Millions of Americans with chronic or disabling conditions rely on home and community-based services (HCBS) to meet daily self-care and independent living needs. These services enable participants to remain safely in their homes and communities rather than moving to a nursing home or other institutional setting. State Medicaid programs are the largest payer for HCBS across the United States. The COVID-19 pandemic has presented numerous challenges and had a significant impact on the provision of HCBS.
In this paper, Milliman’s Jill Herbold and Nick Johnson discuss some challenges faced, actions taken, and the impact that the COVID-19 pandemic may have on HCBS for years to come.
Stop-loss coverage is purchased by self-insured employers looking for coverage from catastrophic medical and pharmacy claims. Based on the most recent data available from S&P Global Intelligence, the stop-loss market stands at approximately $24 billion in premium.
In March, Milliman sent survey participation requests to a wide range of employer stop-loss market participants. Of those receiving a request, 25 provided survey responses. This survey is an update to Milliman’s prior employee stop-loss market survey, which was published in May 2019.
In this paper, Milliman’s Rob Bachler, Nick Johnson, Brian Reed, and Mike Hamachek summarize the findings from the most recent stop-loss survey.
With calendar year 2021 Medicare Advantage (MA) deadlines
rapidly approaching, state Medicaid agencies and MA plans offering Dual
Eligible Special Needs Plans (D-SNPs) must quickly determine how to fulfill new
integration requirements mandated by the Bipartisan Budget Act of 2018.
D-SNPs have become increasingly popular among both MA organizations and dual eligible beneficiaries because of their ability to tailor benefit designs to the needs of this population. Approximately one-quarter of the nation’s 11 million dual eligible beneficiaries are enrolled in one of the 550+ D-SNPs offered throughout the United States as of January 2020.
In this paper, Milliman’s Nick Johnson, Chris Kunkel, and Annie Hallum summarize the new integration requirements and also discuss considerations for stakeholders.
Stop-loss coverage is purchased by self-insured employers
looking for coverage from catastrophic medical and pharmacy claims. Based on
the most recent data available from S&P Global Intelligence, the stop-loss
market stands at approximately $20 billion in premium.
In March 2019, Milliman sent survey participation requests
to approximately 30 employer stop-loss carriers, and 25 provided responses. The
survey asked questions about various topics, including:
- Portfolio characteristics, such as employer size
and types of coverage purchased
- Underwriting measures, such as persistency and
- Pricing measures, such as a carrier’s average
discretionary discount and target loss ratios
- Historical results, both loss ratio and growth
- Product terms offered
In this paper, Milliman’s Rob Bachler, Nick Johnson, and Mike Hamachek provide results of the survey.
In February, the Center for Medicare and Medicaid Innovation released a Request for Applications (RFA) for the Medicare Part D Payment Modernization Model (PMM). The PMM is a voluntary program whose goal is to reduce Part D federal reinsurance costs by adding new program flexibilities and introducing a two-sided risk-sharing arrangement around federal reinsurance costs. Interested Part D plan sponsors were required to submit an application to the Centers for Medicare and Medicaid Services (CMS) by March 15 in order to participate in the 2020 plan year.
There are many unknowns and questions regarding the PMM RFA. Some of these questions are:
• Who is eligible to participate (and who would want to)?
• What types of formulary or other program flexibility might be offered?
• What costs are associated with participating?
• Will this really result in Part D savings?
• How should plans determine information required for the application without insight on key program aspects?
• How would the benchmark be calculated?
• How could this be affected by the U.S. Department of Health and Human Services (HHS) proposal to move drug rebates to point of sale?
• What are the financial implications to the bid?
• What are the potential risks with participating?
In this article, Milliman’s actuaries discuss the answers to these questions.
As states consider implementing managed long-term services and supports (MLTSS) programs and as managed care organizations consider participating in them, it is important to understand what level of savings from managed care may be achievable. This paper by Milliman’s Nick Johnson, Andrew Keeley, and Ali Khan examines Minimum Data Set frequency reports and U.S. Census Bureau American Community Survey population data to compare nursing home usage in states with MLTSS to states without MLTSS.