Tag Archives: Jason Clarkson

Medicaid Fiscal Accountability Regulation considerations for state agencies

The Medicaid Fiscal Accountability Regulation (MFAR) rule proposed by the Centers for Medicare and Medicaid Services (CMS) aims to increase transparency of Medicaid supplemental payments and address concerns over their financing. The proposed rule defines supplemental payments as “extra compensation to certain providers” that are often made to providers on a lump sum basis apart from claim-based payments.  If the proposed rule is implemented, many states may need to revise their Medicaid supplemental payment programs to achieve compliance. This paper by Milliman’s Ben Mori, Tyler Schulze, and Jason Clarkson summarizes the key proposed changes under MFAR for state Medicaid agencies to consider.

Individual market enrollment and ACA subsidies update

Following the introduction of the Patient Protection and Affordable Care Act (ACA), the individual health insurance marketplace has experienced continuous change. To support understanding of the condition and stability of the individual market, Milliman consultants Paul Houchens, Jason Clarkson, and Zachary Fohl prepared the third annual profile of the individual health insurance market for each state along with the District of Columbia.

These state profiles summarize insurer financials, marketplace enrollment, and federal assistance provided to households purchasing insurance coverage through the insurance marketplaces, incorporating recently released data from the 2019 open enrollment period and estimated 2019 effectuated enrollment. 

Aggregate premium assistance expenditures materially increased between 2017 and 2018, but are estimated to slightly decrease from 2018 to 2019. These changes are primarily attributable to national composite subsidy benchmark premiums increasing by 34% in 2018, but declining by (1%) in 2019. Assuming stable marketplace enrollment, federal premium assistance expenditures for 2020 are likely to continue to decline as a result of a (3%) subsidy benchmark premium decrease. Premium rate decreases for 2019 and 2020 are partially attributable to several states implementing state-based reinsurance programs.

All of this information is vital to state, federal, and insurer stakeholders for a number of reasons, including the 1332 State Innovation Waiver, insurer stability, marketplace enrollment, and marketplace premium.

To read more and see the interactive map, please click here.

Report highlights commercial health insurance financial results and emerging trends

Medical loss ratio data published by the Centers for Medicare and Medicaid Services (CMS) provides a detailed picture of insurer financial results from the fourth full year of Patient Protection and Affordable Care Act (ACA) implementation. This data, supplemented with CMS marketplace and statutory financial data through calendar year 2018, illustrates continued stability in group insurance markets in terms of both enrollment and insurer financial results. However, the individual market is experiencing declining enrollment outside the insurance marketplaces and yet significantly improved financial results for the insurers relative to 2014 through 2016.

Individual market enrollment declines prompted several state-based initiatives to improve affordability for nonsubsidized consumers. As of April 2018, seven states have received approval from CMS for a Section 1332 State Innovation Waiver for implementing a state-based reinsurance program to improve premium affordability. The impetus for these state-based initiatives, which primarily benefit consumers not qualifying for federal premium assistance, is supported by a number of national enrollment trends.

  • National off-marketplace enrollment for ACA-compliant coverage declined from 4.9 million in 2016 to 2.4 million in 2018.
  • Marketplace Advance Premium Tax Credit (APTC) consumers represented 56% of national ACA-compliant enrollment in 2016, increasing to approximately 70% in 2018.
  • Marketplace APTC enrollment has remained relatively stable from 2016 to 2018, varying from 8.2 million to 8.6 million across the three-year period.

While individual market enrollment continued to decline in 2018, underwriting margins reported in year-end financial statements indicate the health insurance industry’s margins improved. The individual market experienced a nearly 10% underwriting loss in 2015 compared to underwriting gains likely approaching 10% in 2018.

This report, written by Paul Houchens, Jason Clarkson, and Jason Melek, provides a detailed review of the commercial health insurance industry’s financial results in 2017 and evaluates changes in the market’s expense structure and enrollment relative to prior years. It also discusses emerging financial trends for the commercial health insurance markets.

Medicaid state directed payment overview

In response to the Medicaid managed care final rule, several states have recently received approval from the Centers for Medicare and Medicaid Services (CMS) for state directed payments that support delivery system and provider payment reforms.

These arrangements allow states to require managed care plans to make specified payments to healthcare providers when the payments support overall Medicaid program goals and objectives. These arrangements provide a permissible mechanism for making supplemental payments in managed care programs as an alternative to pass-through programs. While pass-through programs were often opaque and not clearly understood by all affected parties, state directed payments enable states to coordinate value-based purchasing and other delivery system reform initiatives in managed care programs. These arrangements also allow states to coordinate value-based purchasing (VBP) and other delivery system reform initiatives in managed care programs.

As states consider options for state directed payments, it can be helpful to understand the types of programs that have been approved by CMS. In this paper, Milliman’s Jim Pettersson, Ben Mori, Luke Roth, and Jason Clarkson provide background on state directed payment arrangements based on their review of §438.6 (c) “Preprints” and supporting documentation for arrangements approved by CMS as of August 15, 2018.




How have individual market enrollment and Affordable Care Act subsidies data changed?

The Patient Protection and Affordable Care Act (ACA) introduced many changes to the individual health insurance market beginning in calendar year (CY) 2014, including new rating rules and federal financial assistance to purchase health insurance through the insurance marketplaces. It is important to understand the condition and stability of the individual health insurance market and how the ACA has affected its health insurance consumers.

To support this understanding, actuaries Paul Houchens, Jason Clarkson, and Zachary Fohl prepared Milliman’s second annual profile of the individual health insurance market for each state along with the District of Columbia (DC). The profile summarizes insurer financials, marketplace enrollment, and federal assistance provided to households purchasing insurance coverage through the insurance marketplaces, incorporating recently released data from the 2018 open enrollment period and early 2018 effectuated enrollment snapshot.

This information is vital for stakeholders for a number of reasons, including:

1. Future legislation or administrative actions. While the pace of new healthcare reform legislation will likely slow in 2018 with the upcoming mid-term elections, data from the individual marketplace can be useful in informing future policy decisions both at the federal and state level.

2. 1332 State Innovation Waiver (1332 Waiver). The information in our state profile reports can enable a state to better understand the funding and coverage requirements that must be adhered to under Section 1332 of the ACA.

3. Marketplace enrollment trends. One important measure of risk pool stability is enrollment.

4. Cost-sharing reduction (CSR) termination. From CY 2014 through the first nine months of CY 2017, insurers received direct federal payments for the cost of providing CSR variants. However, effective October 2017, CSR payments were terminated by the federal government.

To read the full article which summarizes 2018 individual market enrollment and ACA subsidies, click here.




Commercial health insurance: Overview of 2016 financial results and emerging enrollment and premium data

In this report, Milliman’s Paul Houchens, Jason Clarkson, and Jason Melek provide a detailed review of the commercial health insurance industry’s financial results in 2016 and evaluate changes in the market’s expense structure and enrollment prior to relative years. They also provide enrollment and Advanced Premium Tax Credits estimates for 2017.