Payer Roundup—Amida Care reports HIV privacy breach; UnitedHealth eyes new markets in Minnesota

Privacy written in tiles
Amida Care is not the only health insurer to have inadvertently revealed the HIV status of some of its members. (Owen Moore/CC BY 2.0)

Mailing from Amida Care may have revealed members’ HIV status

Amida Care has become the second insurer to report that its mailings to certain members may have inadvertently revealed their HIV status.

The New York-based nonprofit health plan, which serves Medicaid members with chronic health conditions, sent a flier to 6,231 of its members with HIV inviting them to take part in a research project. The mailings were put in envelopes with a clear window despite instructions to use windowless envelopes, and Amida Care discovered that the words “Your HIV detecta” may have been visible through a blank sheet of paper used to conceal sensitive information.

The insurer has informed patients of the breach and said it is taking steps to prevent such incidents in the future.

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The news of Amida Care’s breach follows on the heels of a similar incident with Aetna mailings. In that case, the insurer sent letters to 12,000 members in which a reference to HIV was visible through the envelope. CVS Caremark, meanwhile, sent mailings to 4,000 individuals in which a reference code containing the letters “HIV” was visible within a clear envelope window. (HIPAA Journal)

UnitedHealth to expand into new markets in Minnesota

UnitedHealth plans to start selling coverage to commercial groups in its home state of Minnesota next year, and it has plans to expand into the state’s Medicare Advantage market.

The former move was driven in part by a new law that allows for-profit HMOs to operate in the state for the first time in decades.

A different regulatory change—the scheduled disappearance of “Medicare Cost” plans—is fueling UnitedHealth’s Medicare Advantage expansion plans in the state, where it previously has sold just Medicare prescription drug plans. (Star Tribune)

Report examines combination of Medicaid expansion, managed care reform

Newly elected Democratic governor Roy Cooper has taken up the mantle of Medicaid managed care reform in North Carolina, but the question remains whether the state will adopt Medicaid expansion.

Thus, a new report from the Duke-Margolis Center for Health Policy examines what would happen if North Carolina did both. It found that expanding Medicaid can help realize the objectives of managed care reform but also noted potential challenges.

For example, such policies would likely increase the number of beneficiaries in rural areas—supporting sustainable membership levels for robust competition among managed care plans—but could also strain existing provider networks and lead to patients seeking care in high-cost settings. (Report)

States’ coverage mandates help broaden access to autism treatment

All but four states require commercial insurers to cover treatment for children with autism spectrum disorder, and a new Health Affairs study suggests that those mandates make a difference.

The study looked at claims data from 2008-2012 from three national insurers and compared individuals age 21 and younger who were subject to the mandates with those who were not. It found that mandates were associated with a 3.4-percentage-point increase in monthly service use and a $77 increase in monthly spending on services specific to autism spectrum disorder.

“These increases suggest that state mandates are an effective tool for broadening access to autism treatment under commercial insurance,” the study concludes. (Study)

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