Tag Archive: Nevada

Back to the future for Nevada’s Silver State Health Insurance Exchange

Nevada’s Silver State Health Insurance Exchange (SSHIX) is asking the federal government to revert from a federally supported health benefit exchange back to an independent state-based exchange. The Nevada exchange began using the federal government’s online enrollment platform soon after its own platform faltered amid technical glitches in the first open enrollment for plan year 2014.

Prompting the move is concern over service quality and rising costs. “The Nevada Exchange is set to spend an estimated $7.2 million dollars to lease HealthCare.gov’s eligibility and enrollment platform in 2018; this number represents a fee increase from the estimated $5.5 million that will be spent in 2017,” SSHIX Executive Director Heather Korbulic wrote in an October 12, 2017 report to the exchange’s board of directors. “The decrease in service and increase in cost is unacceptable.”

Following a September meeting with federal officials, Korbulic reported the exchange received approval to move forward with a “blueprint” application – a business plan to make the case to the feds that the exchange can sustain itself financially and fulfill core functions of plan selection and consumer outreach and enrollment. “This is the first step in getting the Exchange on a sustainable pathway whereby we will have our own technology with sustainable cost structures and regular access to consumer information,” Korbulic wrote.

 


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. 

Deficient economies of scale challenge Nevada non-group market

The scarcity of doctors and medical facilities in vast, thinly populated areas can mean higher costs to insurers. But Nye County, which borders Las Vegas’ Clark County, is one of the state’s largest rural counties — and all four companies will participate there. “It is puzzling to me how carriers are ensuring full county coverage to Nevada’s neighboring states, yet are at a potential loss about how to offer insurance for all but three of Nevada’s counties,” Sandoval wrote the same executives earlier this week. He told them that leaving the exchange vacant in 14 counties will set back years of work to nearly halve Nevada’s uninsured rate.

Source: Governor insists execs work to keep rural Nevadans insured | Charlotte Observer

Nevada Gov. Brian Sandoval is confronting a challenge facing the non-group medical insurance market in states where there are too few patients and providers to make for a viable insurance market. Coverage goes hand in hand with provider networks since without enough providers, coverage isn’t useful. Factoring in overhead, it’s no wonder plan issuers aren’t interested in playing, particularly facing the possible loss of cost sharing subsidies for exchange silver plans.

Even though the Patient Protection and Affordable Care Act pooled entire state non-group populations into a single statewide risk pool, provider networks are by definition local. In less populous areas, it’s possible only statewide integrated payer and provider plans are going to work. Federally Qualified Health Centers may also have to play a larger role in providing primary care in these areas, with the plans covering costlier services provided in more populated parts of a state.

Telemedicine can also play a role in access to consultations with distant specialists and post hospital discharge patient monitoring. But it requires robust advanced telecommunications infrastructure that is typically lacking in less densely populated areas. Here too, the federal government can play a constructive role in financing its construction in areas passed over by private sector providers.

 


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. 

Nevada governor vetoes “Medicaid for All” measure

Nevada Gov. Brian Sandoval rejected proposed legislation that would have allowed Nevadans to purchase Medicaid managed care plans on the state’s health benefit exchange regardless of household income if they are not otherwise Medicaid eligible.

In a June 16 veto message, Sandoval wrote that due to tight legislative deadlines, there was too little time to thoroughly vet the proposal to establish the Nevada Care Plan within the state’s Medicaid program, noting he had approved legislation authorizing a study of the concept. Sandoval also raised concerns that there would be sufficient providers willing to accept the relatively low Medicaid reimbursements and the possibility of households choosing to purchase Medicaid managed care plans to replace commercial plans.

 


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. 

Nevada joins with federal proposals to roll in non-group market

There are efforts at the federal level and now the state level to integrate the problem step child of non-group medical insurance into other forms of insurance to offering greater access at lower cost. The federal proposals would allow individuals not covered in the employer group or other government insurance programs to purchase employer group coverage via the District of Columbia health benefit exchange’s Small Business Health Options (SHOP) and the Federal Employees Health Benefits Program. Pending legislation recently sent to the desk of Nevada Gov. Brian Sandoval takes a different tack. It would authorize the state to seek federal waivers in order to allow Nevadans to purchase Medicaid managed care plan coverage though its health benefit exchange as Vox reported this week. Implicit in both of these moves is a lack of confidence that adequate spread of risk can be achieved in the non-group insurance segment, particularly in smaller states like Nevada.

Noticing the close household income eligibility nexus between its subsidized health benefit exchange and Medicaid populations, Nevada provides Medicaid managed care plans incentive to offer qualified health plans (QHPs) on its exchange to ensure adequate availability of QHPs as Vox’s Sarah Kliff reported in May. With Medicaid enrollments strongly outpacing commercial QHP enrollments in state health benefit exchanges, a number of factors began aligning in 2015 to set the stage for policymakers to allow Medicaid managed care plans to be offered on the exchanges alongside individual Qualified Health Plans (QHPs).

A major question is whether those who enroll in Nevada’s proposed “Medicaid for all” Nevada Care Plan will be able to find medical providers who will accept their plan given the historical shortfall between state Medicaid reimbursement levels and those of Medicare and commercial plans.

 


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. 

Vermont mulls working with nearby states on health benefit exchange enrollment, call center

Lt. Gov. Phil Scott, senators explore alternative to Vermont Health Exchange – VTDigger.

The VTDigger reports Vermont officials are considering partnering with adjacent states or sharing vendor resources for its health benefit exchange eligibility and enrollment and call center functions as an alternative to partnering with the federal government to support its state-based exchange as have Oregon, Nevada and New Mexico.

 


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. 

Nevada assisters forewarned: no advising on choice of plan

Health insurance agents and brokers nationwide worry that federally funded Assisters and exchange funded Navigators that help individuals and families sign up for health coverage offered through state exchange marketplaces will duplicate their own role.  A top Nevada insurance regulator sought to put those fears to rest at an educational symposium this week hosted by the Northern Nevada chapter of the National Association of Health Underwriters (NAHU).

While state-certified assister personnel can assist people enroll in coverage sold on the state’s exchange marketplace, Nevada Health Link, they will not be permitted to help individuals and families select which plan is best for them.

Doing so is within scope of a producer license, noted Todd Rich, chief deputy commissioner of the Nevada Division of Insurance, who warned that regulators would “pull the ticket” of certified assister personnel found to be doing so.  (Nevada has opted to have its Division of Insurance certify and oversee assister personnel).  A primary enforcement method to ensure assisters operate within those boundaries: mystery shoppers.

 


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. 

State government not immune to health insurance crisis

State government employment was once regarded as one of the best deals going for health coverage, with rich benefit packages intended to compensate for lower salaries than those paid in the private sector.  No more if what’s happening in Nevada is indicative of a broader trend.

Nevada state workers now have health benefits that look like those offered employees by smaller private employers, replete with employer-funded health savings accounts (HSAs). And big deductibles to match.

Nevada state workers will pay annual deductibles of $1,900 for individuals and $3,800 for families in 2011.  The state will offset the deductibles by contributing to workers’ HSAs, $700 in the case of individuals, according to this story appearing over the weekend in the Nevada Appeal.

 


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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