Affordable Care Act (ACA) and TRICARE News (Washington Update, July 18, 2018)

CMS to Reduce Funding for ACA Navigators

Last week the administration announced that it will significantly reduce funding for ACA Navigators for the next open enrollment period (Nov. 1-Dec. 15, 2018, for 2019 plans). (See the CMS press release.) The Funding Opportunity Announcement for the Navigator Cooperative Agreement can be found here, and entering CA-NAV-18-001 in the “Opportunity Number” box under “Basic Search Criteria.” Navigator applications are due on August 9.

WORTH REPEATING: New Application/Renewal Process for the Certified Application Counselor (CAC) Program

As reported last week, (CMS) is also implementing a new application and renewal process for Certified Application Counselor Designated Organizations (CDOs). Any organization seeking to become a Certified Application Counselor (CAC) for Plan Year 2019 must apply to become a CDO. Existing CDOs that fail to reapply during the CAC Program re-application window will be de-designated and will not be permitted to certify CACs or assist consumers. In preparation for the next Open Enrollment Period, the deadline to submit an application to become a CDO is September 14, 2018. The CDO Application can be accessed here; guidance for completing the application can be found here.

CMS to Withhold Risk-Adjustment Payments to Insurers – Updated

As reported in the last Update, CMS announced that it will not be making the “risk adjustment” payments to insurers as prescribed by the ACA. These payments are intended to prevent adverse selection by consumers, and risk selection (“cherry-picking”) by insurance companies by redistributing funds from plans with lower-risk enrollees to plans with higher-risk enrollees. See Explaining Health Care Reform: Risk Adjustment, Reinsurance, and Risk Corridors (Kaiser Family Foundation, 8/17/16); Trump Administration Freezes Payments to Affordable Care Act Insurers with Sicker Patients (Fortune, 7/8/18).

Update: Some health-policy experts believe that this decision will cause insurance premiums to rise, disproportionately affecting people with pre-existing conditions. Insurance and consumer groups are also very concerned. On July 17, a group of House and Senate Democrats who serve on health committees wrote to HHS Secretary Azar and CMS Administrator Verma to express their disagreement with the decision and ask for information about how it was reached. See Democrats Ask Trump to Backpedal Decision on Obamacare Risk Adjustment Program (Washington Examiner, 7/16/18). More significantly, it has been reported that the Chairman of the House Ways & Means Committee, Rep. Kevin Brady (R-TX), is in conversations with the administration about restoration of the payments, and that he has not ruled out legislative action to address the problem. See GOP Chairman in Talks with Trump Officials on Restarting Key Obamacare Payments (The Hill, 7/16/18).