MA Market Exits
Two major carriers, Humana and Centene, announced they would be reducing their Medicare Advantage footprint. Centene announced that expected cancellations would drive about a third of their membership, or about 340,300 members, to other plans. Humana also announced this week that it would reduce its footprint, with reductions impacting about 600,000 seniors.
Arkansas Medicaid Expansion Watch
Many Medicaid watchers are keeping an eye on Arkansas. CMS denied an extension of its current waiver, which uniquely places Medicaid Expansion enrollees into private (individual market) coverage. The state is working with CMS on a potential temporary extension while it determines the best course of action. Recently the state announced that if a waiver extension isn’t approved by the end of the year, the Medicaid Expansion enrollees would “receive direct fee-for-service Medicaid rather than a private insurance plan paid for through Medicaid.”
FDA Nomination
President Trump nominated Heidi Overton to lead the FDA. If confirmed, Overton, currently a senior White House policy official, could oversee changes to vaccine recommendations and abortion access.
ACA Litigation Watch
A federal judge issued a mixed ruling regarding last year’s Program Integrity Rule. The judge ruled against HHS around the issue of barring gender-affirming care as an essential health benefit but ruled in favor of HHS on the issues of shorter open enrollment period, removing APTCs for those who fail to reconcile taxes, wider AV range, and the methodology around indexing MOOPs and premium tax credits. Because there are competing rulings, the decision does not change anything treatment of gender- affirming care as an essential health benefit (EHB), though the ruling may suuport HHS’ appeal on these issues.
