Payer Roundup—Payers not leaving ACA market in 2019; Medicaid coverage insufficient for foster children

Survey suggests stable participation and rates in ACA market next year

A new survey from eHealth predicts sunny days ahead for the individual market.

Fifty-three percent of the survey’s respondents, a group that covers more than 200 million Americans, said they will expand their exchange offerings this coming plan year. Another 40% said they will maintain their current offerings. In stark contrast to prior years, half of insurers will reduce premiums or keep them as is; the other half will raise them between 5% and 10%.

The results suggest insurers are feeling good despite the repeal of the individual mandate penalty. More than half (54%) said they do not believe the repeal will significantly impact their enrollment. Thirty-one percent anticipate enrollment to decrease due to the repeal. (Survey - PDF)

Foster children in Medicaid have unmet needs

Although Medicaid covers many foster children, many are slipping through the cracks, California Healthline reported on Tuesday. 

Foster children often have complex medical needs. Half have mental health conditions, and they are twice as likely as other children to have developmental delays. But not all doctors accept Medicaid, and the number of specialists who can help children with these needs is even fewer. 

Care is often uncoordinated and inconsistent as well, as the children often move between foster care and their biological families or multiple foster homes. 

Some states, including Florida, Georgia and Texas, have created separate Medicaid managed care plans for foster children. These plans include more doctors and cover additional services, such as nutrition counseling and art therapy. It's too soon to say with certainty whether the new plans are effective, but some foster parents say they've made a difference. (Article

NCQA director: Give PCMHs a chance

Patient-centered medical homes (PCMHs) got a bad rap after a 2014 study in JAMA said they didn’t save money. But that study only examined the first three years of the program, and a growing body of newer research suggests otherwise.

Paul Cotton, director of federal affairs at the National Committee for Quality Assurance, examined this research on the Health Affairs blog. Several newer studies have found PCMHs can reduce spending on costly chronic conditions through prevention and care management.

Studies that continue to find no benefits use outdated versions of the program’s standards and assess practices that do not have financial incentives to improve, Cotton wrote. But the program has merit, as reflected by these studies and its support from public initiatives, private insurers, medical boards, physicians and even MACRA, he said. (Blog post)