The Scoop: April 8, 2020 Edition

Five states extend SEPs created in response to COVID-19

Find out how your state is taking action to expand access to health coverage and treatment of COVID-19.

The COVID-19 pandemic has, understandably, overshadowed just about everything else in recent weeks. There have been numerous coronavirus-related health policy updates at both the state and federal levels, and we’re keeping track of them here.

Notably, several state-run exchanges have extended their COVID-19 special enrollment periods for uninsured residents: Colorado, Connecticut, Maryland, Massachusetts, and Washington have all added additional time to their COVID-19 special enrollment periods.

These enrollment windows for uninsured residents are ongoing – until at least April 15 and in many cases much later – in 11 states. And the District of Columbia also has a special enrollment window for uninsured residents, which is tied to the tax filing season.

Although the federal government has declined to open a COVID-19 special enrollment period on HealthCare.gov (the exchange used by residents in 38 states), HHS Secretary Alex Azar has said that the federal government will cover the cost of COVID-19 treatment for uninsured Americans. But there is still some uncertainty in terms of how this will work, and it’s not entirely clear that all uninsured Americans will have zero costs stemming from COVID-19 treatment if they become ill.

Utah suspends Medicaid work requirement during COVID-19 emergency

Utah implemented Medicaid expansion in January, albeit with a requirement that enrollees be working, going to school, or participating in job training or job search activities. But amid the COVID-19 pandemic, the state has suspended the work requirement.

Although Medicaid work requirements in several states have received federal approval, they were in effect in only Michigan and Utah as of the start of 2020. Michigan’s work requirement was blocked by a judge last month, so Utah’s decision to suspend its work requirement in light of the COVID-19 situation means that there are currently no states with active Medicaid work requirements.

Kentucky offers temporary Medicaid coverage for uninsured

Kentucky uses HealthCare.gov (as a federally supported state-run exchange), so the state is unable to offer a special enrollment period for uninsured residents. But the state is opening up its Medicaid program to offer temporary coverage to people who don’t have health insurance. The coverage will last through June 30, and is available regardless of income. Details are available on the Kentucky Department for Medicaid Services website.

Individual health insurance enrollments are growing as people lose employer-sponsored coverage

At ACA Signups, Charles Gaba is tracking the number of Americans gaining coverage in the exchanges during this pandemic. Although HealthCare.gov does not have a COVID-19 special enrollment period for uninsured people, the normal special enrollment period rules still apply. That means people who are losing their existing health coverage are able to enroll in a plan in the individual market (on- or off-exchange) – an option that’s always available, nationwide, when a person loses coverage. And 12 of the 13 fully state-run exchanges are allowing anyone without health coverage to enroll right now, without any particular qualifying event.

The widespread job losses related to COVID-19 – and the accompanying loss of insurance coverage – are driving enrollment numbers higher than they would otherwise be in the individual market. And it’s an excellent reminder of how crucial the Affordable Care Act (Obamacare) is. Without it, many of the newly unemployed would have had a much more challenging time maintaining coverage. They’d have had to rely on COBRA or state continuation (neither of which are universally available, and both of which are very expensive), or pass the medical underwriting requirements that were used in the individual market in nearly every state pre-ACA.

But thanks to the ACA, people can enroll in individual market coverage – with premium subsidies and cost-sharing reductions if they’re eligible – regardless of their medical history. And Medicaid expansion, which is also part of the ACA, is providing a much needed safety net for many newly unemployed Americans.

Louisiana Association of Health Plans challenges emergency COVID-19 insurance mandates

Nationwide, numerous insurers have voluntarily waived cost sharing for COVID-19, and insurance departments across the country are implementing a variety of emergency mandates to address the pandemic. But not all insurers are on board with the new requirements. The Louisiana Association of Health Plans plans to challenge the Louisiana Department of Insurance in court over the COVID-19 mandates the Department has implemented, including temporary bans on prescription step therapy and policy cancellations for non-payment of premiums. Louisiana Insurance Commissioner Jim Donelon has noted that the insurers will be able to recoup costs with their 2021 rates, pointing out that his office does not have the authority to reject premium proposals from insurers. (Insurance commissioners in many states do have that authority, but Louisiana is not among them.)

Colorado infertility coverage legislation signed into law

Last week, we told you about Colorado lawmakers’ efforts to ensure that residents with state-regulated plans would have coverage for infertility treatment. Colorado Gov. Jared Polis has since signed the bill into law. All state-regulated health plans in Colorado that are issued or renewed on or after January 1, 2022 will have to cover infertility treatment, with the same cost-sharing that applies to other medical conditions.

South Dakota enacts law to impose limits on prescription step therapy

Step therapy is a process by which health insurers require members to first try lower-cost medications before a plan will cover more expensive options. It’s a cost-saving measure, but it’s also controversial. Last week, South Dakota Gov. Kristi Noem signed SB155 into law, after it passed unanimously in both chambers of the state’s legislature. The law imposes various limits on step therapy, including requirements that any step therapy rules be evidence based, and follow a clear, consumer-friendly exceptions process. SB155 applies to state-regulated health plans that are issued or renewed in 2021 or later.

Utah law caps insulin costs for residents with state-regulated health plans

Utah has enacted HB207, which will cap out-of-pocket costs for insulin at $30/month on state-regulated health plans. The law, which takes effect for plans issued or renewed on or after January 1, 2021, does not apply to self-insured employer-sponsored plans (which cover the majority of workers who have employer-sponsored insurance), as those plans are regulated by the federal government instead. Colorado implemented a $100/month out-of-pocket cap on insulin this year, and several other states have enacted similar legislation over the past few months.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.