Do state officials have authority over Medicare Advantage insurers?

As Pennsylvania officials have attempted to force Highmark into expanding its Medicare Advantage network, Highmark pushed back by claiming that the state lacks authority over the federal program.

The Pennsylvania Attorney General and the departments of health and insurance alleged in a request for an injunction that Highmark must expand its Medicare Advantage plans to include the University of Pittsburgh Medical Center within its network. The officials claimed that by excluding UPMC from its network, the new plans violate a consent agreement that Highmark made with UPMC when the companies decided to stop working together, FierceHealthPayer previously reported.

Highmark responded with its own legal action, asking a U.S. District Court to decide that state officials don't have authority over Medicare Advantage, since it's a federally administered program and the U.S. Department of Health and Human Services already approved the plan, reported the Pittsburgh Business Times.

"The Medicare Advantage statute is explicit that it and the implementing regulations adopted thereunder, 'shall supersede any state law or regulation,'" Highmark said in its request for injunctive relief. Therefore, state regulators can't "lawfully attempt to prevent the marketing and sale of a Medicare Advantage plan that the federal government has expressly approved."

However, the District Court ruled Tuesday that it couldn't intervene in a state matter. "We see no conflict between the determination by the Centers for Medicare and Medicaid Services that Highmark's Community Blue Medicare Advantage plan was compliant with federal regulations and the state's allegation that the same plan violated the consent decree," Senior U.S. District Court Judge Maurice Cohill wrote, according to a separate PBT article.

To learn more:
- read the Pittsburgh Business Times articles on Highmark's legal action and the court's decision