Tag Archive: exchange financial sustainability

Health exchanges’ finances face test in 2nd year – US News

PROVIDENCE, R.I. (AP) — The federal government shelled out billions of dollars to get health insurance marketplaces going in the 14 states that opted to run their own. Now they must act like true marketplaces and start paying for themselves.

Under President Barack Obama’s Affordable Care Act, state-run health insurance exchanges need to be financially self-sustaining starting in January. Some appear to be on that path, while others have shaky funding models or even none at all.

Some states, prohibited from using state money, are imposing fees on plans sold on the marketplaces. Others are spreading costs more widely — which, in one instance, has drawn a federal lawsuit.

via Health exchanges’ finances face test in 2nd year – US News.

The AP reports state-based exchanges (SBEs) present a mixed outlook of their ability to operate financially independent of the federal government when federal exchange establishment grant funding ceases January 1, 2015. The less than certain finances of some SBEs could alter their relationship with the feds. In order to gain initial federal approval, SBEs were required to submit operational “blueprint” plans by January 1, 2013 showing how they intended to fund their operations after the grant funding ends.

Lacking adequate funding to be financially self-sufficient could put SBEs technically in violation of federal rules. States operating SBEs “must ensure that its Exchange has sufficient funding in order to support its ongoing operations beginning January 1, 2015…” (45 Code of Federal Regulations 155.160(b) – Financial support for continued operations.)

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

California exchange retains former state budget chief as financial sustainability advisor

California’s health benefit exchange marketplace, Covered California, has retained the former head of the state’s Department of Finance to provide counsel relative to financial sustainability, budgeting and evaluation analytics, the exchange announced. Ana J. Matosantos served as the Golden State’s top budget official from 2009 to 2013 under the administrations of Arnold Schwarzenegger and Jerry Brown. Matosantos was given a six-month contract and will be paid $120,000 for her services. The appointment of Matosantos comes as the exchange prepares to transition starting in 2015 from federal grant support to an operating budget fully based on revenues from fees assessed on health plan issuers offering qualified health plans (QHPs) through the exchange.

In July of 2013, the California State Auditor deemed Covered California a “high risk” state entity due to uncertainty associated with projected enrollment in exchange QHPs and the associated impact on fee revenues. The State Auditor’s report concluded Covered California “appears to have engaged in a thoughtful planning process to ensure that it will remain solvent in the future,” adding that its “financial sustainability will continue to be an area of risk that will need to be closely monitored.” Last week, Covered California announced robust enrollment in QHPs during the last quarter of 2013 — the first half of the 6-month-long plan year 2014 initial open enrollment period — reporting slightly more than 500,000 Californians enrolled in QHPs during the quarter.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

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