The Scoop: July 22, 2020 Edition

A look at state-level headlines regarding individual health insurance and health reform

Nevada Health Link's open enrollment period for 2021 coverage has been extended – and will run from November 1, 2020 until January 15, 2021. | Image: Andrey Popov / stock.adobe.com

COVID-19 special enrollment period in Massachusetts ends Thursday, July 23

To address the COVID-19 pandemic, nearly all of the fully state-run health insurance exchanges established special enrollment periods to allow uninsured residents to enroll in health coverage even if they didn’t have qualifying events. Those enrollment windows have mostly ended, although a few are still ongoing. The COVID-19 special enrollment period in Massachusetts is scheduled to end this week, on July 23. After that, residents in Massachusetts will need a qualifying event in order to enroll in a private individual-market plan. ConnectorCare plans will continue to be available year-round to people who are newly eligible for that coverage, and Medicaid/CHIP (MassHealth) enrollment is also available year-round.

Montana exchange insurers propose average rate increases of about 3% for 2021

Last week, Montana’s insurance commissioner publicized a summary of the rate changes that insurers have proposed for 2021. In the individual market, insurers are proposing rate increases that vary from about 2 to 5 percent, with an average proposed increase of about 3.1 percent. In the small group market, insurers are proposing rate changes that range from a 4.5 percent decrease to a 3.7 percent increase, although very few members would be affected by the proposed rate decrease; most would instead experience a small rate increase.

The specific details of the rate filings are not yet available, but Montana’s insurance commissioner, Matt Rosendale, has said that he believes it’s inappropriate for insurers to increase rates at all in the current climate, due to strong profits and the reduction in elective medical procedures amid the COVID-19 pandemic. Public comments on the proposed rate changes are being accepted by the Montana Commissioner of Securities and Insurance through August 1.

Tennessee rate proposals range from 6% decrease to increase of nearly 13%; UnitedHealthcare rejoins for 2021

Individual market insurers in Tennessee have filed proposed premiums for 2021 that range from a decrease of 6 percent for Cigna, to an increase of nearly 13 percent for Blue Cross Blue Shield of Tennessee. The filings all include an additional data set that specifically details the anticipated impact of COVID-19 on insurer costs in 2021, although insurers’ projections vary from a slight reduction in costs as a result of COVID-19, to an increase of 4.4 percentage points.

UnitedHealthcare plans to rejoin Tennessee’s individual market for 2021 (just as they will in Maryland), with plans available in western and central Tennessee.

Nevada exchange board approves extension of open enrollment through January 15, 2021

In states that use HealthCare.gov, open enrollment for 2021 coverage will run from November 1 to December 15, 2020. But states that run their own exchange platforms have the flexibility to add additional time to their enrollment windows. Nevada Health Link’s board of directors voted this week to approve an extension to the upcoming open enrollment period: It will begin November 1, 2020 and continue until January 15, 2021.

California, Colorado, and DC have all permanently extended open enrollment. Pennsylvania’s new state-run exchange, which will debut this fall, will also extend open enrollment for 2021 coverage until January 15, 2021.

Georgia enacts laws to protect consumers from surprise balance billing, extend postpartum Medicaid coverage

Earlier this month, we told you about bills that had been passed by Georgia lawmakers to protect consumers from surprise balance billing and to extend postpartum Medicaid coverage for new mothers. Last week, Governor Kemp signed both pieces of legislation into law.

The surprise balance billing protection law will take effect in January 2021. The extension of postpartum Medicaid coverage was dependent on funding being included in the state’s budget, and that funding was left intact in the FY2021 budget that lawmakers approved in late June. But Georgia may also need a waiver or state plan amendment approved by the federal government before the extended postpartum Medicaid coverage could take effect.

Illinois Department of Insurance fines four major insurers more than $2 million for mental health parity violations

The Illinois Department of Insurance has announced fines of over $2 million levied against five major insurers for violations of the Mental Health Parity and Addiction Equity Act. The fines were levied against Celtic, two Cigna entities, HCSC (Blue Cross Blue Shield of Illinois), and UnitedHealthcare for violations that were discovered from 2015-2017, including step therapy and prior authorization violations, failure to use medical necessity guidelines, and failure to establish internal protocols to ensure that plans were in compliance with mental health parity rules.

The Mental Health Parity and Addiction Equity Act, a federal law that was enacted in 2008 (and expanded by the ACA to include individual market plans), requires health insurers to cover mental health and substance abuse treatment — assuming they cover such treatment at all — with the same coverage rules and limitations that they use for medical/surgical care. Large group plans are not required to cover mental health and substance abuse treatment (but if they do, they must do so in the same manner that they cover medical/surgical care), but the ACA does require individual and small group plans to cover mental health and substance abuse care as an essential health benefit.

South Dakota Medicaid expansion advocates will begin gathering signatures to get expansion measure on 2022 ballot

South Dakota is the latest state where voters may eventually get the opportunity to determine whether the ACA’s Medicaid expansion is enacted in the state. Last week, South Dakota Attorney General Jason Ravnsborg published explanations for the two petitions that will be circulated in an effort to gain enough signatures to get on the 2022 ballot. Both call for Medicaid expansion in South Dakota under the terms of the ACA — one via a constitutional amendment and the other via an initiated measure that would require lawmakers to implement Medicaid expansion in the state. The proposals are sponsored by Rick Weiland, a former U.S. Senate candidate and former regional director of FEMA. Medicaid expansion advocates will have until November 2021 to gather the signatures necessary to get the measures on the 2022 ballots: Nearly 17,000 for the initiated measure, and nearly 34,000 for the constitutional amendment.

Voters in Oklahoma approved Medicaid expansion earlier this summer, and voters in Missouri will have a chance to do so on their August 4, 2020 primary ballot. Medicaid expansion had previously been approved by voters in Maine, Utah, Idaho, and Nebraska.

Thus far, South Dakota is one of 13 states that refuse to accept federal funding to expand Medicaid. Coverage is not available to non-disabled adults without minor children, regardless of how low their income is. And parents of minor children can only qualify for Medicaid in South Dakota with a household income that doesn’t exceed 53 percent of the poverty level (for a household of three, that amounts to less than $1,000/month in total household income). There are currently an estimated 14,000 low-income adults in South Dakota who are in the coverage gap, with no access to any financial assistance with their health coverage. If Medicaid is expanded as called for in the ACA, a single person would qualify for Medicaid in South Dakota with an income of up to about $17,600 (that number increases a little each year as the poverty level rises).

22 states, DC sue to block Trump administration’s elimination of LGBTQ healthcare nondiscrimination protections

Last month, the Trump administration finalized regulations that roll back Obama era health care nondiscrimination protections. The rule, which changes how ACA Section 1557 is interpreted and enforced, removes nondiscrimination protections based on gender identity, sexual orientation, and termination of pregnancy. LGBTQ groups soon filed suit against the rule change. This week, attorneys general from 22 states and DC filed a lawsuit seeking to overturn the Trump administration’s new rules for Section 1557. The states challenging the rule include California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Wisconsin and the District of Columbia.

Appeals court upholds Trump administration rules for short-term health plans

Two years ago, the Trump administration finalized new rules for short-term health insurance plans, allowing them to have initial terms of up to 364 days and total duration, including renewals, of up to three years. The rule was challenged in court, but it was upheld by a federal district judge last summer, and has now been upheld again by a panel of judges for the US Court of Appeals for the District of Columbia. The 2-1 ruling from the appeals court panel allows short-term plans to continue to have much longer durations than they were allowed to have in 2017 and 2018. But short-term plans have stricter state-based limits in more than half the states, and are not available at all in some states.

Last month, the U.S. House of Representatives’ Health Subcommittee of the Committee on Energy and Commerce issued a lengthy report detailing the myriad ways that short-term plans leave consumers without adequate coverage, and the misleading marketing and sales tactics that are sometimes used to sell these plans.

Trump administration asks Supreme Court to reinstate Arkansas Medicaid work requirement

Medicaid work requirements have been endorsed by the Trump administration and approved for several states. But due to legal challenges and the widespread unemployment caused by the COVID-19 pandemic, there are no Medicaid work requirements currently in effect anywhere in the country. Arkansas implemented the nation’s first Medicaid work requirement in 2018, which quickly led to thousands of people losing their health coverage. A federal judge overturned the state’s Medicaid work requirement in March 2019, and a federal appeals court panel upheld that decision earlier this year. Now the Trump administration is asking the Supreme Court to intervene in the case and allow the Medicaid work requirement to be reinstated in Arkansas once the COVID-19 situation resolves enough to make that practicable.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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