its systems to ensure they can support consumer traffic, a spokesperson wrote in an email.
Given the end of the public health emergency, some states have invested in their own ACA markets.
New Mexico — which has the highest percentage of Medicaid residents in the nation — announced plans last year to launch its own ACA exchange and told insurers that offer Medicaid managed care plans that they must offer ACA plans to make it easier for people to switch, Korbulic said. Officials from BeWellNM, the ACA exchange in New Mexico, did not respond to interview requests.
But not everyone sees the insurers offering both plans as positive.
Sabrina Corlette, a research professor at the Wellness Center, said the insurance commissioner is concerned that health plans that offer both marketplace and Medicaid products will have a competitive advantage over carriers that offer just one product, opening the market to a larger market. of traditional insurers lean. Insurance reform at Georgetown University.
Insurers with existing Medicaid contracts also already have information about patients’ health and can direct those with more expensive medical conditions to rival ACA plans while marketing their products to healthier members, Corlette said. One solution, she said, is to force insurers to provide the same marketing and communications to every participant.
Anna Dunbar-Hester, senior adviser on Medicaid policy for the insurance lobby group AHIP, countered that information targeting individual members is critical to bridging equity gaps.
“We would love guidelines and messaging guidelines, but not every targeted message has to go through a lengthy state review and approval process, especially given state staffing constraints,” Dunbar-Hester said. “We don’t want something sitting in the pipeline for three months.”
Insurers are generally wary of adding members through special enrollment periods because people with more serious, more expensive health conditions are more likely to sign up for coverage, Corlette said. Because of the threat of adverse selection, Corlette questions how much private insurers will spend on marketing when the public health emergency ends.
“Insurers don’t like the morbidity rate of people who come in during special registrations, so they don’t pay brokers to help people with special registrations,” Colette said. “But after PHE, you want your brokerage staff to be motivated to go out and have the courage to get people to sign up.”
[ad_2]
Source link
