CMS Awarding $8.6 Million to States to Stabilize Health Insurance Markets

CMS said Monday it is giving $8.6 million to 30 states and the District of Columbia to help insurance departments stabilize their health insurance markets and implement and plan for consumer protections and market reforms called for under the Affordable Care Act (ACA).

The minimum award is $274,345. In a statement, CMS said the market reforms covered by the grant are guaranteed availability of coverage, guaranteed renewability of coverage, and essential health benefits.

Activities that may be covered by the grant include:

• Conducting economic analyses and health insurance market scans to improve and expand the number of healthcare coverage options
• Examining plan policies, procedures, and claims-related data related to access to mental health and substance use disorder treatment services, including opioid treatment services

The grants, which run for 2 years, are being provided under the State Flexibility to Stabilize the Market Grant Program.

Learn what states are doing on their own to try to reduce the uninsured rate.

In addition to receiving a minimum award, each applicant awarded a grant will also receive “Workload” funds. Workload funds are determined based on the population and number of health insurance issuers in the state.

CMS said the $8.6 million are unspent Rate Review Grant funding from prior years, since some states either did not request funding from CMS or completed their projects under budget. The funding is part of $250 million for State Rate Review Grants provided by the ACA to improve the process for how states review proposed health insurance rates.

Earlier this summer, CMS halted collections or payments under the risk adjustment program, including amounts for the 2017 benefit year, set by the ACA for the 2014-2018 benefit period. The risk adjustment program included the use of a statewide average premium in order to maintain a budget neutral program. The provision resulted in the creation of a “risk pool” by participating health insurers to help balance the costs of insurers who have high-risk enrollees. The risk adjustment transfer amounts for the 2017 benefit year are $10.4 billion.

CMS recently issued a proposed new rule to readopt a portion of its risk adjustment methodology for the 2018 plan year, according to a recent blog post in Health Affairs, and is accepting comments until September 7. Comments on the proposed rule will only be accepted on the use of the statewide average premium.